
Jonathan HowlandBoston University | BU · Department of Emergency Medicine
Jonathan Howland
PhD, MPH, MPA
About
132
Publications
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Introduction
Epidemiological studies of injury risk factors; behavioral intervention trials on traffic injury prevention and a program (Matter of Balance) to reduce older adults’ fear of falling and enhance mobility and psychosocial status; randomized trials on the acute occupational and neurocognitive effects of low-dose alcohol consumption and the residual next-day effects of intoxication; policy evaluation relative to youth sports concussion.
Additional affiliations
Education
September 1984 - September 1986
September 1983 - May 1984
September 1975 - January 1977
Publications
Publications (132)
Primary care and community-based fall prevention
Background
Fall deaths in the USA almost tripled in the twenty-first century. While various interventions have been effective in reducing fall deaths, they have failed to make a substantial impact at a population level.
Main body
An overarching factor that has been relatively neglected in fall injury prevention is the need for more and better data...
Older adult social isolation and loneliness
This cross-sectional study describes knowledge, perceived competence, and behaviors relative to intimate partner violence (IPV)-related brain injury (BI) among staff in residential domestic violence shelter programs across a New England state. A 23-item questionnaire was administered to registrants of an online IPV-related BI training series. Withi...
Evidence-based practices in concussion management (CM) have been codified into legislation. However, legislation is varied, and implementation is narrowly evaluated. School nurses hold a unique position to assess the implementation of health policies. The implementation of concussion management policies across Massachusetts high schools was evaluat...
Although all states have legislation pertaining to youth sports concussion, most of these laws focus on return-to-play procedures; only a few address return-to-learn (RTL) accommodations for students who have experienced a concussion. To address this gap in the legislation, some states and nongovernmental organizations have developed RTL guidelines...
Between 2009 and 2014, all 50 states and the District of Columbia passed legislation to improve the recognition and management of youth concussed in sports. These laws can include requirements for concussion training for school athletic personnel, concussion education for children and their parents, return-to-play (RTP) procedures, and medical clea...
Background:
In 2011 the Massachusetts Department of Public Health issued regulations pursuant to 2010 Massachusetts youth sports concussion legislation that provided policies and procedures for persons engaged in the prevention, training, management, and return-to-activity for students who sustain head injury during interscholastic athletics, incl...
Purpose: There is evidence of socioeconomic disparities with respect to the implementation of student-sports concussion laws nationally. The purpose of this study was to examine school sociodemographic characteristics associated with the provision of computerised baseline neurocognitive testing (BNT) in Massachusetts (MA) high schools, and to asses...
In 2018, the Massachusetts Department of Public Health (MDPH) conducted focus groups with athletic directors (ADs) from Massachusetts middle and high schools to assess the implementation of legislated regulations relative to the management of concussion (mild traumatic brain injuries; mTBI) among students engaged in extracurricular sports. Two tape...
Purpose::
To evaluate the predictive value of pre-fracture medication usage on 30-day mortality following a hip fracture.
Methods::
Information on age, sex, fracture type, time of death and Charlson co-morbidity index (CCI) was collected from the Danish National Patient Registry on all patients above 60 years, sustaining a hip fracture during th...
Appropriate management by schools of all students with a concussion, regardless of the cause, has not received the same attention as sports-related concussions. Focus groups conducted with Massachusetts School Nurses in 2015 found that some had applied protocols required in the state’s sports concussion regulations to all students with concussion,...
Background
Falls are a serious and common problem among older adults. Low-tech, inexpensive, community-based fall prevention programs have been shown to be both effective and cost effective, however, these programs are not well-integrated into clinical practice.
Research design
We surveyed primary care providers at a convenience sample of two acco...
Primary care provider raw survey data.
(XLSX)
Objective
Unintentional injury is the leading cause of death for infants and young children in the USA, and the children of young mothers are at an even higher risk. Mobile health (mHealth) interventions have been successful in promoting behaviour change for many health conditions. This study assessed interest in mSafety, a text and video messaging...
Background:
Falls are a common and debilitating health problem for older adults. Older adults are often treated and discharged home by emergency department (ED)-based providers with the hope they will receive falls prevention resources and referrals from their primary care provider. This descriptive study investigated falls prevention activities,...
Background:
Opioid medication to treat acutely injured patients is usual care in trauma settings. A higher prevalence of alcohol and other substance misuse in this population compared to the general population increases the vulnerability of such patients to both misuse of their prescribed opioids, and also unintentional opioid overdose. The primar...
In 2015, the Massachusetts Department of Public Health conducted focus groups with school nurses (SNs) and athletic trainers (ATs) from Massachusetts middle and high schools to assess implementation of legislated regulations relative to the management of students' head injuries incurred during extracurricular sports. Four tape-recorded focus groups...
Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in co...
The Massachusetts (MA) Department of Public Health engaged the Injury Prevention Center at Boston Medical Center to develop a statewide baseline (2012) inventory of evidence-based (EB) community falls prevention programs for community-dwelling older adults.
A web-based survey of organizations (n = 825) serving older adults was deployed in two parts...
Background:
Falls among older adults are a common and serious public health problem. Evidence-based fall prevention programs delivered in community settings and targeting older adults living independently are increasingly deployed throughout the nation. These programs tend to be offered by public and private organizations that serve older adults,...
Fourteen percent (43.1 million) of the population in the United States was 65 years and older in 2012. This population is projected to reach 20% (88.5 million) by 2050. Older adults accounted for 17% of all traffic fatalities and 9% of all vehicle occupant injuries in 2012. We explored the effectiveness of three interventions to help older adults a...
Statement of purpose The Massachusetts (MA) Department of Public Health engaged the Injury Prevention Centre at Boston Medical Centre to develop a state-wide baseline (2012) inventory of evidence-based (EB) community falls prevention programs for MA older adults living independently.
Methods/Approach A survey of organisations serving older adults w...
Statement of purpose
An average of 41 infants died each year during 2004–2010 in Massachusetts due to sudden unexplained infant death (SUID). Safe sleep practices can reduce SUID risk. Approximately 40% of new mothers in Massachusetts are enrolled in the Women, Infants, and Children (WIC) program. WIC provides a platform for deploying information o...
Non-supine infant sleep positions put infants at risk for sudden unexpected infant death (SUID). Disparities in safe sleep practices are associated with maternal income and race/ethnicity. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a nutrition supplement program for low-income (≤185% Federal Poverty Level) p...
Problematic alcohol use among college students continues to be a prominent concern in the United States, including the growing trend of consuming caffeinated alcoholic beverages (CABs). Epidemiologically, CAB use is associated with incremental risks from drinking, although these relationships could be due to common predisposing factors rather than...
Background/Purpose: Non-supine infant sleep positions increase risk for sudden unexpected infant death (SUID). Disparities in safe sleep practices are associated with maternal income and race/ethnicity. WIC is a nutrition supplement program for low-income (185% Federal poverty line) pregnant and post-partum women and children up to age 5. Currently...
Alcohol use in college-age individuals is associated with increased injury risk. Many college drinkers end up in the emergency department (ED) as a result of their drinking, providing a unique opportunity to intervene.
This systematic review evaluates the existing evidence for the use of brief ED interventions for alcohol use in the college-age pop...
Beliefs about the effects of mixing caffeine and alcohol on hangover or sleep may play a role in motivation to consume these mixtures; therefore, information is needed about actual effects. We investigated whether intoxication with caffeinated vs. non-caffeinated beer differentially affected perceived sleep quality, sleepiness, and hangover inciden...
Objective:
Although hangover results from excessive alcohol consumption, the specific pathways through which hangover symptoms arise have not been elucidated. Research on predictors of hangover sensitivity may provide clues about such mechanisms. The present study investigated whether tobacco smoking on days of heavy drinking affects next-day hang...
Caffeinated alcoholic beverage (CAB) consumption is widespread among young adults in the United States and is associated with increased negative consequences from alcohol. In addition to the direct pharmacological effects of adding caffeine to alcohol, another possible risk mechanism is via socially learned expectancies, which has received very lit...
For ethical and practical reasons, most injury research employs observational study designs or survey research. Experimental studies, however, have made significant contributions to injury research both in terms of assessing injury prevention interventions and identifying injury risk factors. The following reviews experimental designs and some meas...
We investigated falls at a metropolitan airport to determine fall incidence, identify potential causes of these falls, and suggest opportunities for mitigation.
We used deidentified incident reports of all falls requiring EMS response that occurred at the airport during 2009 and 2010.
On average, one fall occurred every 2.3days. Ninety-six percent...
Predicting continued problematic levels of drinking after the early 20's could help with early identification of persons at risk. This study investigated whether hangover insensitivity could predict postcollege drinking and problems beyond the variance due to drinking patterns. In a preliminary study, 134 college seniors from a laboratory study of...
In 1991 there were 4600 drowning fatalities in the United States1including 924 boating deaths.2For reasons that are unclear, drowning fatalities have decreased substantially over recent decades. Nevertheless, drowning
remains the fourth most common cause of unintentional injury death for all ages and third for ages 5-44 yr.1Although the extent of m...
Dr. O'Brien: Thank you all for participating in the inaugural roundtable discussion for Journal of Caffeine Research. Let us begin with the popular perception of caffeine as an “antidote” to alcohol intoxication. The neurochemical relationship between alcohol and caffeine appears to be complex. Alcohol influences the interaction of several neurotra...
Marketing that promotes mixing caffeinated 'energy' drinks with alcoholic beverages (e.g. Red Bull with vodka) targets young drinkers and conveys the expectation that caffeine will offset the sedating effects of alcohol and enhance alertness. Such beliefs could result in unwarranted risk taking (e.g. driving while intoxicated). The aim of this stud...
This study evaluated sex and family history of alcoholism as moderators of subjective ratings of sleepiness/sleep quality and polysomnography (PSG) following alcohol intoxication in healthy, young adults.
Ninety-three healthy adults [mean age 24.4 ± 2.7 years, 59 women, 29 subjects with a positive family history of alcoholism (FH+)] were recruited....
OBJECTIVES: Both hangover and performance deficits have been documented the day after drinking to intoxication after breath alcohol concentration (BrAC) has returned to near zero. But few studies have examined the relationship between hangover and post-intoxication performance. METHOD: We performed secondary analyses of data from a previously repor...
Congeners are minor compounds other than ethanol that occur naturally in alcohol beverages as a result of distilling and fermenting processes. While ethanol itself is the main source of hangover (subjective distress) and other residual effects of alcohol (cognitive and behavioral), the role of the congeners is of interest due to the potential toxic...
Alcohol-induced hangover, defined by a series of symptoms, is the most commonly reported consequence of excessive alcohol consumption. Alcohol hangovers contribute to workplace absenteeism, impaired job performance, reduced productivity, poor academic achievement, and may compromise potentially dangerous daily activities such as driving a car or op...
To assess the effects of binge drinking on students' next-day academic test-taking performance.
A placebo-controlled cross-over design with randomly assigned order of conditions. Participants were randomized to either alcoholic beverage [mean = 0.12 g% breath alcohol concentration (BrAC)] or placebo on the first night and then received the other be...
This study assessed the effects of heavy drinking with high or low congener beverages on next-day neurocognitive performance, and the extent to which these effects were mediated by alcohol-related sleep disturbance or alcoholic beverage congeners, and correlated with the intensity of hangover.
Healthy heavy drinkers age 21 to 33 (n = 95) participat...
While hip protectors are effective in some clinical trials, many, including all in community settings, have been unable to demonstrate effectiveness. This is due partly to differences in the design and analysis. The aim of this report is to develop recommendations for subsequent clinical research.
In November of 2007, the International Hip Protecto...
Hip protectors represent a promising strategy for preventing fall-related hip fractures. However, clinical trials have yielded conflicting results due, in part, to lack of agreement on techniques for measuring and optimizing the biomechanical performance of hip protectors as a prerequisite to clinical trials.
In November 2007, the International Hip...
Objective: To use the Model of Human Occupation as a conceptual framework to assess the contribution falls self-efficacy makes to six measures of occupational adaptation. Methods: Two-hundred and seventy randomly selected senior housing residents, aged ▪62, were interviewed in their homes to collect information on demographics, fall history, fall r...
Hip fracture is a serious and increasing problem for the elderly population. A variety of currently marketed devices are intended to reduce the risk of hip fracture by shunting the force of a fall away from the greater trochantor. While some of these hip protectors have been evaluated, most have not. Moreover, there are no design standards for the...
Transdermal scopolamine is commonly used by mariners to prevent or treat seasickness. Most studies indicate that scopolamine administered transdermally via an adhesive patch does not impair performance of skills required to navigate a vessel, but trials have not been conducted testing navigation and ship handling under realistic conditions. The aim...
To determine the incidence and covariates of hangover following a night of moderate alcohol consumption at a targeted breath alcohol level.
Data were combined from three randomized cross-over trials investigating the effects of heavy drinking on next-day performance. A total of 172 participants received either alcoholic beverage (mean=0.115 g% brea...
To assess the incidence of hangover we: (1) reviewed the experimental and survey literature; (2) performed secondary analyses on two large population surveys; and (3) calculated the incidence of hangover among young adults participating in several randomized trials we conducted on the aftereffects of heavy drinking. Survey data included adults admi...
Background: Residual effects the day after heavy drinking may cause cognitive and physical impairment in functions critical to safety-sensitive occupations. Methods: We conducted a double blind, randomized, placebo-controlled, crossover study of effects of heavy drinking (mean BrAC 0.11 g% 0.01) on next-day sustained attention/reaction time (psycho...
To examine the relationship between alcohol use and the cause, type and severity of hospitalized injuries.
We used the Total Army Injury and Health Outcomes Database (TAIHOD) to conduct cross-sectional analyses of the association between alcohol comorbidity and the cause, type and severity of soldiers' non-combat injuries requiring hospitalization....
No psychometrically established measure of acute hangover symptoms is published and available to use in experimental investigations. The present investigation combined data across three studies of residual alcohol effects to establish the properties of a new Acute Hangover Scale (AHS) based on symptoms supported in previous lab studies.
Professiona...
The effects of an evening of heavy drinking on next-day occupational performance are mixed across studies and have not been investigated for ship-handling performance. Furthermore, it is not known whether the residual effects of alcohol on next-day performance are due to its effects on sleep.
Merchant marine cadets (N=61) who had been trained on a...
Current US federal regulations on occupational alcohol use for safety-sensitive jobs do not account for impairment from low doses of alcohol and next day effects of heavy drinking. Research on the effects of low doses of alcohol on neurocognitive and simulated occupational tasks suggests that the current per se level of these regulations is set too...
The Journal of Safety Research has partnered with the Injury Center at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA, to briefly report on some of the latest findings in the research community. This report is the sixth in a series of CDC articles. This conference on Hip Protector Use was held at Boston University in...
SUMMARY The scholarship of practice stresses that knowledge should arise out of a dialogue and collaboration between scholars and practitioners. Bringing evidence back to practice completes the scholarship of practice cycle. This article describes a strategic approach to the process of knowledge dissemination and utilization and how that approach w...
The authors surveyed a random sample of college seniors at a university in Boston to determine the prevalence of allergy symptoms and the students' use of medications to relieve symptoms. Of the 400 individuals queries, 58.2% reported some symptoms during the previous year, and 63.0% of that group said their symptoms were moderate to severe. Just o...
This article reviews comprehensive community interventions that sought to reduce (1) cardiovascular disease risks; (2) smoking; (3) alcohol use disorders, alcohol-related injury and illicit drug use; or (4) sexual risk taking that could lead to HIV infection, sexually transmitted disease and pregnancy.
Comprehensive community programs typically inv...
To guide the development of an intervention to reduce the incidence of sexually transmitted diseases (STDs) in urban, adolescent girls, we investigated such girls' reasons for deciding to have or not to have sexual intercourse.
Consecutive girls >or=14 years of age attending an urban adolescent clinic were invited to complete an anonymous survey ab...
The US Department of Transportation (DOT) regulates on-the-job alcohol use by operators of certain categories of commercial transport. For aircraft, trains, and commercial vessels, operators are subject to sanctions for having ≥0.04 g% blood alcohol concentration (BAC). This study examines the effects of alcohol (between 0.04 and 0.05 g% BAC) on si...
In 1997, unintentional injury was the leading cause of death for persons aged 1 to 34 years. Approximately one third of deaths due to unintentional injury in the United States are estimated to be alcohol related. Onset of drinking at an early age has been found to be associated with alcohol dependence, but whether early-onset drinking increases ris...
Under current US Department of Transportation (DOT) regulations, some commercial vehicle operators are subject to sanctions for having > or = 00.04 g% blood alcohol concentrations (BACs) on the job. This study investigated the effects of alcohol (between 0.04 and 0.05 g% BAC) on the simulated operation of a commercial ship's power plant.
A balanced...
Identify associations between lack of formal boater training, drinking and boating, and other unsafe boating practices.
A telephone survey queried respondents (age 16 or older in continental United States) about boating experience, type of boat used, and training.
Of the 3,042 boaters surveyed (70% response), most had no formal training (73%). Boat...
AIMS: Under current U.S. Department of Transportation (DOT) regulations, some commercial vehicle operators are subject to sanctions for having .04 gm% blood alcohol concentrations (BACs) on the job. This study investigated the effects of alcohol (between .04 and .05 gm% BAC) on the simulated operation of a commercial ship's power plant. DESIGN: A...
AIMS: Under current U.S. Department of Transportation (DOT) regulations, some commercial vehicle operators are subject to sanctions for having .04 gm% blood alcohol concentrations (BACs) on the job. This study investigated the effects of alcohol (between .04 and .05 gm% BAC) on the simulated operation of a commercial ship's power plant. DESIGN: A...
Over the past
quarter century, fatality rates in many unintentional injury categories
have declined dramatically, both in the United States and in other
industrialized countries.1 The largest decline in number of
deaths has been from unintentional drownings, which declined from 5700
in 1986 to 3959 in 1996.1- 2 In contrast to other injuries,
the ca...
The purpose of this study was to examine the independent effects of a variety of drinking indicators on self-reported work performance.
Data from a cross-sectional mailed survey (response rate = 71%) of managers, supervisors and workers (N = 6,540) at 16 worksites were analyzed. Average daily volume was computed from frequency and usual quantity re...
To test the hypothesis that changes in the minimum legal drinking age (MLDA) laws would affect drowning among adolescents, the effects of changes in state MLDA laws on drowning were examined for the targeted (18-20 years) and two adjacent (15-17 years and 21-23 years) age groups, over a period of 21 years (1970-90).
Poisson maximum likelihood regre...