American journal of preventive medicine
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Because the incidence of inflicted traumatic brain injury (inflicted TBI) is low, even in populations at increased risk, very large samples are necessary to have adequate statistical power to conduct a randomized clinical trial of the effectiveness of a potential intervention to prevent inflicted TBI. This requirement for large samples, in addition to the logistic demands of prospective clinical trials, makes it prohibitively expensive to conduct such studies. ⋯ However, because these are observational studies, they are susceptible to bias. Approaches are presented to conducting and analyzing case-control studies to evaluate interventions to prevent inflicted TBI while assessing and minimizing possible bias.
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A conference addressing how to establish the incidence of inflicted traumatic brain injury in young children provided the opportunity to examine issues of definitions, passive versus active surveillance, study designs, proxy measures, and statistical issues. Data were presented that had been collected in alternative ways. The participants concluded that an ideal system for measurement of the incidence does not yet exist. ⋯ The ethical issues involved in measuring stigmatized and illegal behavior are not inconsequential. In an ideal system data from different sources-medical, legal, and social service, among others-will need to be linked. Perhaps most importantly, any surveillance approach will need to be maintained so that trend data can be used to assess the effectiveness of prevention efforts.
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People with physical disabilities are more likely to be sedentary than the general population, possibly because they have an accrued sensitivity to environmental features. ⋯ People with physical disabilities who live in neighborhoods with more environmental buoys are more likely to report involvement in leisure-time physical activity.
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Walking to school may be an important source of daily physical activity in children's lives, and government agencies are supporting programs to encourage walking to school (e.g., Safe Routes to School and the CDC's KidsWalk programs). However, little research has looked at differences in behavior across racial/ethnic and income groups. ⋯ Active transportation to school may be an important strategy to increase and maintain physical activity levels for low-income and minority youth. Current policy interventions such as Safe Routes to School have the opportunity to provide benefits for low-income and minority students who are the most likely to walk to school.