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Efficacy of a Minnesota Statute Enacted to Reduce Inflicted Traumatic Brain Injuries Jonathan K

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Efficacy of a Minnesota Statute Enacted to Reduce Inflicted Traumatic Brain Injuries Jonathan K Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2019 Efficacy of a Minnesota Statute Enacted to Reduce Inflicted Traumatic Brain Injuries Jonathan K. James Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Epidemiology Commons, and the Public Health Education and Promotion Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Jonathan K. James has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Raymond Panas, Committee Chairperson, Public Health Faculty Dr. Larissa Estes, Committee Member, Public Health Faculty Dr. Scott McDoniel, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2019 Abstract Efficacy of a Minnesota Statute Enacted to Reduce Inflicted Traumatic Brain Injuries by Jonathan K. James MPH, Walden University, 2013 BA, University of Minnesota, 1997 Submitted in Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health - Epidemiology Walden University February 2019 Abstract This quantitative research is on the efficacy of Minnesota Statute 144.574 enacted in 2005 in response to the growing awareness of behavior leading to inflicted Traumatic Brain Injuries (iTBI) in infants and children. The model for this research is grounded in the Theory of Reasoned Action wherein the education of new parents which graphically explains physiologic changes to the structural architecture of the brain post-trauma, paired with their signature on a social contract (SC), demonstrated a reduction in incidence. Because the enacted statute does not include the signing of a SC, nor does it require face-to-face education as in the model, Statute 144.574 cannot claim to be completely grounded in medical science. The result is that neither legislators nor the medical and public health community know whether the statute is effective. This research explored the difference in the incidence pre-and post-enactment, in rural vs. urban communities, the proportion of incidence and ethnicity, and an ordinal shift in the distribution of severity. All births in Minnesota from 1998 through 2017 were included. Cases defined using International Classification of Disease were extracted from the brain and spinal cord injury, hospital discharge, and vital statistics, secondary databases. A Z-test was employed to compare the incidence in a control cohort born prior to enactment to the incidence in an interventional cohort born post-enactment. Results suggest the statute has not resulted in lowering incidence, have uncovered an unanticipated statistically significant increase in rural vs. urban incidence, yet point to a trend in favor of less severe iTBI. These results represent a positive social change grounded in society’s imperative and social justice of protecting children by informing public health officials, caregivers, and legislators of the need for meaningful reform and strengthening of programs leading to lowering the incidence of iTBI in children in Minnesota. Efficacy of a Minnesota Statute Enacted to Reduce Inflicted Traumatic Brain Injuries by Jonathan K. James MPH, Walden University, 2013 BA, University of Minnesota, 1997 Submitted in Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health - Epidemiology Walden University February 2019 Dedication I dedicate my research to my parents from whom I absorbed a curiosity about the world. My father is a polymath who appreciates theology and science as complementary. My mother was a nurse. This work is in keeping with their urgency to improve the lives of others. I dedicate the construction and gears of logic herein with appreciation for my brother Theodore who has disassembled almost everything to examine how it works. With the noted exception of grandpa’s pocket watch, he is able reassemble everything as well. To my brother Stewart who continues challenged me to improve my writing through thoughtful feedback, this research project is grounded in issues of social justice. And, I dedicate the journey and completed dissertation to my wife Carla who continues to support my love of learning. Acknowledgments I wish to acknowledge O. Douglas Wangensteen, Ph.D., my Honors Physiology Professor at the University of Minnesota. Dr. Wangensteen offered me space in his lab to perform research and in those three years taught me scientific methods. Dr. Wangensteen was Chair of the University of Minnesota Medical School Admissions committee, yet during many early morning conversations inspired me to choose research and Public Health as my path. This research project was launched with the support and encouragement of Jon Roesler, Epidemiologist and Director at the Minnesota Department of Health. It was in conversations with Jon Roesler that I began to focus on injuries specifically to the brain. Jon handed me the baton and encouraged me to pursue evaluative research on the efficacy of public health policy to lower the incidence of brain injuries as a primary risk to health. It is with most sincere gratitude I acknowledge my dissertation committee, Dr. Estes, Dr. McDoniel, and especially my Chair Dr. Raymond Panas, who is both an advocate and a mentor. Without the guidance of Dr. Panas this research project would have remained in the idea stage. And, I acknowledge Walden University as an institution that encourages scholars to apply what is learned, to make a positive contribution, and seek social justice. Table of Contents Chapter 1: Introduction to the Study ....................................................................................1 Symptoms of Brain Injury .............................................................................................2 Costs Associated with Traumatic Brain Injuries ...........................................................6 Minnesota Statue 144.574 ..............................................................................................6 Provenance of the Statute in Medical Research .............................................................9 Publicity and Changing Public Attitudes .....................................................................11 Purpose of this Study ...................................................................................................14 Conceptual Framework ................................................................................................15 Untangling Terminology ..............................................................................................16 Social Change ..............................................................................................................17 Summary ......................................................................................................................19 Chapter 2: Literature Review .............................................................................................21 Introduction ..................................................................................................................21 Key Literature ..............................................................................................................22 Historical Legal Authority of Statutes Protecting the Child ........................................34 Summary ......................................................................................................................41 Chapter 3: Research Methodology .....................................................................................44 Introduction ..................................................................................................................44 Research Design and Rationale ...................................................................................45 Methodology ................................................................................................................49 Sources of Data ............................................................................................................52 i Data Analysis ...............................................................................................................57 Statistical Analysis Software (SAS) Code ...................................................................61 Threats to Validity .......................................................................................................62 Ethical Considerations .................................................................................................65 Summary ......................................................................................................................66 Chapter 4: Results ..............................................................................................................67 Introduction ..................................................................................................................67 Population Data ............................................................................................................68
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