Douglas Wiebe

• University of Pennsylvania

Objective Concussion symptoms can be clustered into domains and understanding how multiple symptom domains present clinically may guide more accurate interventions. We investigate the associations between concurrent symptom domains and clinical recovery outcomes, as well as the role of sex in these relationships. Methods We analysed data from the...

Objective Describe the factor structure of the 22-symptom Sport Concussion Assessment Tool (SCAT), using confirmatory factor analysis (CFA) for a priori hypothesized symptom domains. Study Design Prospective observational study. Setting/Participants Collegiate student-athletes with concussion. Independent Variables Symptoms were collected via th...

Objectives. To examine whether, through interactions with preexisting socioeconomic status vulnerabilities, the COVID-19 pandemic exacerbated exposure to firearm violence among communities with a legacy of redlining (i.e., grading the creditworthiness of neighborhoods based on their sociodemographic composition). Methods. We used an exogenous popul...

This comparative effectiveness study estimates the size of the US firearm stock by 2034.

Importance Sport-related concussions (SRC) can significantly impact students’ attendance and academic performance, highlighting the importance of gradual return-to-learn protocols for recovery. Understanding the association between missed school days and recovery, especially across genders, is vital for effective concussion management in high schoo...

Importance Handheld cellphone use while driving is associated with increased motor vehicle crash risk among adolescents. Objective To examine the association of handheld cellphone use while driving with kinematic risky driving (KRD) events—hard braking and rapid acceleration—in adolescent drivers. Design, Setting, Participants Adolescents aged 16...

Background Growing interest has motivated recent studies to examine differences in recovery after sport-related concussion (SRC) by sex. However, heterogeneity in study design, participants, and recovery outcomes has led to mixed findings. Further work is needed to evaluate potential differences by sex and to investigate the role of related charact...

Distracted driving is responsible for nearly 1 million crashes each year in the United States alone, and a major source of driver distraction is handheld phone use. We conducted a randomized, controlled trial to compare the effectiveness of interventions designed to create sustained reductions in handheld use while driving (NCT04587609). Participan...

Objective This study aims to characterise the motivations of firearm owners and examine whether firearm ownership motivations and carriage varied by state stand your ground law status. Methods Using a nationally representative survey of US adults in 2023, we asked firearm owners (n=2477) about their firearm motivations and behaviours, including r...

Background Most Americans believe that gun-free zones make locations more vulnerable to violent crimes, particularly active shootings. However, there is no empirical evidence regarding the impact of gun-free zones on protecting locations from violence. The objective of this study was to estimate the association between gun-free zones and active sho...

OBJECTIVE Epidemiology provides fundamental opportunities to protect student-athlete health. The goal of this study was to describe the epidemiology of sport-related concussion (SRC) across 8 years (2015/2016–2022/2023) and compare boys’ and girls’ sports for SRC incidence and SRC mechanisms. METHODS This was a retrospective cohort study performed...

Importance Handheld phone use while driving is a major factor in vehicle crashes. Scalable interventions are needed to encourage drivers not to use their phones. Objective To test whether interventions involving social comparison feedback and/or financial incentives can reduce drivers’ handheld phone use. Design, Setting, and Participants In a ra...

Introduction Paediatric concussion is a common injury. Approximately 30% of youth with concussion will experience persisting postconcussion symptoms (PPCS) extending at least 1 month following injury. Recently, studies have shown the benefit of early, active, targeted therapeutic strategies. However, these are primarily prescribed from the specialt...

Background Traumatic brain injury (TBI) is an acute injury that is understudied in civilian cohorts, especially among women, as TBI has historically been considered to be largely a condition of athletes and military service people. Both the Centres for Disease Control and Prevention (CDC) and Department of Defense (DOD)/Veterans Affairs (VA) have d...

Background Advancements in linking publicly available census records with vital and administrative records have enabled novel investigations in epidemiology and social history. However, in the absence of unique identifiers, the linkage of the records may be uncertain or only be successful for a subset of the census cohort, resulting in missing data...

Background Epidemiology provides fundamental opportunities to protect student-athlete health. Objective Describe the epidemiology of sport-related concussion (SRC) across 7 years (2015/16–2021/22), and compare boys’ and girls’ sports SRC incidence. Design Retrospective cohort. Setting State-wide high school head injury surveillance system. Part...

Background Firearm manufacturing and imports grew in the US during the mid-2000s. We hypothesise those increases corresponded to increased international firearms trafficking and in turn were associated with increases in firearm homicides abroad. Methods We used the Global Burden of Disease database to quantify annual firearm and non-firearm homici...

Objective Determine post-concussive affective symptoms among university student-athletes in the context of the COVID-19 pandemic. Design Ivy League−Big Ten Epidemiology of Concussion Study surveillance and prospective cohort study. Student-athletes consent and enroll. Setting 19 universities; two athletic conferences in the United States, years 2...

Objective Determine the incidence and effects of additional injuries to American football players who sustained a sport-related concussion (SRC). Design Prospective concussion surveillance system and cohort study. Setting The Ivy League-Big Ten Epidemiology of Concussion Study spans 28 sports at the 8 Ivy League and 12 of 14 Big Ten universities....

Objective Describe mechanism of injury (MOI) for sport-related concussion (SRC) and sex differences within sports. Design Parent study is a prospective cohort study. Setting Collegiate sports. Participants Student-athletes (n=697) in basketball (n=148; 47.3% male), lacrosse (n=212; 58.5% male), soccer (n=267; 44.2% male), water polo (n=70; 57.1%...

Objective To provide data on characterizing returning to drive after concussion in adolescents. Design Prospective cohort study. Setting A large integrated pediatric health system. Participants Concussed adolescents ≤28 days of injury, ages 16.5–18 years with a driver’s license. Interventions (or Assessment of Risk Factors) Adolescents complete...

Objective Identify sex- and sport-specific differences in recovery time after sport-related concussion (SRC). Design The Ivy League-Big Ten Epidemiology of Concussion Study entails a surveillance system and prospective cohort study of SRC of student-athletes. Setting 18 universities from two collegiate athletic conferences in the United States....

Background Researchers often use publicly available data sources to describe injuries occurring in professional athletes, developing and testing hypotheses regarding athletic-related injury. It is reasonable to question whether publicly available data sources accurately indicate athletic-related injuries resulting from professional sport participat...

Objective The first objective was to establish the respective factor structures of a concussion perceptions inventory that was adapted for youth athletes (ages 8–14 years) and their parents from the Perceptions of Concussion Inventory for Athletes. The second objective was to understand the associations between the concussion perceptions of youth a...

BACKGROUND Concussion is a common adolescence injury that can result in a constellation of symptoms, negatively affecting their academic performance, neurobiological development, and quality of life. Mobile health (mHealth) technology has been shown its promising role in managing real-time symptoms. However, there is limited evidence about mHealth...

Background A concussion is a common adolescent injury that can result in a constellation of symptoms, negatively affecting academic performance, neurobiological development, and quality of life. Mobile health (mHealth) technologies, such as apps for patients to report symptoms or wearables to measure physiological metrics like heart rate, have been...

Background: Affective symptoms, specifically, anxiety, are often overlooked after sport-related concussion (SRC), and may contribute to prolonged recovery. Objective: To examine the impact of anxiety during clinical recovery among adolescents (13-18y) enrolled in a randomized trial of aerobic exercise for SRC. Methods: Patients at three sites...

Trauma centers use registry data to benchmark performance using a standardized risk adjustment model. Our objective was to utilize national claims to develop a risk adjustment model applicable across all hospitals, regardless of designation or registry participation. Patients from 2013–14 Pennsylvania Trauma Outcomes Study (PTOS) registry data were...

Background Sobriety checkpoints are a highly effective strategy to reduce alcohol-impaired driving, but they are used infrequently in the USA. Recent evidence from observational studies suggests that using optimized sobriety checkpoints—operating for shorter duration with fewer officers—can minimize operational costs without reducing public health...

Early targeted heart rate (HR) aerobic exercise has been shown to reduce the duration of recovery from sport-related concussion (SRC) as well as the incidence of Persistent Post-Concussive Symptoms (PPCS). It is not known, however, if more severe oculomotor and vestibular presentations of SRC benefit from a prescription of aerobic exercise. The cur...

Background: Sobriety checkpoints are a form of proactive policing in which law enforcement officers concentrate at a point on the roadway to systematically perform sobriety tests for all passing drivers. We investigated whether sobriety checkpoints unintentionally reduce assaults in surrounding areas. Methods: Exposures of interest were sobriety...

Background: Firearm violence is one of the leading preventable causes of death and injury in the United States and is on the rise. While policies regulating access to firearms offer opportunities to prevent firearm-related deaths, an understanding of the holistic impact of changing state firearm policies on firearm homicide rates over the last 30...

Introduction: Access to care has been measured by geographic distance, transport time or provider density. For emergency care sensitive conditions, like out-of-hospital cardiac arrest (OHCA), market area coverage may be associated with short-term outcomes due to the need for access to definitive care. Our objective was to evaluate the association o...

Objective: The aims of this study were to determine the incentivization strategy that maximizes patient adherence to report symptoms and activity via ecological momentary assessment (EMA) after pediatric concussion, and assess the feasibility of tracking concussed youth using EMA from the emergency department (ED) setting. Methods: This study wa...

Purpose of Review Firearm policies have the potential to alleviate the public health burden of firearm violence, yet it is unclear which policies are effective. The current review aims to summarize studies that use synthetic control methods to overcome previous methodological limitations when examining the impacts of firearm policies. Recent Findi...

Objective: This study aims to identify modifiable factors related to firearm homicide (FH). Summary background data: Many socioeconomic, legislative and behavioral risk factors impact FH. Most studies have evaluated these risk factors in isolation, but they coexist in a complex and ever-changing American society. We hypothesized that both restri...

Importance: Firearm violence remains a critical public health challenge, disproportionately impacting some US regions. County-level variation may hold key insights into how firearm mortality rates vary across the US. Objective: To model county-level changes in firearm mortality rates (total, homicide, and suicide) from 1989 to 1993 vs 2015 to 20...

Introduction Student-athletes’ time demands include scholastic, athletic, and social events that may influence sleep duration; and the association between sleep duration, athletic performance, and injury risk are inconclusive. Further, limited research investigates long-term habitual sleep patterns in collegiate student-athletes. We aimed to descri...

Growing evidence suggests that drug interactions may be responsible for much of the known association between opioid use and unintentional traumatic injury. While prior research has focused on pairwise drug interactions, the role of higher-order (i.e., drug-drug-drug) interactions (3DIs) has not been examined. We aimed to identify signals of opioid...

Benzodiazepine receptor agonists and related medications, such as Z-drugs and dual orexin receptor antagonists (BZDs), have been associated with unintentional traumatic injury due to their central nervous system (CNS)-depressant effects. Drug-drug interactions (DDIs) may contribute to the known relationship between BZD use and unintentional traumat...

Objective To examine the progression of collegiate student athletes through five stages of a return-to-activity protocol following sport-related concussion (SRC). Methods In a multisite prospective cohort study, we identified the frequency of initial 24–48 hours physical and cognitive rest, and the sequence of (1) symptom resolution and return to...

Traumatic brain injury (TBI) is associated with the development of a range of neurodegenerative pathologies, including chronic traumatic encephalopathy (CTE). Current consensus diagnostic criteria define the pathognomonic cortical lesion of CTE neuropathologic change (CTE-NC) as a patchy deposition of hyperphosphorylated tau in neurons, with or wit...

Background: Use of muscle relaxants is rapidly increasing in the USA. Little is understood about the role of drug interactions in the known association between muscle relaxants and unintentional traumatic injury, a clinically important endpoint causing substantial morbidity, disability, and death. Objective: We examined potential associations be...

Statement of Purpose Motor vehicle crashes are a leading cause of adolescent death and disability. Risky driving behaviors are associated with adolescent motor vehicle crashes. We report on initial data for risky driving behaviors in adolescent drivers using a smartphone application. Methods/Approach Prospective data was collected using Way to Dri...

Statement of Purpose To compare the effectiveness of novel interventions aimed at building the habit of putting down one’s phone while driving, among drivers eligible for a smartphone telematics-based auto-insurance rate. Methods/Approach We enrolled 1,670 Progressive Snapshot usage-based auto insurance customers in a 10-week randomized trial (NCT...

Context: Football continues to report the highest rate of sport-related concussions (SRC) in high school athletics. To mitigate SRC risk the Michigan High School Athletic Association (MHSAA) implemented rules aimed at reducing the number of collisions occurring in practices. Objective: Estimate rates of SRC in MHSAA football programs and evaluat...

Objective To determine the incentivization strategy that maximizes patient adherence to report symptoms and activity via ecological momentary assessment (EMA) following pediatric concussion. Background Concussion is a common pediatric injury. Traditionally, outcome assessment has occurred at discrete points-in-time, days or weeks apart, relying on...

Background and aims Sobriety checkpoints are an effective strategy to reduce alcohol-impaired driving, motor vehicle crashes, injuries, and fatalities. The aim of this study was to identify the geographic extent over which individual sobriety checkpoints affect alcohol-impaired driving. Design, setting, participants Spatial ecological panel analys...

Background The impact of injury extends beyond the hospital stay, but trauma center performance metrics typically focus on in-hospital mortality. We compared risk adjusted rates of in-hospital and long-term mortality among Pennsylvania trauma centers. We hypothesized that centers with low rates of in-hospital mortality would also have low rates of...

To the Editor Rideshare use has increased exponentially throughout the last decade, and motor vehicle crashes are a leading cause of death or injury globally. In the study by Conner et al,¹ the examination of associations between Uber trips and motor vehicle crashes in Houston, Texas, is a welcome addition to an important and emerging area of inqui...

Introduction: Competition in the healthcare market is a theoretical driver of innovation, cost-savings, and improved quality. When patients are treated for certain emergent conditions, such as out-of-hospital cardiac arrest (OHCA), individuals have less choice in their treating hospital. For patients undergoing elective cardiac valve replacement su...

Background: Policy changes are often necessary to contain the detrimental impact of epidemics such as those brought about by coronavirus disease (COVID-19). In the earlier phases of the emergence of COVID-19, China was the first to impose strict restrictions on movement (lockdown) on January 23rd, 2020. A strategy whose effectiveness in curtailing...

Background Sport-related concussion is a public health problem, particularly in adolescents. Quality of life is reduced in adolescents with persistent post-concussive symptoms (symptoms >28 days). We replicated a previous randomised controlled trial to validate the safety, efficacy, and generalisability of, and objective adherence to, prescribed ea...

Importance: Many children and adolescents in the United States are exposed to neighborhood gun violence. Associations between violence exposure and children's short-term mental health are not well understood. Objective: To examine the association between neighborhood gun violence and subsequent mental health-related pediatric emergency departmen...

While injury is a leading cause of death and debility in older adults, the relationship between intensity of care and trauma remains unknown. The focus of this analysis is to measure the overall intensity of care delivered to injured older adults during hospitalization. Methods: We used Centers for Medicare and Medicaid Services Medicare fee-for-...

The Coronavirus Disease 2019 (COVID-19) pandemic brought unprecedented socially isolating measures to mitigate the spread of disease, heightening the importance of public outdoor urban greenspace. Here, we investigated the association between tree-rich greenspace and mental health in a large opportunity sample surveyed using a crowdsourcing researc...

Background Although alcohol breath testing devices that pair with smartphones are promoted for the prevention of alcohol‐impaired driving, their accuracy has not been established. Methods In a within‐subjects laboratory study, we administered weight‐based doses of ethanol to two groups of 10 healthy, moderate drinkers aiming to achieve a target pe...

The determinants of the intake of high-fat products are not well recognized, but fat preference may be one of them. The aim of this study was thus to determine whether intake of different types of high-fat food is associated with fat preference in people with normal and increased body weight. Participants aged 20–40 years [n = 421] were enrolled in...

Importance: Because of the negative consequences of concussion, considerable research efforts have been directed toward understanding the risk factors for sport-related concussion (SRC) and its outcomes to better inform strategies for risk reduction. Girls are suggested to have an increased risk of concussion, warranting exploration into sex-depen...

In Reply We appreciate the concerns expressed by Barber et al about potential misclassification in medical billing coding of firearm injury intent in response to our article.¹ Although many states and payers require external cause-of-injury coding, these codes are not routinely inspected for accuracy. This problem may have been exacerbated when the...

Objective Sobriety checkpoints have strong empirical and theoretical support as an intervention to reduce alcohol‐involved motor vehicle crashes. The purpose of this study was to examine whether checkpoint size (the number of police officers) and checkpoint duration (the amount of time in operation) affect associations between individual checkpoint...

Background Hedonic hunger occurs in response to a desire to consume food for pleasure. The μ-opioid system regulates the hedonic impact of food and the opioid receptor mu 1 gene (OPRM1) polymorphism has been associated with fat intake. Objectives The aim of this study was to determine whether the intake of high-fat food is associated with hedonic...

Introduction: We explore the use of CCTV footage to map suicidal self-injurious behavior on a subway platform to better understand the settings and the situational conditions of individuals just before they attempt suicide. Methods: We use footage from CCTV cameras for gaining new insight into the situational conditions that relate to suicidal self...

Efforts to characterize the late effects of traumatic brain injury (TBI) have been in progress for some time. In recent years much of this activity has been directed towards reporting of chronic traumatic encephalopathy (CTE) in former contact sports athletes and others exposed to repetitive head impacts. However, the association between TBI and de...

This paper describes follow-up for a cohort of 4530 residents living in the asbestos manufacturing community of Ambler, PA, U.S. in 1930. Using re-identified census data, cause and date of death data obtained from the genealogic website Ancestry.com, along with geospatial analysis, we explored relationships among demographic characteristics, occupa...

Context: Past work has identified sex differences in sport-related concussion (SRC) incidence and recovery time; however, few have examined sex differences in specific recovery trajectories: time to symptom resolution, return-to-academics, and return-to-athletic activity across collegiate sports. Objective: To examine sex differences in SRC recover...

Background. Since 2005, most US states have expanded civilian rights to use deadly force in self-defense outside the home. In most cases, legislation has included removing the duty to retreat anywhere one may legally be, commonly known as stand-your-ground laws. The extent to which these laws affect public health and safety is widely debated in pub...

Antidepressants are very widely used and associated with traumatic injury, yet little is known about their potential for harmful drug interactions. We aimed to identify potential drug interaction signals by assessing concomitant medications (precipitant drugs) taken with individual antidepressants (object drugs) that were associated with unintentio...

Identifying effective strategies to promote healthy eating and reduce obesity is a priority in the USA, especially among low-income and minority groups, who often have less access to healthy food and higher rates of obesity. Efforts to improve food access have led to more supermarkets in low-income, ethnically diverse neighborhoods. However, this a...

Context: Return-to-play following sport-related concussion(SRC) requires authorized clearance from a healthcare provider(HCP). Variability in HCPs and facilities where athletes seek care may influence return time. Objective: Determine the initial examiner, HCPs that authorize clearance, and medical facilities authorizing clearance among high school...

Importance Firearm injury research in the US has focused on fatal injuries. The incidence and epidemiologic factors associated with nonfatal firearm injuries are less understood. Objective To evaluate estimates of incidence and trends over time of fatal and nonfatal firearm injuries. Design, Setting, and Participants A cross-sectional, ecologic s...

Background: Firearm homicides occur less frequently in US states with more firearm control laws. However, firearms are easily transported across state lines, and laws in one location may affect firearm violence in another. This study examined associations between within-state firearm laws and firearm homicide while accounting for interference from...

Interrupted time series designs are a valuable quasi-experimental approach for evaluating public health interventions. Interrupted time series extends a single group pre-post comparison by using multiple time points to control for underlying trends. But history bias-confounding by unexpected events occurring at the same time of the intervention thr...

Background Efforts to minimize harms from opioid drug interactions may be hampered by limited evidence on which drugs, when taken concomitantly with opioids, result in adverse clinical outcomes. Objective To identify signals of opioid drug interactions by identifying concomitant medications (precipitant drugs) taken with individual opioids (object...

Background: Elevated blood phosphorus levels are common and associated with a greater risk of death for patients receiving chronic dialysis. Phosphorus-rich foods are prevalent in the American diet, and low-phosphorus foods, including fruits and vegetables, are often less available in areas with more poverty. The relative contributions of neighbor...

Background Policy changes are often necessary to contain the detrimental impact of epidemics such as the coronavirus disease (COVID-19). China imposed strict restrictions on movement on January 23 rd , 2020.Interrupted time series methods were used to study the impact of the lockdown on the incidence of COVID-19. Methods The number of cases of COVI...

Background The determinants of the intake of high-fat products are not well understood. Objective The aim of this study was to examine the relations between fat perception, intake of high-fat food, and body-weight status, taking into account the polymorphism of the genes that encode the proteins involved in oral fat perception. Methods A total of...

Statement of Purpose Stand your ground (SYG) laws extend the right to use lethal force in self-defense. These laws have been controversial with media attention focusing on adolescent deaths – particularly Black adolescent deaths – including Trayvon Martin. Despite evidence that SYG law increase firearm homicides in adults, its impact on adolescents...

Background Traumatic injury is not evenly distributed across race and class in America. Black men are marginalized in society, often live in disadvantaged neighborhoods, and are at higher risk for injury mortality and ongoing physical and psychological problems following injury, including post-traumatic stress disorder (PTSD) and depression. While...

Statement of Purpose The public stock of firearms in the U.S. is increasing by an estimated three to five million firearms per year. Without enacting unpopular (and unconstitutional) controls on the purchase of firearms, there are few options for limiting the availability of firearms, and reducing rates of physical harm. One approach, which does no...

Purpose School violence, frequently resulting in serious injury, is a major public health concern, and can make students afraid to go school. Few studies investigate the myriad factors that contribute to school violence. We are conducting a mixed-methods study of school assaults, including violence that happen on the way to or from school. Approac...

Statement of Purpose We are honing the ReCoUPS (Recovering Concussion Update on the Progression of Symptoms) protocol to monitor concussion patients using ecologic momentary assessment (EMA), and accrue data revealing the relationship between physical and cognitive rest and clinical outcomes in the days and weeks post-injury. Methods/Approach Our...

Statement of Purpose Interrupted time series (ITS) designs are a valuable quasi-experimental approach for evaluating public health interventions. ITS extends a single group pre-post comparison by using multiple timepoints to control for underlying trends. But history bias – confounding by unexpected events occurring at the same time of the interven...

Introduction Little literature addresses the burden of injury in Botswana, including trauma from motor-vehicle crashes (MVCs). In response, the University of Botswana and the Botswana Ministry of Health and Wellness are collaborating with the University of Pennsylvania to enhance injury and trauma research capacity in Botswana. Here we describe thi...

Traditional research methods typically utilize singular forms of data to conceptualize and measure violence. Methodologies designed to examine the impact of violence have been structured to primarily examine the interpersonal. However, scholars in community psychology, anthropology, and social work, and so forth, have recognized additional dimensio...

Objectives This study clarifies three important issues regarding situational or opportunity theories of victimization: (1) whether engaging in risk activities triggers violent assault during specific, often fleeting moments, (2) how environmental settings along individuals’ daily paths affect their risk of violent assault, and (3) whether situation...

Background: Federal law requires background checks for firearms purchased from licensed dealers, but states can extend requirements to private sales of handguns and purchases at gun shows (universal background checks for handguns [UBC-HG]). Although firearm homicide disproportionately affects African Americans, little is known about how UBG-HG imp...

Establishing whether specific laws impact rates of firearm homicide in adolescents is critical for identifying opportunities to reduce preventable adolescent death. We evaluated Florida’s Stand Your Ground law, enacted October 2005, using an interrupted time series design from 1999 to 2017. We used segmented quasi-Poisson regression to model underl...

Introduction: State-level legislation requiring CPR education prior to high school graduation (CPR Legislation) is associated with an increased likelihood of community-level CPR training. CPR Legislation has also been shown to be associated with increased bystander CPR. We hypothesized that states with recent CPR Legislation would be associated wit...

Background: Adolescents who live near more alcohol outlets tend to consume more alcohol, despite laws prohibiting alcohol purchases for people aged <21 years. We examined relationships between adolescents' exposure to alcohol outlets, the sources through which they access alcohol, and their alcohol consumption. Methods: Participants for this lon...