Book Summary: While much needs to be done in order to minimize the suicide attempts and suicides of adolescents, the work of Stop Youth Suicide (SYS) campaign and the comprehensive grassroots' approach is showing signs of success in the state of Kentucky. The 2013 national Youth Risk Behavior Survey (YRBS) showed that for the first time, indicators of youth suicide in the state are at or below the national average, where they were previously always above. In the three rural counties where the school systems have partnered with SYS and the Division of Adolescent Medicine in Lexington, there is an actual absence of completed suicides compared to the average of three per year prior to this partnership. In order to maintain and improve that statistic, we must ensure that students do not have easy access to weapons, guns and drugs by ensuring that these items are properly stored in homes where children are present. Kentucky's educators must continue to develop ways to provide safe and supportive school environments. In this book, the authors have gathered presentations from the 2017 Annual Stop Youth Suicide Campaign Conference, which we hope will be of interest and help to the readers.

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It is estimated that US children 2 to 18 years of age spend an average of 5.5 hours, daily, using media of all types. 1 During these years, it is estimated they will have viewed over 200,000 acts of violence just on television. 2 In this issue of the Southern Medical Journal, Dr. Robert DuRant and colleagues reported on their findings that an increased frequency of watching professional wrestling on television was associated with an increase in reported date fighting and other violent behaviors, risky sexual behavior, and smoking cigarettes, among a multistate random sample of adolescents aged 16 to 20 years. 3 In this cross-sectional study, 22.4% of males and 13.6% of females reported watching professional wrestling on television during the 2 weeks before the survey. Prior research, including experimental and longitudinal studies, has consistently demonstrated strong associations between exposure to media violence and desensitization to violence, greater acceptance of violence as a means of solving problems, and violent behavior, as well as depression, anxiety, and sleep disturbance. 4

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Background and Objectives: Tennessee has low breastfeeding rates and has identified opportunities for improvement to enhance maternity practices to support breastfeeding mothers. We sought a 10% relative increase in the aggregate Joint Commission measure of breastfeeding exclusivity at discharge (TJC PC-05) by focusing on high-reliability (≥90%) implementation of processes that promote breastfeeding in the delivery setting. Methods: A statewide, multidisciplinary development team reviewed evidence from the WHO-UNICEF “Ten Steps to Successful Breastfeeding” to create a consensus toolkit of process indicators aligned with the Ten Steps. Hospitals submitted monthly TJC PC-05 data for 6 months while studying local implementation of the Ten Steps to identify improvement opportunities, and for an additional 11 months while conducting tests of change to improve Ten Steps implementation using Plan-Do-Study-Act cycles, local process audits, and control charts. Data were aggregated at the state level and presented at 12 monthly webinars, 3 regional learning sessions, and 1 statewide meeting where teams shared their local data and implementation experiences. Results: Thirteen hospitals accounting for 47% of live births in Tennessee submitted data on 31,183 mother–infant dyads from August 1, 2012, to December 31, 2013. Aggregate monthly mean PC-05 demonstrated “special cause” improvement increasing from 37.1% to 41.2%, an 11.1% relative increase. Five hospitals reported implementation of ≥5 of the Ten Steps and two hospitals reported ≥90% reliability on ≥5 of the Ten Steps using locally designed process audits. Conclusion: Using large-scale improvement methodology, a successful statewide collaborative led to >10% relative increase in breastfeeding exclusivity at discharge in participating Tennessee hospitals. Further opportunities for improvement in implementing breastfeeding supportive practices were identified.

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