Rebecca M Cunningham

Rebecca M Cunningham
University of Michigan | U-M · Department of Emergency Medicine

MD

About

324
Publications
26,327
Reads
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7,225
Citations
Citations since 2016
155 Research Items
5086 Citations
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Additional affiliations
January 2005 - December 2012
University of Michigan

Publications

Publications (324)
Article
Researchers have documented that vacant lot greening can reduce community-level crime and violence. Busy Streets Theory (BST) suggests that residents who are involved in the greening process can help to improve physical environments and build social connections that deter crime and violence. Yet few researchers have explored how community engagemen...
Article
Firearm possession increases the likelihood of hospital visits among adolescents and emerging adults. To better inform prevention practices, we examine data among adolescents and emerging adults (A/EAs; ages 16 to 29) presenting to an urban emergency department for any reason to understand the differences in firearm possession between males and fem...
Article
This Viewpoint argues that academic medical centers should address firearm violence through clinical care, education of health care professionals, research, and public policy discussions.
Article
Full-text available
Purpose In addition to firearm-related intimate partner homicides, approximately 4.5 million adults in the US are threatened or harmed with a firearm by their intimate partner. It is unknown how many children are exposed to firearm-related IPV specifically, but an estimated 8–15 million children are exposed to parental IPV each year in the US. We s...
Article
Firearms are the leading cause of death for high-school age teens. To inform prevention efforts, we characterize the prevalence of healthcare provider (HCP) counseling of caregivers of teens around firearm safety, safety conversation elements, and caregiver receptivity towards counseling. A cross-sectional web survey (6/24/2020–7/22/2020) was condu...
Article
Firearm injury is a significant public health concern among youth living in the United States. Youth with exposure to violence (ETV) are more susceptible to carrying and using a firearm. Few researchers, however, have examined psychological mechanisms undergirding the association between ETV and firearm aggression. Retaliatory attitudes have been d...
Conference Paper
Statement of Purpose The purpose of this study is to determine the association between prior exposure to violence and violent victimization has on firearm carriage among parents. In order to examine this association, the research question examined in this study is, what is the role of exposure to violence and prior victimization on firearm ownershi...
Conference Paper
Statement of Purpose Firearms are the leading cause of death for high-school aged youth, with firearm access the most significant risk factor for adolescent firearm injury. Parental rules regarding teen firearm access have not been previously characterized. We estimate prevalence of firearm safety/access rules among parents of high-school age teens...
Conference Paper
Researchers have reported that improving the condition of vacant lots through greening (e.g. remediation, mowing, landscaping) can help to reduce fear of crime and violence. Busy Streets Theory (BST) suggests that residents who are involved in neighborhood improvement can help to establish orderly physical environments and social connections that c...
Conference Paper
Violence affects people across the lifespan with significant short- and long-term consequences for individuals, communities and society at large. Neighborhood environments play an important role in health and safety outcomes with a demonstrated relationship between some of the poorest socioeconomic conditions and greatest disparities. The purpose o...
Article
Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for older adult populations. To inform prevention efforts, we conducted a probability-based web survey (12/1/2019–12/23/2019) of 2048 older adults (age 50–80) to characterize national estimates of firearm ownership, safety practices, and attitudes about health...
Article
Objective: Simultaneous alcohol and nonmedical prescription drug use (NMPDU) increases acute risks (e.g., overdose) associated with each; understanding social, substance use, and mental health predictors of same-day use may suggest intervention targets. Method: At an urban emergency department, research assistants recruited youth ages 14-24 repo...
Article
Full-text available
Background A pediatric injury prevention course has not been available as a massive open online course (MOOC). Creating a comprehensive topic course is particularly challenging because the traditional, week-by-week linear curriculum design is often a barrier to learners interested in only specific topics. We created a novel, flexible course as both...
Article
Full-text available
The objective of this study was to assess parents’ firearm storage behaviors during the COVID-19 pandemic and characterize reasons why some parents made their firearms more accessible during this time. In June-July 2020, the study team conducted the FACTS National Survey—a cross-sectional, web-based, survey of 2,924 parents and their teens (ages14–...
Article
Firearms are the leading cause of death among young adults. Given community violence is an important correlate of youth firearm carriage, we evaluated: 1) If the association between perceived community violence and firearm carriage is stronger when perceived police bias is greater; and 2) If this moderated association differs by race. Cross-section...
Article
The classical two-arm randomized clinical trial (RCT) is designed to test the efficacy or effectiveness of an intervention, which may consist of one or more components. However, this approach does not enable the investigator to obtain information that is important in intervention development, such as which individual components of the intervention...
Article
Background and objectives Youth violence is an alarming public health problem, yet, violence screening and interventions are not systematically offered in primary care (PC). This paper describes data from a pilot effectiveness-implementation trial of an efficacious youth violence prevention programme (SafERteens). Methods The study was conducted i...
Article
Background: Youth violence is a leading cause of adolescent mortality, underscoring the need to integrate evidence-based violence prevention programs into routine emergency department (ED) care. Objectives: To examine the translation of the SafERteens program into clinical care. Methods: Hospital staff provided input on implementation facilita...
Chapter
Firearm injury is a significant public health problem in the United States. Almost 40,000 people died and 134,000 were injured in the United States in 2017. Two-thirds of U.S. firearm deaths in 2017 were suicides, just as in every year in the last decade. Although the majority of firearm deaths are White men, the epidemic disproportionately affects...
Article
Unmaintained vacant land in urban areas is associated with a number of negative outcomes for residents of urban areas, including mental and physical health, safety, and quality of life. Community programs which promote land parcel maintenance in urban neighborhoods have been found to reverse some of the effects that unmaintained land has on nearby...
Article
To describe and identify the correlates of firearm purchasing at the beginning of the COVID-19 pandemic among US families with teenagers. In June–July 2020, we conducted a national survey of 2924 parents and their teenagers in the US. We report results from this survey to describe firearm purchasing behaviors following the start of the COVID-19 pan...
Article
Objective: Cannabis use is broadly associated with risky sexual behaviors, but evidence regarding how cannabis is related to condomless sex at the individual level is mixed. A better understanding of the context in which cannabis use is occurring, that is, why individuals are using cannabis on a particular day, could help clarify these relationshi...
Article
Same-day alcohol and cannabis use is relatively common in adolescents and young adults, constituting a higher-risk behavior relative to single-substance use. However, the association between quantity of alcohol and cannabis use on co-use days is understudied. We examined the association between the quantity of alcohol and same-day cannabis use with...
Article
The main purpose of this article and this special section is to encourage greater attention to the key gaps that exist in our understanding of the epidemiology of adolescent firearm violence and to provide a pathway forward for future longitudinal research that will inform prevention efforts. This increased attention is especially salient given: (a...
Article
Research Summary We examined petition and respondent characteristics from extreme risk protection order (ERPO) cases in Oregon for the 15 months after implementation (n = 93). Most petitions were filed by law enforcement (65%) a were more likely to be granted than petitions filed by family/household members (p < 0.001). Most ERPO respondents were r...
Chapter
Firearm injuries are the second leading cause of child and adolescent death in the United States, with homicides currently responsible for 1915, or nearly 60%, of all firearm deaths occurring in the pediatric population. Rates of pediatric firearm homicide have increased over 20% in the past 4 years, and significant disparities persist with regard...
Article
Background The distinction between within- and between-person associations with drug use disorder (DUD) has implications for intervention targets and content. We used longitudinal data from youth entering an urban emergency department (ED) to identify factors related to changes in DUD diagnosis, with particular emphasis on alcohol use. Methods Res...
Article
Purpose There are few efficacious prevention interventions for emerging adults (ages 18-25) drug use and concomitant risks (e.g., sexual risk behaviors). We developed and evaluated the feasibility and acceptability of an Emergency Department (ED)-initiated brief intervention (BI) combined with booster messaging as a clinician-extender primarily foc...
Article
Community rapid response may reduce opioid overdose harms, but is hindered by the lack of timely data. To address this need, we created and evaluated the Michigan system for opioid overdose surveillance (SOS). SOS integrates suspected fatal overdose data from Medical Examiners (MEs), and suspected non-fatal overdoses (proxied by naloxone administra...
Preprint
BACKGROUND Effective, acceptable programs to reduce consequences of cyberbullying are needed. OBJECTIVE This study used “Agile” qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyber-harassment and cyberbullying vic...
Article
Background Cybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking. Objective This study uses agile qualitative methods to refine and...
Article
More than 652 000 people in the US died from firearm injuries between 1999 and 2018.¹ Given that firearms are embedded within US culture (in 2018, 21.9% of individuals owned a firearm and 35.2% lived in households with firearms²) evidence-based public health measures and policies that enhance firearm safety are needed. Firearm injuries are multifac...
Article
Objectives: To evaluate motivations for firearm possession among urban young adults and determine if differences emerge between parents and non-parents, and to identify if storage practices differed according to motivation for firearm possession and parenting status. Methods: We used cross-sectional data among young adults seeking urban emergenc...
Article
Objective Same day use of alcohol and cannabis is prevalent among emerging/young adults and increases the risk for negative consequences. Although motives for alcohol and cannabis use are well-documented, specific motives on co-use days are under-investigated. We examined differences in motives on single substance use (i.e. alcohol or cannabis) ver...
Article
Introduction: Prescription opioid use and driving is a public health concern given the risks associated with drugged driving, but the issue remains under-studied. We examined the prevalence and correlates of driving after taking prescription opioids (DAPO) among adults seeking emergency department (ED) treatment. Methods: Participants (aged 25-6...
Article
Introduction Exposure to violence is a risk factor for firearm carriage. Youth exposed to violence also have difficulty envisioning positive future outcomes (e.g., educational outcomes), which can increase the likelihood of firearm carriage over time. Researchers, however, have not yet examined whether changes in exposure to violence over time can...
Article
Objective This study examined the association between baseline substance use and mental health, and non-partner violence trajectories among youth presenting to an urban emergency department who screened positive for drug use. Non-partner violence is physically violent victimization or aggression involving someone other than a dating partner. Metho...
Article
Objective: Preventing sexual violence among college students is a public health priority. This paper was catalyzed by a summit convened in 2018 to review the state of the science on campus sexual violence prevention. We summarize key risk and vulnerability factors and campus-based interventions, and provide directions for future research pertaining...
Article
Introduction Youth who carry firearms—and peers that surround them—are at increased risk for violent injuries. Because firearm carriage behaviors can change over time within an individual, it is important to identify individual and social-contextual determinants that explain this within-person variability in carriage. Methods The authors identifie...
Conference Paper
Statement-of-Purpose Firearm violence is a leading cause of U.S. mortality. Intensive longitudinal daily data studies [ILDDS] have not examined firearm carriage or same-day/next-day predictors of carriage or violent conflict. Such data are necessary to inform violence interventions. Methods/Approach ED youth/young adults (age=16–29) screening posi...
Conference Paper
Statement-of-Purpose Despite a 30% reduction nationwide in new opioid prescriptions since 2012, prescription opioid overprescribing, as well as opioid misuse and overdose remain significant U.S. public health issues. To address a deficit in educational resources/tools for clinical providers and their patients, the Injury Prevention Center (UM-IPC),...
Conference Paper
Statement of Purpose Youth violence is a leading cause of morbidity and mortality. Adolescent primary care visits provide an opportunity for violence screening and delivery of interventions, which are not typically offered in this setting. Thus, we examined implementation of an evidenced-based behavioral intervention (SafeERteens) in primary care....
Article
Intervention effects observed in efficacy trials are rarely seen when programs are broadly disseminated, underscoring the need to better understand factors influencing fidelity. The Michigan Model for Health™ (MMH) is an evidence-based health curriculum disseminated in schools throughout Michigan that is widely adopted but delivered with limited fi...
Preprint
Full-text available
Mobile health (mHealth) applications are a powerful medium for providing behavioral interventions, and systematic reviews suggest that theory-based interventions are more effective. However, how exactly theoretical concepts should be translated into features of technological interventions is often not clear. There is a gulf between the abstract nat...
Article
BACKGROUND The Michigan Model for Health™ (MMH) is the official health curriculum for the State of Michigan and prevailing policy and practice has encouraged its adoption. Delivering evidence‐based programs such as MMH with fidelity is essential to program effectiveness. Yet, most schools do meet state‐designated fidelity requirements for implement...
Article
Full-text available
The U.S. opioid epidemic is a critical public health problem. As substance use and misuse typically begin in adolescence and emerging adulthood, there is a critical need for prevention efforts for this key developmental period to disrupt opioid misuse trajectories, reducing morbidity and mortality [e.g., overdose, development of opioid use disorder...
Article
Full-text available
Background: Precipitants of alcohol use transitions can differ from generalized risk factors. We extend prior research by predicting transitions in alcohol use disorder (AUD) during adolescence and emerging adulthood. Methods: From 12/2009-9/2011, research assistants recruited 599 drug-using youth age 14-24 from Level-1 Emergency Department in F...
Article
Objective: To inform development of cyberbullying interventions that are both accurate and meaningful to all adolescents, this qualitative analysis examines experiences of online peer victimization among a sample of predominately minority and low-income youth. Methods: Adolescents ages 13-17 years who reported past-year cyberbullying on a previo...
Article
The debate about whether measurement reactivity exists in daily diary research on substance use is still unsettled due to the issues of study design and statistical methodology. This study proposes a time-varying effect model (TVEM) that characterizes the trajectory of substance use behaviors with nonparametric functions determined by the data rath...
Article
Firearm violence is a leading cause of death for urban adolescents and young adults (A/YAs). Little is known about patterns of risky firearm behaviors (RFBs) that may increase firearm-related fatality and non-fatal injury risk. To inform prevention efforts, we examined the rates and correlates of RFBs, including firearm carriage in risky situations...
Article
What's New Pediatric residents report lack of confidence in providing firearm safety anticipatory guidance. A self-paced online curriculum, including video demonstration of firearms, safe storage options, and counseling methods for families improved resident self-efficacy, confidence, and knowledge surrounding firearm injury prevention counseling.
Article
Full-text available
Background: Despite intervention efforts to date, the prevalence of risky drinking among adolescents and emerging adults remains high, increasing the risk for health consequences and the development of alcohol use disorders. Peer influences are particularly salient among this age group, including via social media. Thus, the development of efficaci...
Preprint
BACKGROUND Despite intervention efforts to date, the prevalence of risky drinking among adolescents and emerging adults remains high, increasing the risk for health consequences and the development of alcohol use disorders. Peer influences are particularly salient among this age group, including via social media. Thus, the development of efficaciou...
Article
Full-text available
The original version of the article unfortunately contained a typo in the last author name. The author name was incorrectly listed as Mark Zimmerman. The correct name should be Marc A. Zimmerman.
Article
Firearm injuries are the second-leading cause of death for US children and adolescents (ages 1-18). This analysis quantified the federal dollars granted to research for the leading US causes of death for this age group in 2008-17. Several federal data sources were queried. On average, in the study period, $88 million per year was granted to researc...
Article
Nationwide firearm-related mortality rates increased in 2015-17 after remaining relatively stable in 1999-2014. Recent increases are reflected across most states and demographics to varying degrees, which suggests a worsening epidemic of firearm mortality that is geographically and demographically broad. In both time periods the fractions of firear...
Article
Background: The psychosocial correlates and longitudinal trajectories of driving after drinking (DAD) among youth remain understudied in at-risk populations. Objectives: We investigated the relationships of DAD trajectories and negative peer and parental influences, substance use, and mental health among predominantly marijuana-using youth seeking...
Article
Objective: Interpersonal violence is a significant public health problem, with substance use a key risk factor. Intensive longitudinal methods (ILMs) provide data on daily patterns/relationships between substance use and violence, informing prevention. Prior daily research has not focused on these relationships among urban minority samples. Metho...
Article
Full-text available
The long-term consequences of exposure to firearm injury—including suicide, assault, and mass shootings—on children’s mental and physical health is unknown. Using PRISMA-ScR guidelines, we conducted a scoping review of four databases (PubMed, Scopus, PsychINFO, and CJ abstract) between January 1, 1985 and April 2, 2018 for articles describing long-...
Article
Full-text available
Intentional and unintentional firearm injury is the second leading cause of death for youth, underscoring the need for effective primary prevention approaches that focus on increasing safe storage by caregivers and decreasing handling/carriage among youth. This article describes the state of the science for prevention of firearm injuries among chil...
Article
Full-text available
Risk and protective factors for firearm assault (FA) have been established, but little is known about factor preceding transitions in FA behavior. We modeled covariate effects on individuals’ transitions in FA behavior (Yes/No) using inhomogeneous, continuous-time, Markov Chains. 3287 assessments were made across five initial biannual follow-ups, a...
Article
Full-text available
Five teams of FACTS researchers conducted a series of rigorous scoping reviews of the existing published scientific literature from the fields of medicine, public health, psychology, behavioral health, and criminology from January of 1985 through April of 2018 utilizing the Preferred Reporting Items for Scoping Reviews (Tricco et al., Ann Intern Me...
Article
Full-text available
We conducted a scoping review to determine the current state of knowledge and areas for advancements in research on the association of firearm laws with child and adolescent firearm-related outcomes. We queried Scopus, EMBASE, Pubmed, and CJ Abstracts for English language original empirical research articles on policies affecting child and adolesce...
Article
Objective: This study describes the prevalence of eating disorders among adult patients who present to the emergency department for medical care and examines the relationship between eating disorders, depression, and substance use disorders. Method: Emergency department patients aged 21-65 years (n = 1,795) completed a computerized questionnaire...
Article
Full-text available
Importance Firearm injuries are the second leading cause of death among US children and adolescents. Because of the lack of resources allocated to firearm injury prevention during the past 25 years, research has lagged behind other areas of injury prevention. Identifying timely and important research questions regarding firearm injury prevention is...
Conference Paper
Research Objective: Appropriate surveillance indicators for opioid overdose are critical to accurately quantifying the opioid epidemic’s scope and severity. Naloxone administration by emergency medical services has been proposed as a measure for opioid-related overdose counts. However, the sensitivity and positive predictive value of naloxone as an...