Preventing Youth Injuries Caused by Violence

    • July 14, 2009

The Problem: Violent injury is a major cause of adolescent illness and death. The American Academy of Pediatrics and some researchers believed that primary care and emergency department physicians could help prevent assault injuries caused by violence. More research was needed to guide interventions.

Grantee Perspective: In 1996, Tina L. Cheng, MD, MPH was director of a program for teen parents and their children at Children's National Medical Center in Washington, D.C., and an assistant professor at George Washington University. “There are things we can do to prevent these injuries,” said Cheng, who had conducted research on adolescent violence.

In 1996, the Robert Wood Johnson Foundation (RWJF) Generalist Physician Faculty Scholars Program gave Cheng a chance to continue her work, enhance her research abilities and engage with a network of other generalist physicians.

Cheng and colleagues conducted in-person or telephone interviews with three groups of youth ages 12–19 who showed up at a D.C. emergency department: youth who had been injured in assaults, unintentionally injured youth and uninjured youth. They studied the risk and protective factors associated with assault injuries and examined whether primary care and emergency department physicians are positioned to assess risk or intervene with youth.

Evan Charney, MD, Cheng’s Generalist Physician Faculty Scholars national advisory committee mentor, helped her develop her research skills by asking “the hard questions,” according to Cheng. “He [did] a lot of that for me.” Her mentor at Children’s National Medical Center, Peter Scheidt, provided subject-matter expertise. Both mentors promoted Cheng’s career as a generalist physician and researcher.

Results: In an article in Pediatrics (2003), Cheng et al. reported that past fights, past fight injuries and seeing someone shot were associated with assault injury. They also found that most youth had primary care providers, suggesting that these providers have access to at-risk teens for assessing their risk and intervening to help.

In an article in Academic Emergency Medicine (2003), Cheng and colleagues reported that most youth assault injuries involved people they knew and that over time, many youth may be both victims and perpetrators. Researchers concluded that these findings may inform interventions based in emergency departments.

  • As a result of this research, Cheng received funding to conduct randomized controlled trials of two violence-prevention interventions with youth injured in assaults:
  • A mentoring program featuring a problem-solving curriculum for the youth and home visits with a health educator for the parents (1999–2004, with $1.2 million from the Health Resources and Services Administration’s Maternal and Child Health Bureau).
  • In-person or telephone case-management services (1999–2002, with $300,000 from the Maternal and Child Health Bureau).

In both studies the control group received a list of community resources.

Cheng also received a Robert Wood Johnson Foundation Local Initiative Funding Partners grant to continue and evaluate the Generations Program. The grant is called “Comprehensive health care services and parenting education for teen parents and their children” (2001–05, $960,000, ID# 042817). Generations, which Cheng established in 1995, provides a range of youth and family services. The U.S. Department of Health and Human Services provides the primary funding.

Cheng is an investigator on the National Children’s Study, which examines the effects of environmental influences on the health and development of 100,000 children from before birth until age 21. The National Institute of Child Health and Human Development, the Centers for Disease Control and Prevention, and the U.S. Environmental Protection Agency are funding the study (2007–12, $10.8 million).

“The support of this [Generalist Physician Faculty Scholars] program clearly influenced my ability to focus on a generalist career and build a well-funded applied-research program,” said Cheng, who in 2002 joined Johns Hopkins University, where she is chief of General Pediatrics and Adolescent Medicine and a professor of pediatrics. “I’ve developed relationships with like-minded generalists that have continued today.”

From 2008 to 2009, Cheng also was president of the Academic Pediatric Association.

RWJF Perspective: The Robert Wood Johnson Foundation established the Generalist Physician Faculty Scholars Program to create a cadre of respected generalist leaders in medical schools who would be in a position to influence curriculum, admissions and scholarship. Junior faculty in family medicine, internal medicine and pediatrics conducted research and built their careers under the guidance of mentors.

“Given the shortage of primary care physicians, we need innovative approaches to encourage medical students to choose careers in generalist fields. The Generalist Physician Faculty Scholars Program was designed to emphasize a scholarly foundation for generalists and improve the quality of the education provided to students who choose this important career path,” said Pamela S. Dickson, MBA, assistant vice president of RWJF’s Health Care Group.

When the program ended in 2008, RWJF created the Robert Wood Johnson Physician Faculty Scholars Program to strengthen the leadership and academic productivity of junior medical school faculty who are dedicated to improving health and health care. It is open not only to generalists, but all physicians.