Research Projects

IPRC investigators carry out numerous research projects in the areas of prevention, acute care, rehabilitation, surveillance, and biomechanics. Current projects are listed below:

• Trauma System Evaluation
  PI: James Torner, PhD
  The State of Iowa is implementing a trauma system to provide a comprehensive strategy for care of injured persons. The start date of the system was January 1, 2001, with the hospitals and EMS providers given three years to obtain training. The project will utilize pre- (1997-2000) and post- (2001-2003) data to assess the effectiveness of trauma system implementation using categorization, education, and defined criteria for triage of trauma cases. Performance (e.g. response times) and outcome indicators (e.g. mortality) will be assessed before and after implementation. Project analysis will utilize databases from trauma registry hospitals, discharge data, and mortality data and will take into account the possible clustering of transfer to particular hospitals. Stratification will be done by nature and cause of injury as well as by physiologic, anatomic, and mechanistic categories.

• Rural Smoke Alarm Trial
  PI: Corinne Peek-Asa, MPH, PhD
  Fires and burns are the seventh leading cause of injury death in the United States. Although home smoke alarms reduce the risk of dying in a fire by half and the risk of having a reportable fire by three-fourths, even after nearly three decades of availability their use is not universal. There is uncertainty about whether different types of alarms or lifespans of batteries could increase the prevalence of homes with working alarms. This project aims to compare the effectiveness in rural households of two alternative types of smoke alarm and of two different lifespans of battery. The primary study outcome is the presence of working smoke alarms. Using randomized control trial methods, we will install new, battery-powered photoelectric alarms in 400 homes and ionizing alarms in 400 homes at baseline. In half the homes in each group the alarms will have alkaline batteries, while in the other half they will have lithium batteries. Homes will be chosen randomly from the 1,004 rural homes of an existing longitudinal cohort study of health and safety. After 18 and 42 months we will revisit the homes to determine which homes still have operating alarms. If there is a between-group difference in the prevalence of homes with working alarms, we will use quantitative and qualitative methods to try to determine the reasons. In addition, we will investigate two secondary study aims. First, for the 800 alarm study households, we will use logistic regression methods to identify the demographic, behavioral and environmental risk factors from interview and observed data for failure to have all alarms working after 18 months. Second, to evaluate the validity of self-reported information on working smoke alarms, we will compare information from household interviews and inspections.

• Temperament as a Risk Factor for Bicycling Injuries
  PI: Jodie Plumert, PhD
  Bicycle crashes are among the most common causes of severe injuries in childhood (Rivara, 1985). Despite growing national concern over promoting children's bicycling safety, the underlying causes of bicycle crashes remain poorly understood. In particular, little is known about the kinds of temperamental traits that put children at risk for bicycling injuries. One reason why we know so little about the behaviors that put children at risk for bicycling injuries is that it is difficult to study bicycling behavior without putting research participants at risk for injury. Another reason we know so little about the causes of bicycling crashes is that it is difficult to study bicycling behavior in a controlled environment. Recent advances in virtual environment technology, however, offer a way to address the problem of bicycling safety in a controlled manner without putting children at risk for injury. Using a high-fidelity, interactive bicycling simulator, we can safely present children with the same kinds of bicycling challenges that they confront in the real environment.
  The overall aim of this project is to use an immersive, interactive bicycling simulator to identify the kinds of temperamental traits that may put certain children at greater risk for bicycling injuries. As a first step in the research program, we will focus specifically on children's ability to negotiate traffic-filled roadways. The specific aims of this proposal are to 1) identify temperamental traits associated with errors in negotiating traffic-filled roadways; and 2) examine how temperamental traits lead to such errors in negotiating traffic-filled roadways. Together, these studies will provide important information about who is most at risk for bicycle crashes that may lay the groundwork for the development of pediatrician-based intervention strategies for reducing bicycling injuries.

• Driver Impairment, Self-Awareness and Crash-Risk in Obstructive Sleep Apnea Syndrome
  PI: Matthew Rizzo, MD
  Automobile driving is a crucial aspect of everyday life, yet vehicular crashes represent a serious public health problem. Many motor vehicle crashes are caused by sleepy drivers, and drivers with sleep disorders such as Obstructive Sleep Apnea Syndrome (OSAS) are at particular risk for a crash. Sleep deprivation among OSAS sufferers causes cognitive dysfunction and increases the risk of falling asleep at the wheel. Some drivers with OSAS are especially likely to drive while impaired because they are unaware of their drowsiness and cognitive impairment. Still, the cognitive basis of driving performance errors in sleepy drivers with OSAS is not well described and few tools are available for detecting and alerting those drivers who are at greatest risk for a crash. An important step toward reducing potential future injury and damages caused by sleep-related crashes in OSAS will be to improve general understanding of the effects of sleepiness on driver performance and safety errors. We propose to expand the available knowledge of driver safety in OSAS by testing a set of hypotheses. Our proposed experiments will assess: (1) cognitive functions using standardized neuropsychological tests (of attention, perception, memory, and executive functions), (2) physiologic indices of sleep (including EEG, autonomic functions, and lid closure), (3) standard self-ratings of sleepiness and awareness of acquired cognitive impairment, and (4) driving performance in OSAS. To measure driving performance, we will use a state-of-the-art fixed-base interactive driving simulator, known as SIREN, that allows us to observe driver errors in an environment that is challenging yet safe for the driver and tester, under conditions of optimal stimulus and response control. The results of this study of 50 drivers with OSAS and 50 drivers without a sleep disorder will increase the understanding of the role of cognitive impairment and self-awareness on driving safety errors and falling asleep at the wheel in OSAS. A better understanding of how driving performance deteriorates in sleepy motorists with OSAS and whether they are even aware of their impairment are necessary steps in the rational development of interventions that could help prevent crashes by these drowsy drivers. The techniques used in this study could ultimately be adapted to develop future tools for screening, identifying, advising, and alerting drivers with OSAS who are at greater risk for impaired driving due to drowsiness, cognitive dysfunction, and lack of insight into their impairment. Fair and accurate means of detecting unfit drivers with OSAS will help mitigate the tragedy of motor vehicle crashes caused by these impaired individuals.

• The Impact of Intimate Partner Violence on Women’s Physical and Psychological Health: A Study of Intentionally Injurious Behavior in Rural Populations
  PI: Erika Lawrence, PhD
  Intimate partner violence is a major cause of injuries to women and children, and the primary cause of intentional injuries. The goal of the proposed research is to integrate the approaches of public health and clinical psychology to explain the longitudinal course of intimate partner violence and its impact on women’s physical and psychological health. There are three aims to the proposed research. The first aim is to describe and predict the course of intimate partner violence—both psychological and physical violence, over a 12-month period. The second aim is to demonstrate the impact of intimate partner violence on women’s physical and psychological health. The third aim is to demonstrate that the impact of intimate partner violence on women’s health is modified by (a) women’s interpretations of their partner’s violence, (b) women’s emotional reactions following the violence, (c) the frequency of the aggressor’s alcohol use during violent episodes, and (d) rurality. Advertisements will be placed in newspapers and ad circulars in Benton, Washington, Cedar, Jones, Linn, and Johnson Counties to recruit female participants aged 18-55 who have been living with a male partner for at least four months. The sample will comprise 100 moderately victimized women and 100 severely victimized women, based on Straus’ (1979) Conflict Tactics Scales classifications, with the goal of recruiting at least half of the participants from rural communities. Data will be collected via 60-minute in-person sessions at Time 1 and via 60-minute telephone sessions at Times 2-4, for a total of four waves of data collection over a 12-month period. Data collection is expected to take 20 months to complete. Questionnaires will be administered to assess demographics, relationship history, psychological and physical violence, physical health, depression and anxiety. A semi-structured interview will be administered to assess violence-related injury and the factors modifying the impact of intimate partner violence on women’s health (interpretations, emotional reactions, alcohol use, rurality). Participants will be paid $30 for each wave of data collection. Growth curve analyses will be conducted to examine the longitudinal course of violence and to test the specific hypotheses. The findings from the proposed study will be used by the Principal Investigator to develop an empirically driven primary prevention program targeting intimate partner violence.

• Effects of Phenytoin on Driving Safety
  PI: Erik St. Louis, MD
  Automobile driving is a crucial aspect of everyday life, yet vehicular crashes represent a serious public health problem. Patients with epilepsy are at elevated risk for automobile crashes, causing great personal suffering and financial costs to society. Most collisions involving epileptic drivers are not seizure related but may instead result from cognitive effects upon driving performance of epilepsy and antiepileptic drugs (AEDs). Several million American drivers take AEDs for treatment of medical conditions besides epilepsy and may also be at risk for cognitive impairments that can reduce driving performance. Empirical evidence of the effects of AEDs on driving performance would enable development of driving guidelines that could lower the risk of injurious motor vehicle collisions; however, this evidence is currently lacking.

The broad goal of our project is to determine the specific effects of the most commonly utilized AED, phenytoin, by assessing driving performance and cognitive abilities in neurologically normal volunteers taking phenytoin in a randomized, double-blind, placebo-controlled, crossover study. Our proposed experiments will assess: (1) cognitive functions using standardized neuropsychological tests (of attention, perception, memory, and executive functions), (2) driving performance during phenytoin and placebo administration, and (3) the effects of phenytoin-related cognitive performance upon driving performance. To measure driving performance, we will use a state-of-the-art fixed-base interactive driving simulator that allows us to observe driver errors in an environment that is challenging yet safe for the driver and tester, under conditions of optimal stimulus and response control. The results of this study of 30 drivers treated with phenytoin and placebo will increase the understanding of the role of AED-related cognitive impairment on driving safety errors. A better understanding of the impact of AEDs upon driving performance is necessary to rationally develop interventions that could help prevent crashes by drivers treated with AEDs.

Previous projects have included a biomechanical study of injuries caused by tractor runover, an evaluation of an intervention  project aimed at preventing tractor rollover injuries, a study of secondary injuries to farmers with disabilities, and the establishment of a hospital emergency room based injury surveillance system. Other projects have examined the efficacy of head injury prevention educational programs, studied the prevalence of domestic violence in rural areas, and utilized advanced driving simulation to study the driving characteristics of persons diagnosed as having Alzheimer's disease.