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The development and dissemination of culturally relevant health care information has traditionally taken a "top-down" approach. Governmental funding agencies and research institutions have too often dictated the importance and focus of health-related research and information dissemination. In addition, the digital divide has affected rural communities in such a way that their members often do not possess the knowledge or experience necessary to use technological resources. And, even when they do, their skills may be limited, adequate only for implementing applications and programs designed by others who live and work outside of these communities. This need became the driving force in the creation of the Native Telehealth Outreach and Technical Assistance Program. The goal of the program is to equip Native community members, at both the lay and professional levels, with the means to use technology to address tribal health care needs. The transfer of relevant technical knowledge and skills enables participants to develop projects which enhance the community-wide dissemination of health care information. Nine community health advocates and professionals participated in the initial cohort. Eight of the participants successfully developed multimedia-based projects including Web sites, interactive CD-ROMs, and video focusing on a variety of health concerns. At the conclusion of the 18-month program period, projects were disseminated throughout rural communities. The NTOTAP staff continues to evaluate the use of these projects and their benefits within the rural communities. (Contains 2 tables and 1 figure.)

Purpose: All-terrain vehicle (ATV) injury is an increasingly serious problem, particularly among rural youth. There have been repeated calls for ATV safety education, but little study regarding optimal methods or content for such education. The purpose of this study was to determine if an ATV safety video was effective in increasing ATV safety knowledge when used in a community-based statewide hunter education program. Methods: During the baseline phase, surveys focusing on ATV safety were distributed to students in the Arkansas hunter safety program in 2006. In the intervention phase a year later, an ATV safety video on DVD was provided for use in required hunter education courses across Arkansas. The same survey was administered to hunter education students before and after the course. Findings: In the baseline phase, 1,641 precourse and 1,374 postcourse surveys were returned and analyzed. In the intervention phase, 708 precourse and 694 postcourse surveys were completed. Student knowledge of ATV safety after watching the video was higher than in preintervention classes. Knowledge of appropriate helmet usage increased from 95% to 98.8% (P less than 0.0001). Awareness of the importance of not carrying a passenger behind the driver increased from 59.5% to 91.1% (P less than 0.0001). Awareness of importance of hands-on ATV rider training increased from 82.1% to 92.4% (P less than 0.0001). Conclusions: A brief ATV safety video used in a hunter education course increased ATV safety knowledge on most measures. A statewide hunter education program appears to be a useful venue for ATV safety education.

Children and adolescents who are left-handed may have a higher risk of unintentional injuries than those who are right-handed. Researchers compared 265 children between six and 18 years old with unintentional injuries to 494 children the same age without injuries (control group). Eighteen percent of the children with unintentional injuries were left-handed, compared with 11% of those in the control group. No other significant differences were found between the two groups of children. Twenty percent of the left-handed children had been admitted to the hospital in the past for unintentional injuries, compared with 12% of the right-handed children. Parents of left-handed children were more likely to view their child as clumsy than parents of right-handed children.

A self-report questionnaire was used to study the patterns and contributing phenomena of alcohol use at a boarding school for Native Americans. Results indicate that 86% of the students used alcohol at some time. Drinking behavior was positively correlated with stressful experiences, low familial support and feelings of depression. Little correlation was found between alcohol use and peer support.

School preparedness includes the possibility of a natural disaster, but recent events also confirm a need for preparedness and prevention efforts for intentional mass casualty incidents (MCIs). This survey examined the preparedness for the prevention and response for MCIs at public schools in Arkansas. This survey demonstrated that most school districts in Arkansas have plans for responding to a mass casualty event, but less than one half have a plan for prevention or mitigation of such an event. Since this survey was conducted, Arkansas has passed a law requiring all school districts to develop such an emergency response plan. The findings highlight a need for continued planning and preparation. For example, most schools had not conducted a mass casualty drill. Most superintendents had not met with local EMS officials, and only a few have regularly scheduled meetings. Schools should continue to plan and prepare for the unwelcome prospect of a disaster at a school. School district administrators, nurses, physicians, local emergency response agencies, and the local medical community should all be involved in formulating a coordinated plan for their local community schools.

OBJECTIVE. Recent school shootings and terrorist events have demonstrated the need for well-coordinated planning for school-based mass-casualty events. The objective of this study was to document the preparedness of public schools in the United States for the prevention of and the response to a mass-casualty event. METHODS. A survey was mailed to 3670 school superintendents of public school districts that were chosen at random from a list of school districts from the National Center for Education Statistics of the US Department of Education in January 2004. A second mailing was sent to nonresponders in May 2004. Descriptive statistics were used for survey variables, and the [chi square] test was used to compare urban versus rural preparedness. RESULTS. The response rate was 58.2% (2137 usable surveys returned). Most (86.3%) school superintendents reported having a response plan, but fewer (57.2%) have a plan for prevention. Most (95.6%) have an evacuation plan, but almost one third (30%) had never conducted a drill. Almost one quarter (22.1%) have no disaster plan provisions for children with special health care needs, and one quarter reported having no plans for postdisaster counseling. Almost half (42.8%) had never met with local ambulance officials to discuss emergency planning. Urban school districts were better prepared than rural districts on almost all measures in the survey. CONCLUSIONS. There are important deficiencies in school emergency/disaster planning. Rural districts are less well prepared than urban districts. Disaster/mass-casualty preparedness of schools should be improved through coordination of school officials and local medical and emergency officials. KEY WORDS. disasters, emergency aid, school health, terrorism. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2005-0927

School preparedness includes the possibility of a natural disaster, (1,2) but recent events also confirm a need for preparedness and prevention efforts for intentional mass casualty incidents (MCIs). (3-7) This [...]

Objective. All-terrain vehicle (ATV) injuries among children represent a significant and growing problem. Although state-level analyses have characterized some aspects of pediatric ATV-related injuries, little information on the national impact on hospitalization is available. This study was designed to characterize more fully the patterns of injury, hospital length of stay, and hospital charges associated with ATV-related injuries, with a nationally representative sample. Methods. Analyses were based on the 1997 and 2000 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID). The KID is the only national, all-payer database of hospital discharges for children. KID data were weighted to represent all discharges from general hospitals in the United States. Discharges with external cause-of-injury codes consistent with off-road ATV-related injuries were selected, and the affected population was described. Nationally representative rates of ATV-related injuries were calculated, and changes between 1997 and 2000 were documented. Results. An estimated 5292 children were hospitalized because of ATV-related injuries during the 2-year period, and hospitalizations increased 79.1% between 1997 and 2000. Rates of ATV-related hospitalization were highest among adolescent white male subjects, consistent with previous studies. Most patients had hospital lengths of stay of 8 days. Injury severity varied considerably, with more than one third of patients sustaining moderate to severe injuries. Approximately 1% of hospitalizations resulted in in-hospital deaths. Total hospital charges for this injury mechanism were $74367677 for the 2-year study period. Most of these charges were paid by private insurers. Conclusions. This study provides evidence supporting recent substantial increases in childhood ATV-related injuries. The hospitalization impact of ATV-related injuries among children is considerable. Our data support the need for ongoing creative attempts to identify effective strategies to decrease ATV injuries among children. Pediatrics 2005;115:e316-e321. URL: www. pediatrics.org/cgi/doi/10.1542/peds.2004-1585; pediatrics, injury, all-terrain vehicle.

Risk Factors for Suicide Among Indian Adolescents at a Boarding School Synopsis Suicide rates among American Indians, especially adolescents, are higher than those for the general population. This paper summarizes […]

This study explored the latent structure of adolescent alcohol use and the construct validity of that structure. Using data gathered from 2,096 American Indian high school students, a double cross-validation design uncovered a three-dimensional latent structure of adolescent alcohol use: quantity/frequency, negative consequences, and serious problem drinking. Quantity/ frequency was a significant predictor of both psychological adjustment (depressive symptoms and antisocial behavior) and three measures of others' perceptions of youth's drinking. Negative consequences offered a significant increment in prediction of these variables over and above quantity/frequency in 9 of the 10 analyses. Serious problem drinking was significant only in predicting boys' antisocial behavior and in predicting others' thinking that girls had a problem with drinking. Implications for developmental research are considered. [ABSTRACT FROM AUTHOR]

Objective: The Institute of Medicine has issued two reports over the past 10 years raising concerns about the care of children in the emergency medical care system of the United States. Given that children are involved in most mass casualty events and there are deficiencies in the day-to-day emergency care of children, this project was undertaken to document the preparedness of hospitals in AR for the care of children in mass casualty or disaster situations., Design: Mailed survey to all emergency department medical directors in AR. Nonresponders received a second mailed survey and an attempt at survey via phone., Participants: Medical directors of the emergency departments of the 80 acute care hospitals in AR., Results: Seventy-two of 80 directors responded (90 percent response rate). Only 13 percent of hospitals reported they have pediatric mass casualty protocols and in only 28 percent of hospitals the disaster plan includes pediatric-specific issues such as parental reunification. Most hospitals hold mass casualty training events (94 percent), at least annually, but only 64 percent report including pediatric patients in their disaster drills. Most hospitals include local fire (90 percent), police (82 percent), and emergency medical services (77 percent) in their drills, but only 23 percent report involving local schools in the disaster planning process. Eighty-three percent of hospitals responding reported their staff is trained in decontamination procedures. Thirty-five percent reported having warm water showers available for infant/children decontamination. Ninety-four percent of hospitals have a plan for calling in extra staff in a disaster situation, which most commonly involves a phone tree (43 percent). Ninety-three percent reported the availability of Ham Radios, walkie-talkie, or Arkansas Wireless Information Network (AWIN) units for communication in case of land line loss, but only 16 percent reported satellite phone or Tandberg units. Twelve percent reported reliance on cell phones in this situation., Conclusions: This survey demonstrated important deficiencies in the preparedness of hospitals in AR for the care of children in disaster. Although many hospitals are relatively well prepared for the care of adults in disaster situations, the needs of children are different and hospitals in AR are not as well prepared for pediatric disaster care.