This career development proposal is designed to prepare the candidate, currently an Assistant Professor of Social Medicine and Pediatrics, to be an independent clinician-scientist in the area of child abuse research. The applicant has worked closely with Dr. Desmond Runyan - a leader in child abuse research - as her primary sponsor, and has identified Dr. Stephen Hooper as a co-sponsor because of his expertise in neuro-developmental assessment. The training portion of this grant includes supervised work with both sponsors as well as formal courses in epidemiology, the biological basis of childhood exceptionalities, the selection and theoretical background of measurement tools used for pediatric outcome assessment, and responsible conduct of research. This application also benefits from the collaboration, research infrastructure, and supplemental funding of the CDC-sponsored UNC Injury Prevention Research Center, mentors in ethics within Social Medicine, and statewide public health resources including the Office of the Chief Medical Examiner and the State Center for Vital Statistics. The research component is a prospective, longitudinal study of a statewide population of children under age 2 years who have suffered any type of non-penetrating traumatic brain injury (TBI) that is serious enough to warrant observation in an intensive care unit. It is unique in that it will provide the first population based data of inflicted TBI (iTBI) in the United States. The series of proposed studies build on data already collected in a CDC-sponsored study (C. Runyan), linkages with public health data, and data unique to this application that will be gathered by telephone at one and two year follow-up from the injury, and by home visits after the child's third birthday. Study 1 will determine incidence and case fatality rates of non-iTBI and iTBI, as well as compare patterns of injury and initial clinical presentation between the two groups. Study 2 will utilize follow-up calls to the cohort to determine intermediate functional outcomes and non-biologic data about the post-injury family. A model of how non-biologic factors mediate cohort outcomes will be explored. Study 3 will utilize home visits to determine differences in developmental cognitive and behavioral outcomes between children with inflicted and non-inflicted TBI, using standardized neuropsychological tests. Further information will be collected on the child's family including indices of coping and family functioning. The hypothesis is that children with inflicted TBI will fare more poorly than children with non-inflicted TBI partially due to the injury type, and partially due to the post-injury family environment. Preliminary data on a model which encompasses these three studies will be developed. Finally, Study 4 will describe the initial and longitudinal social and legal ramifications for children with iTBI. In addition to publications, data from this mentored research will be used to develop additional, independent research awards.
