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Flynn-O'Brien KT, Sathya C, Kotagal M, Banks S, Agoubi LL, Kuhls DA, Nathens A, Hink AB, Rivara FP. Preinjury and Event-Related Characteristics of Pediatric Firearm Injuries: The American College of Surgeons Firearm Study, United States, March 2021‒February 2022. Am J Public Health 2024:e1-e13. [PMID: 39146518 DOI: 10.2105/ajph.2024.307754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Objectives. To assess differences in contextual factors by intent among pediatric firearm injury patients and determine factors associated with data missingness. Methods. We retrospectively queried the American College of Surgeons Firearm Study database (March 1, 2021-February 28, 2022) for patients aged 18 years or younger. We stratified preinjury, firearm-related, and event-related factors by intent and compared them by using Fisher exact, χ2, or 1-way analysis of variance testing. Secondary analysis estimated the adjusted odds of missingness by using generalized linear modeling with binominal logit link. Results. Among 17 395 patients, 2974 (17.1%) were aged 18 years or younger; 1966 (66.1%) were injured by assault, 579 (19.5%) unintentionally, and 76 (2.6%) by self-inflicted means. Most contextual factors differed by intent, including proportion of youths with previous adverse childhood experiences, mental illness, and violent assaults or injury, firearm type and access, perpetrator relationship, and injury location. In adjusted analyses, age, trauma center designation, intent, and admission status were associated with missingness. Conclusions. Contextual factors related to pediatric firearm injury vary by intent. Specific predictors associated with missingness may inform improved future data collection. Public Health Implications. Contextual factors related to pediatric firearm injury can be obtained in a systematic manner nationally to inform targeted interventions. (Am J Public Health. Published online ahead of print August 15, 2024:e1-e13. https://doi.org/10.2105/AJPH.2024.307754).
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Affiliation(s)
- Katherine T Flynn-O'Brien
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Chethan Sathya
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Meera Kotagal
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Samantha Banks
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Lauren L Agoubi
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Deborah A Kuhls
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Avery Nathens
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Ashley B Hink
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
| | - Frederick P Rivara
- Katherine T. Flynn-O'Brien is with the Department of Surgery, Medical College of Wisconsin, Milwaukee. Chethan Sathya is with the Division of Pediatric Surgery, Cohen Children's Medical Center, New Hyde Park, NY. Meera Kotagal is with the Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Samantha Banks is with the Firearm Injury and Policy Research Program, University of Washington, Seattle. Lauren L. Agoubi is with the Department of Surgery, University of Washington, Seattle. Deborah A. Kuhls is with the Department of Surgery, Kirk Kerkorian School of Medicine, Las Vegas, NV. Avery Nathens is with Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. Ashley B. Hink is with the Department of Surgery, Medical University of South Carolina, Charleston. Frederick P. Rivara is with the Departments of Pediatrics and Epidemiology, University of Washington, Seattle
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Cina A, Tarozzi I, Arunkumar P, Gitto L. Firearm Fatalities in the Pediatric Population: A Retrospective Study From the Cook County Medical Examiner's Office. Am J Forensic Med Pathol 2024:00000433-990000000-00212. [PMID: 39133144 DOI: 10.1097/paf.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
ABSTRACT Gunshot injuries are one of the leading causes of death from trauma in the United States. In recent years, the US has experienced an increasing number of fatal pediatric cases related to firearms.A search of the database of the Cook County Medical Examiner's Office over the period January 2016-December 2021 revealed 418 deaths by gunshot wounds (GSWs) among people aged between 0 and 18 years old. Subjects were subcategorized in infants (0 to 1 year), toddlers (≥1 to 3 years), preschool (≥3 to 6 years), preadolescents (≥6 to 12 years), and adolescents (≥12 to 18 years).Most victims were males (n = 374) and adolescents (357 males and 30 females). Homicide (n = 373) was the most common manner of death. Only 2 deaths were accidental. Single GSWs deaths (n = 232) were more common than multiple GSWs (n = 186) and preferentially directed to the head in both homicides and suicides. Gang or robbery related events in areas of readily available firearms explained 4.5% of homicides (17 out of 373 cases). Among deaths by self-inflicted GSWs (n = 36), 7 cases were linked to psychiatric disorders, 3 to family difficulties, 2 to history of playing Russian roulette, and 2 to bullying at school.Pediatric gunshot injuries and deaths are an important public health problem. Understanding and addressing individual and societal risk factors should be the first step toward prevention.
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Affiliation(s)
- Alexandra Cina
- From the Albert Einstein Medical Center, Philadelphia, PA
| | - Ilaria Tarozzi
- Modena Local Health Agency, Legal Medicine and Risk Management Department, Modena, Italy
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Christensen JT, Jones MS, Hoffmann JP. Bullying Victimization and Youth's Likelihood of Carrying a Handgun. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241270006. [PMID: 39126167 DOI: 10.1177/08862605241270006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
Recent research suggests that bullying victimization increases the risk of handgun carrying among adolescents. Yet, little to no research has considered whether different types of bullying victimization (i.e., physical, verbal, cyber) shape handgun-carrying behaviors among youth. Understanding these relationships can, however, inform intervention efforts addressing youths' access to and motives for carrying handguns. The purposes of this study are twofold. First, we establish whether there is a relationship between bullying victimization and youth handgun carrying. Second, we seek to determine whether certain types of bullying victimization are associated more strongly with handgun carrying than others, using data from the 2022 Florida Youth Substance Abuse Survey (FYSAS, n = 47,572), a statewide representative sample of Florida middle school and high school students. The results from multinomial regression models indicate that physical bullying and cyberbullying victimization were associated with an elevated risk of carrying a handgun in the past 12 months. Interventions that underscore the importance of comprehensive anti-bullying interventions that not only address traditional physical aggression among adolescents but also mitigate the evolving challenges posed by unsupervised digital spaces may reduce the risk of handgun carrying.
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Tomas CW, Timmer-Murillo S, Kallies KJ, Snowden AJ, Borisy-Rudin F, Busalacchi M, Mackenzie R, Kostelac CA, Cassidy LD, deRoon-Cassini TA. Examining the role of social vulnerability, neighborhood characteristics, and geospatial patterns of firearm-related injuries and clinical outcomes in Milwaukee county. Soc Sci Med 2024; 352:117035. [PMID: 38850675 DOI: 10.1016/j.socscimed.2024.117035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/17/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Previous work has shown socioenvironmental factors can influence firearm injury. Milwaukee County, Wisconsin is a diverse midwestern county with historic disinvestment in marginalized communities yielding stark segregation along racial and ethnic lines. It is also one of the many U.S. counties burdened by surging firearm injuries. The differences among communities within Milwaukee County provides a unique opportunity to explore the intersection of socioenvironmental factors that may affect clinical outcomes and geospatial patterns of firearm injury. METHODS The trauma registry from the regional adult level 1 trauma center was queried for patients who sustained a firearm-related injury from 2015 to 2022 (N = 2402). The Social Vulnerability Index (SVI) ranking was derived using patient residence addresses to evaluate its association with traumatic injury clinical outcomes (i.e., in-hospital mortality, length of hospital stay, ICU or ventilator treatment, or injury severity score) and risk screening results for alcohol use disorder (AUD), posttraumatic stress disorder (PTSD), and depression. We evaluated hotspots of firearm injury density over time for patient residences and injury locations and distances between locations. A spatially lagged regression model tested the association between firearm injury density and SVI domains, alcohol outlet types, and park coverage. RESULTS Most firearm injury patients were younger, male, racial or ethnic minorities from disadvantaged neighborhoods (SVI total; M = 0.86, SD = 0.15). SVI was not associated with any clinical outcomes. Of those screened, 12.9% screened positive for AUD and 44.5% screened at risk for PTSD, depression, or both. Hotspot analysis indicated consistent concentrations of firearm injury density. There were no differences in clinical outcomes between those injured inside or outside the home. Census tracts with lower socioeconomic status, greater off-premises and lower on-premises alcohol outlet density were associated with greater firearm injury density. CONCLUSIONS In Milwaukee County, firearm injury patients are injured in and often return to the same disadvantaged neighborhoods that may hamper recovery. Results replicate and expand previous work and implicate specific socioenvironmental factors for intervention and prevention of firearm injury.
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Affiliation(s)
- C W Tomas
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, USA; Comprehensive Injury Center, Medical College of Wisconsin, USA.
| | - S Timmer-Murillo
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, USA
| | - K J Kallies
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, USA
| | - A J Snowden
- Department of Social and Cultural Sciences, Marquette University, USA
| | - F Borisy-Rudin
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, USA; Wisconsin Alcohol Policy Project, Comprehensive Injury Center, Medical College of Wisconsin, USA
| | - M Busalacchi
- Wisconsin Alcohol Policy Project, Comprehensive Injury Center, Medical College of Wisconsin, USA
| | - R Mackenzie
- Comprehensive Injury Center, Medical College of Wisconsin, USA
| | - C A Kostelac
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, USA; Comprehensive Injury Center, Medical College of Wisconsin, USA
| | - L D Cassidy
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, USA
| | - T A deRoon-Cassini
- Comprehensive Injury Center, Medical College of Wisconsin, USA; Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, USA
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Richards JA, Kuo E, Stewart C, Shulman L, Parrish R, Whiteside U, Boggs JM, Simon GE, Rowhani-Rahbar A, Betz ME. Reducing Firearm Access for Suicide Prevention: Implementation Evaluation of the Web-Based "Lock to Live" Decision Aid in Routine Health Care Encounters. JMIR Med Inform 2024; 12:e48007. [PMID: 38647319 PMCID: PMC11063417 DOI: 10.2196/48007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/12/2023] [Accepted: 02/27/2024] [Indexed: 04/25/2024] Open
Abstract
Background "Lock to Live" (L2L) is a novel web-based decision aid for helping people at risk of suicide reduce access to firearms. Researchers have demonstrated that L2L is feasible to use and acceptable to patients, but little is known about how to implement L2L during web-based mental health care and in-person contact with clinicians. Objective The goal of this project was to support the implementation and evaluation of L2L during routine primary care and mental health specialty web-based and in-person encounters. Methods The L2L implementation and evaluation took place at Kaiser Permanente Washington (KPWA)-a large, regional, nonprofit health care system. Three dimensions from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model-Reach, Adoption, and Implementation-were selected to inform and evaluate the implementation of L2L at KPWA (January 1, 2020, to December 31, 2021). Electronic health record (EHR) data were used to purposefully recruit adult patients, including firearm owners and patients reporting suicidality, to participate in semistructured interviews. Interview themes were used to facilitate L2L implementation and inform subsequent semistructured interviews with clinicians responsible for suicide risk mitigation. Audio-recorded interviews were conducted via the web, transcribed, and coded, using a rapid qualitative inquiry approach. A descriptive analysis of EHR data was performed to summarize L2L reach and adoption among patients identified at high risk of suicide. Results The initial implementation consisted of updates for clinicians to add a URL and QR code referencing L2L to the safety planning EHR templates. Recommendations about introducing L2L were subsequently derived from the thematic analysis of semistructured interviews with patients (n=36), which included (1) "have an open conversation," (2) "validate their situation," (3) "share what to expect," (4) "make it accessible and memorable," and (5) "walk through the tool." Clinicians' interviews (n=30) showed a strong preference to have L2L included by default in the EHR-based safety planning template (in contrast to adding it manually). During the 2-year observation period, 2739 patients reported prior-month suicide attempt planning or intent and had a documented safety plan during the study period, including 745 (27.2%) who also received L2L. Over four 6-month subperiods of the observation period, L2L adoption rates increased substantially from 2% to 29% among primary care clinicians and from <1% to 48% among mental health clinicians. Conclusions Understanding the value of L2L from users' perspectives was essential for facilitating implementation and increasing patient reach and clinician adoption. Incorporating L2L into the existing system-level, EHR-based safety plan template reduced the effort to use L2L and was likely the most impactful implementation strategy. As rising suicide rates galvanize the urgency of prevention, the findings from this project, including L2L implementation tools and strategies, will support efforts to promote safety for suicide prevention in health care nationwide.
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Affiliation(s)
- Julie Angerhofer Richards
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Elena Kuo
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Christine Stewart
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Lisa Shulman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Rebecca Parrish
- Department of Mental Health & Wellness, Kaiser Permanente Washington, Seattle, WA, United States
| | - Ursula Whiteside
- NowMattersNow.org, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, United States
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Department of Mental Health & Wellness, Kaiser Permanente Washington, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
- Firearm Injury and Policy Research Program, University of Washington, Seattle, WA, United States
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Kim B, Thorpe LE, Spoer BR, Titus AR, Santaella-Tenorio J, Cerdá M, Gourevitch MN, Matthay EC. State-Level Firearm Laws and Firearm Homicide in US Cities: Heterogenous Associations by City Characteristics. J Urban Health 2024; 101:280-288. [PMID: 38536598 PMCID: PMC11052935 DOI: 10.1007/s11524-024-00851-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/28/2024]
Abstract
Despite well-studied associations of state firearm laws with lower state- and county-level firearm homicide, there is a shortage of studies investigating differences in the effects of distinct state firearm law categories on various cities within the same state using identical methods. We examined associations of 5 categories of state firearm laws-pertaining to buyers, dealers, domestic violence, gun type/trafficking, and possession-with city-level firearm homicide, and then tested differential associations by city characteristics. City-level panel data on firearm homicide cases of 78 major cities from 2010 to 2020 was assessed from the Centers for Disease Control and Prevention's National Vital Statistics System. We modeled log-transformed firearm homicide rates as a function of firearm law scores, city, state, and year fixed effects, along with time-varying city-level confounders. We considered effect measure modification by poverty, unemployment, vacant housing, and income inequality. A one z-score increase in state gun type/trafficking, possession, and dealer law scores was associated with 25% (95% confidence interval [CI]:-0.37,-0.1), 19% (95% CI:-0.29,-0.07), and 17% (95% CI:-0.28, -0.4) lower firearm homicide rates, respectively. Protective associations were less pronounced in cities with high unemployment and high housing vacancy, but more pronounced in cities with high income inequality. In large US cities, state-level gun type/trafficking, possession, and dealer laws were associated with lower firearm homicide rates, but buyers and domestic violence laws were not. State firearm laws may have differential effects on firearm homicides based on city characteristics, and city-wide policies to enhance socioeconomic drivers may add benefits of firearm laws.
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Affiliation(s)
- Byoungjun Kim
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Surgery, New York University Grossman School of Medicine, 1 Park Ave 6-815, New York, NY, USA.
| | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Ben R Spoer
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Andrea R Titus
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Julian Santaella-Tenorio
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Marc N Gourevitch
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Ellicott C Matthay
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Karavas AN, Olia K, Scantling D, Nudel J, Kriegel J, Edwards NM. Management of penetrating cardiac injury and tricuspid regurgitation with extracorporeal-membrane oxygenation (ECMO): a case report. J Cardiothorac Surg 2024; 19:64. [PMID: 38321531 PMCID: PMC10845754 DOI: 10.1186/s13019-024-02557-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/30/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Gunshot wounds (GSW) to the heart are lethal, and most patients die before they arrive to the hospital. Survival decreases with number of cardiac chambers involved. We report a case of a 17-year-old male who survived a GSW injury involving two cardiac chambers with acute severe tricuspid regurgitation (TR) who subsequently developed cardiogenic shock requiring extracorporeal membrane oxygenation (ECMO) support. CASE PRESENTATION A 17-year-old male sustained a single gunshot wound to the left chest, resulting in pericardial tamponade and right hemothorax. Emergency sternotomy revealed injury to the right ventricle and inferior cavoatrial junction with the adjacent pericardium contributing to a right hemothorax. The cardiac injuries were repaired primarily. Tricuspid regurgitation was confirmed immediately postoperatively. Five days after presentation, the patient developed cardiogenic shock secondary to TR requiring emergent stabilization with ECMO. He subsequently underwent successful tricuspid valve replacement. CONCLUSIONS This is the first report to our knowledge of successful ECMO support of severe TR due to gunshot injury to the heart.
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Affiliation(s)
- Alexandros N Karavas
- Division of Cardiac Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA.
| | - Keeyon Olia
- Department of Medicine, University of New England College of Osteopathic Medicine, Biddeford, ME, 04005, USA
| | - Dane Scantling
- Division of Trauma and Acute Care Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Jacob Nudel
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Jacob Kriegel
- Division of Cardiac Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Niloo M Edwards
- Division of Cardiac Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
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Roess AA, Henderson LF, Adams LM, Renshaw KD. Association Between Firearm Purchasing in Response to the COVID-19 Pandemic and Symptoms of Anxiety, Depression, and Stress, August 2021. AJPM FOCUS 2024; 3:100171. [PMID: 38293250 PMCID: PMC10825591 DOI: 10.1016/j.focus.2023.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Introduction Firearm sales and firearm-related injuries and deaths increased during the pandemic. Little is known about motivations for firearm purchasing in response to the COVID-19 pandemic and the mental health status of first-time purchasers. The purpose of this study was to estimate the association between firearm purchasing in response to the COVID-19 pandemic and anxiety symptoms, depressive symptoms, and stress. Methods The authors analyzed data from a survey that approximated a nationally representative sample of American adults (N=3,528) who either did not own firearms (n=2,327) or purchased firearms for the first time in response to the pandemic (n=240). Self-reported stress, depressive symptoms, and anxiety symptoms were determined using standardized self-assessment questionnaires (Perceived Stress Scale, Patient Health Questionnaire, and Depression Anxiety Stress Scale, respectively). Using multivariable logistic regression, the association between firearm purchasing and each mental health measure were assessed after controlling for demographics and other determinants. Results In each model, first-time firearm owners were more likely to be younger, live in urban areas, believe the government does too much for its citizens, stay home, stock up on items, and keep their children at home. First-time owners had significantly higher odds of anxiety and depressive symptoms than non-owners (AOR=1.05; 95% CI=1.04, 1.07 and AOR=1.15; 95% CI=1.04, 1.26, respectively). Conclusions First-time firearm purchasers report higher depressive and anxiety symptoms than non-owners, suggesting that there may be a risk of suicide and other related firearm violence.
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Affiliation(s)
- Amira A. Roess
- Department of Global and Community Health George Mason University, Fairfax, Virginia
| | - Laura F. Henderson
- Department of Global and Community Health George Mason University, Fairfax, Virginia
| | - Leah M. Adams
- Department of Psychology, George Mason University, Fairfax, Virginia
| | - Keith D. Renshaw
- Department of Psychology, George Mason University, Fairfax, Virginia
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Rieger A, Campbell J, Garthe R. Connecting to Community: Violence Prevention Barriers, Geography, and Preventionist Perceptions of Community Leadership and Opportunities. Health Promot Pract 2024:15248399231222468. [PMID: 38264910 DOI: 10.1177/15248399231222468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Violence is a public health concern, negatively impacting individual and community health and safety. Although violence can be prevented, prevention efforts are complex in part because they require addressing community factors. Despite an increase in funding and support for community violence prevention, relatively little is known about what prevention practice barriers may be related to community factors. This study addressed this gap by surveying a statewide sample of violence preventionists. We explored if coordination and logistical barriers and rural geography are associated with perceptions of two community factors: community opportunities and leadership quality. As part of a statewide assessment of violence and prevention efforts, 130 violence preventionists completed surveys. Results showed that both perceived coordination barriers and rural geography were negatively associated with perceptions of existing community opportunities, representative/influential leadership, and leadership commitment. Perceived logistical barriers were positively associated with perceived leadership commitment. Findings suggest that support reducing community coordination barriers in particular-and to support rural violence prevention work more broadly-is needed.
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Affiliation(s)
- Agnes Rieger
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jeanna Campbell
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Rachel Garthe
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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10
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Ewell Foster C, Derwin S, Bornheimer LA, Magness C, Kahsay E, Eis M, Verdugo JL, Smith T, Massey L, Rivara FP, King CA. Firearm Safe Storage in Rural Families: Community Perspectives About Ownership and Safety Messaging. Health Promot Pract 2024; 25:33-48. [PMID: 37148185 DOI: 10.1177/15248399231166418] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Firearm-related injuries are the leading cause of death among youth in the United States, and rates of firearm-related suicide in rural youth are more than double those in urban youth. Although safe firearm storage has been shown to reduce firearm injuries, little is known about how to culturally tailor such interventions for rural families in the United States. Informed by community-based participatory methods, focus groups and key informant interviews were conducted to design a safe storage prevention strategy for rural families. Participants included a broad array of community stakeholders (n = 40; 60% male, 40% female; age 15-72, M = 36.9, SD = 18.9) who were asked to identify acceptable messengers, message content, and delivery mechanisms that were perceived as respectful to the strengths of rural culture. Independent coders analyzed qualitative data using an open coding technique. Emerging themes included (1) community norms, values, and beliefs about firearms; (2) reasons for ownership; (3) firearm safety; (4) storage practices; (5) barriers to safe storage; and (6) suggested intervention components. Firearms were described as a "way of life" and family tradition in rural areas. Owning firearms for hunting and protection influenced family storage decisions. Intervention strategies that use respected firearm experts as messengers, refer to locally derived data, and that reflect community pride in firearm safety and responsible ownership may improve the acceptability of prevention messages in rural areas.
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Affiliation(s)
| | - Sarah Derwin
- Marquette County Health Department, Negaunee, MI, USA
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11
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Morrison M. The Mass Incarceration Trauma Framework: A Conceptual Model for Understanding Trauma among Individuals Who Experience Incarceration. SOCIAL WORK 2023; 69:8-16. [PMID: 37935034 DOI: 10.1093/sw/swad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/04/2023] [Accepted: 05/25/2023] [Indexed: 11/09/2023]
Abstract
The Mass Incarceration Trauma (MIT) framework is a conceptual model for understanding the role of trauma in the lives of individuals who experience incarceration in the United States. This population faces poverty, violence, and discrimination across the life span. The MIT framework is guided by an ecological systems perspective, a foundational theoretical approach in social work that recognizes that effective assessment and intervention require an understanding of the complex contexts in which individuals live. The MIT framework presents the cumulative trauma exposures commonly faced by this population before, during, and after incarceration at the individual, social, environmental, and historical levels. Because traumatic stress undermines health and daily functioning, it is essential that interventions for this population address both the ongoing risk for trauma exposure and the consequences of multiple, repeated past exposures across ecological systems. It is to be hoped that a new and fundamental focus on the poverty, contexts of violence, and lifetime disadvantages experienced by those who cycle through prisons in the United States might reframe the question of how our society should prevent and respond to crime as well as respond to those swept into the criminal justice system.
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12
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Romer D, Bushman BJ, Rich M. Media Influences on Children and Advice for Parents to Reduce Harmful Exposure to Firearm Violence in Media. Pediatr Clin North Am 2023; 70:1217-1224. [PMID: 37865441 DOI: 10.1016/j.pcl.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Firearm violence is now the leading cause of youth fatalities in the United States. This article outlines the various ways that entertainment media glorify the use of firearms and how this content can influence youth interest and use of guns. Social media are also increasingly serving as a source of risk for exposure to firearms. Counseling parents about the impact of media exposure to firearms on their children's health, and how to mitigate these risks, can be effective in promoting their children's health and safety.
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Affiliation(s)
- Dan Romer
- Annenberg Public Policy Center, University of Pennsylvania, 202 South 36th Street, Philadelphia, PA 19104, USA.
| | - Brad J Bushman
- School of Communication, The Ohio State University, 3016 Derby Hall, Columbus, OH 43210, USA
| | - Michael Rich
- Harvard Medical School, Digital Wellness Lab, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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13
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Sidell M, Negriff S, Koebnick C, Grant DL, Nau C, Zhou H, Hechter R. Trends in firearm injury in a southern California health care system from 2010 to 2020. BMC Public Health 2023; 23:2220. [PMID: 37950238 PMCID: PMC10636882 DOI: 10.1186/s12889-023-17116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Firearm injury is a significant public health concern in the United States. METHODS Data on fatal and nonfatal firearm injuries were obtained from a cohort of N = 7,473,650 members of Kaiser Permanente Southern California, a large integrated healthcare system between 2010 and 2020. Age-adjusted rates of combined fatal and nonfatal firearm injury per 100,000 members were calculated by year, with the 2010 US census as the reference population. Trends were evaluated using Poisson or negative binomial regression. RESULTS There was an increasing trend in overall firearm injuries between 2010 and 2020 among adults in this large integrated healthcare system (p < .0001), primarily driven by non-self-inflicted firearm injuries (p < .0001). Self-inflicted injuries decreased during this time (p = .01). Injuries among youth showed no significant change. CONCLUSION There was an increasing trend in firearm injuries between 2010 and 2020 among adults in this large integrated healthcare system, primarily driven by non-self-inflicted firearm injuries; however, self-inflicted injuries decreased during this time. Injuries among youth showed no significant change.
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Affiliation(s)
- Margo Sidell
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA.
| | - Sonya Negriff
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Corinna Koebnick
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Deborah Ling Grant
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Claudia Nau
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Hui Zhou
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Rulin Hechter
- Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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14
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Lei L, Goldstick JE, Maust DT. Impact of firearm injury in children and adolescents on health care costs and use within a family. Prev Med 2023; 175:107681. [PMID: 37633600 PMCID: PMC10592083 DOI: 10.1016/j.ypmed.2023.107681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/29/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
In 2020, firearm injury became the leading cause of death in U.S. children and adolescents. This study examines sequelae of firearm injury among children and adolescents in terms of health care costs and use within a family over time using an event study design. Using data from a large U.S. commercial insurance company from 2013 to 2019, we identified 532 children and adolescents aged 1-19 years who experienced any firearm-related acute hospitalization or emergency department (ED) encounter and 1667 of their family members (833 parents and 834 siblings). Outcomes included total health care costs, any acute hospitalization and ED visits (yes/no), and number of outpatient management visits, each determined on a quarterly basis 2 years before and 3 years after the firearm injury. Among injured children and adolescents, during the first quarter after the firearm injury, quarterly total health care costs were $24,018 higher than pre-injury; probability of acute hospitalization and ED visits were 27.9% and 90.4% higher, respectively; and number of outpatient visits was 1.8 higher (p < .001 for all). Quarterly total costs continued to be elevated during the second quarter post-injury ($1878 higher than pre-injury, p < .01) and number of outpatient visits remained elevated throughout the first year post-injury (0.6, 0.4, and 0.3 higher in the second through fourth quarter, respectively; p < .05 for all). Parents' number of outpatient visits increased during the second and third years after the firearm injury (0.3 and 0.5 higher per quarter than pre-injury; p < .05). Youth firearm injury has long-lasting impact on health care within a family.
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Affiliation(s)
- Lianlian Lei
- Department of Psychiatry, University of Michigan, United States of America.
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, United States of America; Department of Emergency Medicine, University of Michigan, United States of America
| | - Donovan T Maust
- Department of Psychiatry, University of Michigan, United States of America; Institute for Healthcare Policy and Innovation, University of Michigan, United States of America; Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States of America
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15
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Weigend Vargas E, Hsieh HF, Lee DB, Goldstick JE. Firearm homicides among hispanics and white non-hispanics: measuring disparities. Inj Prev 2023; 29:437-441. [PMID: 37620011 DOI: 10.1136/ip-2023-044933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Firearm homicides are increasing in the United States, and firearm homicides are a critical driver of racial health disparities. One such disparity that has received limited attention is excess firearm homicides among Hispanics, relative to White Non-Hispanics; comprehensively characterising this disparity is the purpose of this brief report. Using data from CDC WONDER, we examined temporal trends (2012-2021) in firearm homicide rate disparities between Hispanics and White Non-Hispanics in the U.S. Focusing on recently elevated rates (2018-2021), we estimated this disparity across demographics (gender, age, urbanicity, and race), and across U.S. states. These data clearly show nearly universal excess firearm homicide among Hispanics, relative to White Non-Hispanics, with larger differences among men, younger age groups, and in metropolitan areas. Similarly, nearly all states show higher rates of firearm homicide among Hispanics, relative to White Non-Hispanics, though the magnitude of the difference varies substantially.
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Affiliation(s)
- Eugenio Weigend Vargas
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
| | - Hsing-Fang Hsieh
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel B Lee
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason E Goldstick
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
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16
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Kawano B, Agarwal S, Krishnamoorthy V, Raghunathan K, Fernandez-Moure JS, Haines KL. State Firearm Laws and Rate of Assault-Related Firearm Death. J Am Coll Surg 2023; 237:409-418. [PMID: 37162091 DOI: 10.1097/xcs.0000000000000753] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Studying firearm-related mortality is important to reduce preventable firearm death in the US. This study aims to determine the relationship between firearm laws and assault death with firearms. STUDY DESIGN This ecologic study used public data from the CDC Wide-Ranging Online Data for Epidemiologic Research on decedents age 18 years or older who died from assault with firearms between 2009 and 2018 in all 50 states and Washington, DC. The outcomes were the rate of mortality per 100,000 persons from assault death by firearm used. Exposures of interest included the presence of 7 state firearm laws extracted from the RAND State Firearm Law Database. Welch's t tests were performed to compare mean mortality rate in states with each firearm law to states without each law. RESULTS There were 114,945 deaths from assault with firearms from 2009 to 2018. States with "stand your ground" laws had a higher assault mortality rate from all firearms and from other/unspecified firearms than states without stand your ground laws (p = 0.026; p = 0.023). States with background checks for private sales of handguns and long guns had a lower assault mortality rate from handguns and rifles, shotguns, and large firearms, respectively, than states without either law (p = 0.019; p = 0.030). CONCLUSIONS Stand your ground laws are correlated with a higher rate of gun-related assault death, but background checks on private sales are correlated with a lower rate. Future studies should elucidate the specific pathways by which state laws reduce, or fail to reduce, firearm-related assault death.
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Affiliation(s)
- Bradley Kawano
- From the Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery (Kawano, Agarwal, Fernandez-Moure, Haines), Duke University Medical Center, Durham, NC
| | - Suresh Agarwal
- From the Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery (Kawano, Agarwal, Fernandez-Moure, Haines), Duke University Medical Center, Durham, NC
| | - Vijay Krishnamoorthy
- the Department of Anesthesiology (Krishnamoorthy, Raghunathan), Duke University Medical Center, Durham, NC
| | - Karthik Raghunathan
- the Department of Anesthesiology (Krishnamoorthy, Raghunathan), Duke University Medical Center, Durham, NC
| | - Joseph S Fernandez-Moure
- From the Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery (Kawano, Agarwal, Fernandez-Moure, Haines), Duke University Medical Center, Durham, NC
| | - Krista L Haines
- From the Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery (Kawano, Agarwal, Fernandez-Moure, Haines), Duke University Medical Center, Durham, NC
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17
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Waltzman D, Sarmiento K, Daugherty J, Lumba-Brown A, Klevens J, Miller GF. Firearm-Related Traumatic Brain Injury Homicides in the United States, 2000-2019. Neurosurgery 2023; 93:43-49. [PMID: 36727717 PMCID: PMC10391713 DOI: 10.1227/neu.0000000000002367] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/15/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading cause of homicide-related death in the United States. Penetrating TBI associated with firearms is a unique injury with an exceptionally high mortality rate that requires specialized neurocritical trauma care. OBJECTIVE To report incidence patterns of firearm-related and nonfirearm-related TBI homicides in the United States between 2000 and 2019 by demographic characteristics to provide foundational data for prevention and treatment strategies. METHODS Data were obtained from multiple cause of death records from the National Vital Statistics System using Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database for the years 2000 to 2019. Number, age-adjusted rates, and percent of firearm and nonfirearm-related TBI homicides by demographic characteristics were calculated. Temporal trends were also evaluated. RESULTS During the study period, there were 77 602 firearm-related TBI homicides. Firearms were involved in the majority (68%) of all TBI homicides. Overall, men, people living in metro areas, and non-Hispanic Black persons had higher rates of firearm-related TBI homicides. The rate of nonfirearm-related TBI homicides declined by 40%, whereas the rate of firearm-related TBI homicides only declined by 3% during the study period. There was a notable increase in the rate of firearm-related TBI homicides from 2012/2013 through 2019 for women (20%) and nonmetro residents (39%). CONCLUSION Firearm-related violence is an important public health problem and is associated with the majority of TBI homicide deaths in the United States. The findings from this study may be used to inform prevention and guide further research to improve treatment strategies directed at reducing TBI homicides involving firearms.
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Affiliation(s)
- Dana Waltzman
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
| | - Kelly Sarmiento
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
| | - Jill Daugherty
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
| | | | - Joanne Klevens
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
| | - Gabrielle F. Miller
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
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18
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Roess AA, Henderson LF, Adams LM, Renshaw KD. Predictors of firearm purchasing during the coronavirus pandemic in the United States: a cross-sectional study. Public Health 2023; 219:159-164. [PMID: 37244224 DOI: 10.1016/j.puhe.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES This study aimed to compare determinants of firearm purchasing related to the pandemic. STUDY DESIGN This was a cross-sectional survey. METHODS A total of 3853 online panel participants completed a survey between December 22, 2020, and January 2, 2021, to approximate a nationally representative sample of US adults (aged ≥18 years). Four firearm ownership groups were created: non-owners, a proxy for first-time COVID-19 owners, prepandemic owners with COVID-19 purchase, and prepandemic owners without COVID-19 purchase. Explanatory variables were in four domains: demographics, concern about the pandemic, actions taken in response to COVID-19, and emotional response to COVID-19. Multivariate analysis estimated the adjusted odds of the outcomes. RESULTS Respondents were categorized as non-owners (n = 2440), pandemic-related purchasers with no other firearms (n = 257), pandemic-related purchasers with other firearms (n = 350), and those who did not purchase in response to the pandemic but have other firearms (n = 806). Multivariable logistic regression found that compared with non-owners, those who had firearms at home with no pandemic-related purchases are more likely to be male, live in rural settings, have higher income, and be Republican. CONCLUSIONS The results highlight the changing profile of American firearm owners and identify that those who purchased firearms for the first time (in response to the pandemic) should be the focus of tailored public health interventions, including provision of education about recommended firearm storage to reduce firearm violence, particularly because they are more likely to have children at home, and belong to demographic groups that may have less experience with firearm safety.
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Affiliation(s)
- A A Roess
- Department of Global and Community Health, College of Public Health, George Mason University, 4400 University Blvd, Fairfax, VA, 22030, USA.
| | - L F Henderson
- Department of Global and Community Health, College of Public Health, George Mason University, 4400 University Blvd, Fairfax, VA, 22030, USA
| | - L M Adams
- Department of Psychology, George Mason University, 4400 University Blvd, Fairfax, VA, 22030, USA
| | - K D Renshaw
- Department of Psychology, George Mason University, 4400 University Blvd, Fairfax, VA, 22030, USA
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19
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ROCHE JESSICAS, CARTER PATRICKM, ZEOLI APRILM, CUNNINGHAM REBECCAM, ZIMMERMAN MARCA. Challenges, Successes, and the Future of Firearm Injury Prevention. Milbank Q 2023; 101:579-612. [PMID: 37096629 PMCID: PMC10126989 DOI: 10.1111/1468-0009.12621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/21/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Firearm injury is a leading cause of death in the United States, with fatality rates increasing 34.9% over the past decade (2010-2020). Firearm injury is preventable through multifaceted evidence-based approaches. Reviewing past challenges and successes in the field of firearm injury prevention can highlight the future directions needed in the field. Adequate funding, rigorous and comprehensive data availability and access, larger pools of diverse and scientifically trained researchers and practitioners, robust evidence-based programming and policy implementation, and a reduction in stigma, polarization, and politicization of the science are all needed to move the field forward.
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Affiliation(s)
| | - PATRICK M. CARTER
- University of Michigan Institute for Firearm Prevention
- University of Michigan Injury Prevention Center
- University of Michigan School of Medicine
- University of Michigan School of Public Health
- Michigan Youth Violence Prevention CenterUniversity of Michigan School of Public Health
| | - APRIL M. ZEOLI
- University of Michigan Institute for Firearm Prevention
- University of Michigan School of Public Health
| | - REBECCA M. CUNNINGHAM
- University of Michigan Institute for Firearm Prevention
- University of Michigan Injury Prevention Center
- University of Michigan School of Medicine
- University of Michigan School of Public Health
| | - MARC A. ZIMMERMAN
- University of Michigan Institute for Firearm Prevention
- University of Michigan Injury Prevention Center
- University of Michigan School of Public Health
- Michigan Youth Violence Prevention CenterUniversity of Michigan School of Public Health
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20
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Kawano B, Agarwal S, Krishnamoorthy V, Raghunathan K, Fernandez-Moure JS, Haines KL. Restrictive Firearm Laws and Firearm-Related Suicide. J Am Coll Surg 2023; 236:37-44. [PMID: 36519906 DOI: 10.1097/xcs.0000000000000431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND There were 23,854 suicides by firearms in 2017 in the US, accounting for 60% of all gun deaths. Studying firearm-related mortalities is vital for reducing preventable gun deaths. This study aims to determine the association between state-level presence of restrictive firearm laws and suicide rates with firearms. STUDY DESIGN This ecological study used data from the CDC Wide-Ranging Online Data for Epidemiologic Research on decedents older than 18 years who died from intentional self-harm with firearms between 2009 and 2018. Exposures of interest were state-level restrictive firearm laws: background checks on private sales, mandatory waiting periods, and prohibited possession for domestic violence restraining orders or mental health red flags. Outcomes were rates of suicide with firearms per 100,000 persons over the 10-year period within each state. Welch's t -tests compared mean mortality rates in exposed and unexposed states. RESULTS There were 208,621 deaths from intentional self-harm with firearms from 2009 to 2018. States with background checks, mandatory waiting periods, and prohibited possession were associated with lower suicide rates for all firearm types compared with states without these laws (p < 0.05). Only states with background checks and mandatory waiting periods were associated with lower suicide rates by handguns and large firearms (p < 0.05). CONCLUSION Background checks and mandatory waiting periods correlated with fewer suicides by all firearms and specific firearm types. This reduction could be due to firearm laws directly preventing people from accessing guns or existing concurrently with other suicide prevention measures. More research should be directed to understanding how firearm laws can help reduce suicide rates.
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Affiliation(s)
- Bradley Kawano
- From the Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery (Kawano, Agarwal Fernandez-Moure, Haines), Duke University Medical Center, Durham, NC
| | - Suresh Agarwal
- From the Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery (Kawano, Agarwal Fernandez-Moure, Haines), Duke University Medical Center, Durham, NC
| | - Vijay Krishnamoorthy
- Department of Anesthesiology (Krishnamoorthy, Raghunathan) Duke University Medical Center, Durham, NC
- the Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, NC (Krishnamoorthy, Raghunathan, Haines)
| | - Karthik Raghunathan
- Department of Anesthesiology (Krishnamoorthy, Raghunathan) Duke University Medical Center, Durham, NC
- the Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, NC (Krishnamoorthy, Raghunathan, Haines)
| | - Joseph S Fernandez-Moure
- From the Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery (Kawano, Agarwal Fernandez-Moure, Haines), Duke University Medical Center, Durham, NC
| | - Krista L Haines
- From the Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery (Kawano, Agarwal Fernandez-Moure, Haines), Duke University Medical Center, Durham, NC
- the Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, NC (Krishnamoorthy, Raghunathan, Haines)
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21
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Ross CS, Gradus JL, Siegel MB, Alcorn T, Garverich S, Lincoln A. Distinct groups of firearm owners with differential risk for suicide in the United States: A latent class analysis. Prev Med 2022; 164:107185. [PMID: 36041545 DOI: 10.1016/j.ypmed.2022.107185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/18/2022] [Accepted: 07/30/2022] [Indexed: 11/28/2022]
Abstract
Suicide is a leading cause of mortality and firearm suicide accounts for the majority of fatalities. Firearm owners are a diverse population and firearm-specific suicide prevention programs should be tailored to distinct at-risk firearm-owning groups. This study set out to identify groups of firearm owners with differential suicide risk having unique characteristics that could be used to customize suicide prevention efforts. We conducted a nationally-representative survey of 2646 firearm owners to assess individual suicide risk, suicide risk factors, and demographic characteristics. A Latent Class Analysis identified unique segments of firearm owners at increased risk of suicide with similar underlying suicide risk factors and demographic characteristics. We found almost one in ten (9.6%) of firearm owners were at increased risk of suicide with 25% reporting suicide ideation, 6.6% reporting suicide planning, and 1.8% reporting previous suicide attempts. We identified three unique groups of firearm owners with higher than average suicide risk. Relative to other groups of firearm owners, one at-risk group were more affluent with a history of adverse experiences and mental health challenges, a second group had more male veterans with high levels of alcohol consumption, and third group had more non-heterosexual women who experienced trauma. We conclude that there are three unique groups of firearm owners with higher than average suicide risk with very different characteristics. In addition to broad suicide prevention efforts, customized firearm suicide prevention programs should be developed individually for these different firearm-owning populations, taking into consideration the unique suicide risk factors and demographics of each group.
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Affiliation(s)
- Craig S Ross
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, United States of America
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, United States of America; Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, United States of America.
| | - Michael B Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, United States of America
| | - Ted Alcorn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY 10032
| | - Suzanne Garverich
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA 02115, United States of America
| | - Alisa Lincoln
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA 02115, United States of America
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22
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Lee LK, Fleegler EW, Goyal MK, Doh KF, Laraque-Arena D, Hoffman BD, Injury Violence And Poison Prevention CO. Firearm-Related Injuries and Deaths in Children and Youth. Pediatrics 2022; 150:189687. [PMID: 36207778 DOI: 10.1542/peds.2022-060071] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. In 2020, firearms resulted in 10,197 deaths (fatality rate 9.91/100,000 youth 0-24 years old). Firearms are the leading mechanism of death in pediatric suicides and homicides. Increased access to firearms is associated with increased rates of firearm deaths. Substantial disparities in firearm injuries and deaths exist by age, gender, race, ethnicity, and sexual orientation and gender identity and for deaths related to legal intervention. Barriers to firearm access can decrease the risk to youth for firearm suicide, homicide, or unintentional shooting injury and death. Given the high lethality of firearms and the impulsivity associated with suicidal ideation, removing firearms from the home or securely storing them-referred to as lethal means restriction of firearms-is critical, especially for youth at risk for suicide. Primary care-, emergency department-, mental health-, hospital-, and community-based intervention programs can effectively screen and intervene for individuals at risk for harming themselves or others. The delivery of anticipatory guidance coupled with safety equipment provision improves firearm safer storage. Strong state-level firearm legislation is associated with decreased rates of firearm injuries and death. This includes legislation focused on comprehensive firearm licensing strategies and extreme risk protection order laws. A firm commitment to confront this public health crisis with a multipronged approach engaging all stakeholders, including individuals, families, clinicians, health systems, communities, public health advocates, firearm owners and nonowners, and policy makers, is essential to address the worsening firearm crisis facing US youth today.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Kiesha Fraser Doh
- Division of Pediatrics and Emergency Medicine, Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | - Danielle Laraque-Arena
- New York Academy of Medicine, Mailman School of Public Health at Columbia University, Departments of Epidemiology and Pediatrics, New York, NY
| | - Benjamin D Hoffman
- Division of General Pediatrics, Oregon Health and Science University, Portland, OR
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23
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Suicide versus homicide firearm injury patterns on trauma systems in a study of the National Trauma Data Bank (NTDB). Sci Rep 2022; 12:15672. [PMID: 36123380 PMCID: PMC9485125 DOI: 10.1038/s41598-022-17280-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Abstract
Firearm related mortality in the USA surpassed all other developed countries. This study hypothesizes that injury patterns, weapon type, and mortality differ between suicide groups as opposed to homicide. The American College of Surgeons National Trauma Database was queried from January 2017 to December 2019. All firearm related injuries were included, and weapon type was abstracted. Differences between homicide and suicide groups by sex, age, race, and injury severity were compared using a Mann–Whitney test for numerical data and Fisher’s exact test for categorical data. The association between weapon type and mortality relative to suicide as opposed to homicide was assessed in Fisher’s exact tests. Significance was defined as p < 0.05. There were 100,031 homicide and 11,714 suicide subjects that met inclusion criteria. Homicides were mostly assault victims (97.6%), male (88%), African–American (62%), had less severe injury (mean (ISS) 12.07) and a median age of 20 years old (IQR: 14, 30, p < 0.01). Suicides were mostly male (83%), white (79%), had more severe injury (mean ISS 20.73), and a median age of 36 years old (IQR: 19, 54, p < 0.01). Suicide group had higher odds of head/neck (OR = 13.6) or face (OR = 5.7) injuries, with lower odds of injury to chest (OR = 0.55), abdominal or pelvic contents (OR = 0.25), extremities or pelvic girdle (OR = 0.15), or superficial soft tissue (OR = 0.32). Mortality rate was higher for suicide group (44.8%; 95% confidence interval (CI) 43.9%, 45.7%) compared to the homicide group (11.5%; 95% CI 11.3%, 11.7%). Suicide had higher mortality, more severe injuries, and more head/neck/facial injuries than homicide. Majority of suicides were with handguns.
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24
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Racial Differences in Firearms Used and Autopsies Following Gun Deaths Exist. J Surg Res 2022; 279:666-681. [PMID: 35932721 DOI: 10.1016/j.jss.2022.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/18/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Disparities in gun violence across race are well documented. Studying these disparities is essential to reduce preventable gun deaths. This study evaluates the relationship between sociodemographic factors and firearms used in gun deaths. MATERIALS AND METHODS This retrospective cohort study of firearm mortalities from 2009 to 2018 used the Mortality Multiple Cause-of-Death Public Use Record from the National Center for Health Statistics. The primary outcome was the type of firearm used and the secondary outcome was autopsy status. Factors of interest include race, ethnicity, gender, marital status, age, education, and place of death. Factors significantly associated with outcomes in univariate analyses were included in separate multivariate logistic regression models for assaults, intentional self-harm, and accidents. RESULTS A total of 276,127 firearm deaths from 2009 to 2018 were analyzed. Compared to White victims, Black victims were less likely to die from handguns (accident: odds ratio [OR] = 0.70, P < 0.05; self-harm: OR = 0.84, P < 0.001; assault: OR = 0.58, P < 0.001) and rifles, shotguns, or large firearms (accident: OR = 0.30, P < 0.001; self-harm: OR = 0.37, P < 0.001; assault: OR = 0.28, P < 0.001). Black decedents were more likely to undergo autopsy than White decedents (accident: OR = 2.14, P < 0.001; intentional self-harm: OR = 2.02, P < 0.001; assault: OR = 2.02, P < 0.001). Ethnicity, gender, marital status, age, education, and other racial identities were also associated with firearms used and autopsy rates (P < 0.05). CONCLUSIONS Differences in firearms used and autopsy rates following gun deaths exist by race, ethnicity, gender, marital status, age, and education. Future studies should investigate the relationship between sociodemographic factors and firearms used and autopsy status following gun deaths.
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25
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Warner TD. Always at the Ready: Fears, Threats, and Unsafe Gun Storage in Households With Children. VIOLENCE AND VICTIMS 2022; 37:441-458. [PMID: 35896329 DOI: 10.1891/vv-2021-0017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Guns are present in many households in the U.S., including those with children. Safe storage of guns at home can mitigate the increased risks of both the unintentional and intentional injury that in-home gun access presents; yet estimates suggest fewer than half of gun owners store their weapon(s) safely. Unsafe storage in homes with children is especially problematic given that gun-owning parents make incorrect assumptions about both children's awareness of firearm storage locations, and their actions upon encountering an unsecured gun. There is limited identification and understanding of why some parents do not engage in safe storage practices. Using 2019 survey data from an internet-based sample of gun-owning adults with children at home, this study explores various potential correlates of unsafe storage. Findings suggest that unsafe storage occurs not in response to crime/victimization fears, but from broader, group- and status-based threats. Understanding the complex factors preventing gun-owning parents from implementing safe storage practices has important implications for both victimization scholarship and public health/injury prevention efforts.
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Affiliation(s)
- Tara D Warner
- Department of Criminal Justice, University of Alabama at Birmingham, Birmingham, AL
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26
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Smart R, Schell TL, Morral AR, Nicosia N. Geographic Disparities in Rising Rates of Firearm-Related Homicide. N Engl J Med 2022; 387:189-191. [PMID: 35830647 PMCID: PMC9746702 DOI: 10.1056/nejmc2203322] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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27
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Goldstick JE, Jay J. Agent-Based Modeling: an Underutilized Tool in Community Violence Research. CURR EPIDEMIOL REP 2022; 9:135-141. [PMID: 35821794 PMCID: PMC9263807 DOI: 10.1007/s40471-022-00292-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/27/2022]
Abstract
Purpose of Review Recent Findings Summary
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Affiliation(s)
- Jason E. Goldstick
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109-2800 USA
- Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109 USA
- Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48105 USA
| | - Jonathan Jay
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118 USA
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28
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Degli Esposti M, Gravel J, Kaufman EJ, Delgado MK, Richmond TS, Wiebe DJ. County-Level Variation in Changes in Firearm Mortality Rates Across the US, 1989 to 1993 vs 2015 to 2019. JAMA Netw Open 2022; 5:e2215557. [PMID: 35666501 PMCID: PMC9171565 DOI: 10.1001/jamanetworkopen.2022.15557] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Firearm violence remains a critical public health challenge, disproportionately impacting some US regions. County-level variation may hold key insights into how firearm mortality rates vary across the US. OBJECTIVE To model county-level changes in firearm mortality rates (total, homicide, and suicide) from 1989 to 1993 vs 2015 to 2019 and identify and characterize hot spots showing unexpected changes over time. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional study with 2 time points using a novel small area estimation method to analyze restricted access mortality microdata by cause of death and US county. The analysis included 3111 US counties from 49 states and the District of Columbia from January 1, 1989, to December 31, 2019. Bayesian spatial models were fitted to map geographical variation in changes in age-standardized firearm mortality rates (per 100 000 person-years) from 1989 to 1993 vs 2015 to 2019. County outliers (or hot spots) were defined as having observed rates that fell outside the 95% credible intervals of their expected posterior predictive distribution. These counties were characterized using visualization and descriptive statistics of their characteristics. Data were analyzed from June to December 2021. EXPOSURES County of residence. MAIN OUTCOMES AND MEASURES Five-year age-standardized mortality rates by US county, age, and cause of death for 1989 to 1993 and 2015 to 2019. RESULTS Between 1989 and 2019, 1 036 518 firearm deaths were recorded in counties across the US. Suicide was the most common cause of firearm mortality (589 285 deaths) followed by homicide (412 231 deaths). Age-standardized rates (deaths per 100 000 individuals) for firearm deaths and suicides increased from 1989 to 1993 vs 2015 to 2019 (mean [SD] change, 0.16 [8.78] for firearm deaths and 1.21 [6.91] for suicides), while firearm homicides decreased (mean [SD] change, -0.39 [3.96]). However, these national trends were not homogeneous across counties and often varied by geographical region. The West and Midwest showed the most pronounced increases in firearm suicide rates, whereas the Southeast showed localized increases in firearm homicide rates, despite the national decreasing trend. Critical hot spots were identified in urban counties of Alabama, and firearm homicide rates (per 100 000) in Baltimore City, Maryland, almost doubled from 29.71 to 47.43, and by 2015 to 2019 it accounted for 66.7% of all firearm homicide in Maryland. By contrast, District of Columbia showed promising improvements over time, decreasing from 56.5 firearm homicides per 100 000 in 1989 to 1993 to 14.45 in 2015 to 2019. CONCLUSIONS AND RELEVANCE There was substantial variation in rates and changes in firearm deaths among US counties. Geographical hot spots may be useful to inform targeted prevention efforts and local policy responses.
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Affiliation(s)
- Michelle Degli Esposti
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Jason Gravel
- Department of Criminal Justice, Temple University, Philadelphia, Pennsylvania
| | - Elinore J. Kaufman
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - M. Kit Delgado
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Therese S. Richmond
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Biobehavioral Health Sciences Department, University of Pennsylvania School of Nursing, Philadelphia
| | - Douglas J. Wiebe
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
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29
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Goldstick JE, Cunningham RM, Carter PM. Current Causes of Death in Children and Adolescents in the United States. N Engl J Med 2022; 386:1955-1956. [PMID: 35443104 PMCID: PMC10042524 DOI: 10.1056/nejmc2201761] [Citation(s) in RCA: 222] [Impact Index Per Article: 111.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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30
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Abstract
OBJECTIVES This study explores the changing prevalence of adolescent handgun carriage, with attention to differences across sociodemographic groups. METHODS Data were drawn from repeated cross-sectional, nationally representative surveys conducted annually from 2002 to 2019, the National Survey on Drug Use & Health. The study sample included adolescents aged 12 to 17 (N = 297 055). Logistic regression models estimated the prevalence of past year handgun carriage across cohort and sociodemographic subgroups. Interactions between 4-time cohorts and other variables explored sociodemographic variability in prevalence rates over time. RESULTS Handgun carriage increased significantly, particularly among rural, White, and higher-income adolescents. Carriage increased by 41% over cohorts, with predicted prevalence rates increasing from 3.3% in 2002-2006 to 4.6% in 2015-2019. Across cohorts, rural (5.1%), American Indian/Alaskan Native (5.2%), lower-income (<$20 000; 3.9%), male (5.9%), and older (16-17 years old; 4.5%) adolescents were the most likely to report carriage. However, these patterns changed significantly over time, with White and higher-income adolescents (>$75 000) most likely to carry in the most recent cohorts. Predicted carriage rates increased from 3.1% to 5.3% among White adolescents, from 2.6% to 5.1% among higher-income adolescents, and from 4.3% to 6.9% among rural adolescents between the 2002-2006 and 2015-2019 cohorts. Carriage among Black, American Indian/Alaskan Native, and lower-income adolescents decreased. CONCLUSIONS Adolescent handgun carriage is increasing, concentrated among particular subgroups of youth, and carriage patterns across sociodemographic groups have changed over time. Programs to address the risk of adolescent gun carriage should be tailored to the specific sociocultural and place-based concerns of diverse adolescents.
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31
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Magee LA, Lucas B, Fortenberry JD. Changing epidemiology of firearm injury: a cohort study of non-fatal firearm victimisation before and during the COVID-19 pandemic, Indianapolis, Indiana. BMJ Open 2022; 12:e059315. [PMID: 35321899 PMCID: PMC8943482 DOI: 10.1136/bmjopen-2021-059315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine victimisation rates, geographic patterns and neighbourhood characteristics associated with non-fatal firearm injury rates before and during the COVID-19 pandemic. DESIGN A retrospective cohort study. SETTING City of Indianapolis, Indiana, USA, 1 January 2017-30 June 2021. PARTICIPANTS Intentional non-fatal firearm injury victims from Indianapolis Metropolitan Police Department records. The study included information on 2578 non-fatal firearm injury victims between ages 0 and 77 years. Of these victims, 82.5% were male and 77.4% were black. PRIMARY AND SECONDARY OUTCOME MEASURES Rates of non-fatal firearm injuries per 100 000 population by victim age, race, sex and incident motive. Prepandemic and peripandemic non-fatal firearm injury rates. RESULTS Non-fatal shooting rates increased 8.60%, from 57.0 per 100 000 person-years in prepandemic years to 65.6 per 100 000 person-years during the pandemic (p<0.001). Rates of female victims (15.2 vs 23.8 per 100,000; p<0.001) and older victims (91.3 vs 120.4 per 100,000; p<0.001) increased significantly during the pandemic compared with the prepandemic period. Neighbourhoods with higher levels of structural disadvantage (IRR: 1.157, 95% CI 1.012 to 1.324) and prepandemic firearm injury rates (IRR: 1.001, 95% CI 1.001 to 1.002) was positively associated with higher rates of non-fatal firearm injuries during the pandemic, adjusting for neighbourhood characteristics. CONCLUSIONS Non-fatal firearm injuries increased significantly during the COVID-19 pandemic, particularly among female and older victims. Efforts are needed to expand and rethink current firearm prevention efforts that both address the diversification of victimisation and the larger societal trauma of firearm violence.
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Affiliation(s)
- Lauren A Magee
- O'Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Bailee Lucas
- O'Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - James Dennis Fortenberry
- Department of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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32
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Abstract
We introduce an approach to identify latent topics in large-scale text data. Our approach integrates two prominent methods of computational text analysis: topic modeling and word embedding. We apply our approach to written narratives of violent death (e.g., suicides and homicides) in the National Violent Death Reporting System (NVDRS). Many of our topics reveal aspects of violent death not captured in existing classification schemes. We also extract gender bias in the topics themselves (e.g., a topic about long guns is particularly masculine). Our findings suggest new lines of research that could contribute to reducing suicides or homicides. Our methods are broadly applicable to text data and can unlock similar information in other administrative databases. There is an escalating need for methods to identify latent patterns in text data from many domains. We introduce a method to identify topics in a corpus and represent documents as topic sequences. Discourse atom topic modeling (DATM) draws on advances in theoretical machine learning to integrate topic modeling and word embedding, capitalizing on their distinct capabilities. We first identify a set of vectors (“discourse atoms”) that provide a sparse representation of an embedding space. Discourse atoms can be interpreted as latent topics; through a generative model, atoms map onto distributions over words. We can also infer the topic that generated a sequence of words. We illustrate our method with a prominent example of underutilized text: the US National Violent Death Reporting System (NVDRS). The NVDRS summarizes violent death incidents with structured variables and unstructured narratives. We identify 225 latent topics in the narratives (e.g., preparation for death and physical aggression); many of these topics are not captured by existing structured variables. Motivated by known patterns in suicide and homicide by gender and recent research on gender biases in semantic space, we identify the gender bias of our topics (e.g., a topic about pain medication is feminine). We then compare the gender bias of topics to their prevalence in narratives of female versus male victims. Results provide a detailed quantitative picture of reporting about lethal violence and its gendered nature. Our method offers a flexible and broadly applicable approach to model topics in text data.
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33
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Zwald ML, Holland KM, Bowen DA, Simon TR, Dahlberg LL, Stein Z, Idaikkadar N, Mercy JA. Using the Centers for Disease Control and Prevention’s National Syndromic Surveillance Program Data to Monitor Trends in US Emergency Department Visits for Firearm Injuries, 2018 to 2019. Ann Emerg Med 2022; 79:465-473. [DOI: 10.1016/j.annemergmed.2022.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
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34
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Richards JE, Kuo E, Stewart C, Bobb JF, Mettert KD, Rowhani-Rahbar A, Betz ME, Parrish R, Whiteside U, Boggs JM, Simon GE. Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use. JAMA HEALTH FORUM 2021; 2:e211973. [PMID: 35977197 PMCID: PMC8796974 DOI: 10.1001/jamahealthforum.2021.1973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/14/2021] [Indexed: 12/03/2022] Open
Abstract
Question Did patients respond to a standard question about firearm access on a mental health questionnaire, and, if so, how did they respond? Findings In this cross-sectional study of 128 802 patients receiving care for mental health and substance use, 83% of primary care patients answered a standard question about firearm access and 21% reported access. In mental health clinics, 92% of patients answered the question and 15% reported access. Meaning In this study, most patients reported firearm access on standard questionnaires; this screening practice may improve efforts to identify and engage patients at risk of suicide in discussions about securing firearms. Importance Firearms are the most common method of suicide, one of the “diseases of despair” driving increased mortality in the US over the past decade. However, routine standardized questions about firearm access are uncommon, particularly among adult populations, who are more often asked at the discretion of health care clinicians. Because standard questions are rare, patterns of patient-reported access are unknown. Objective To evaluate whether and how patients self-report firearm access information on a routine mental health monitoring questionnaire and additionally to examine sociodemographic and clinical associations of reported access. Design, Setting, and Participants Cross-sectional study of patients receiving care for mental health and/or substance use in primary care or outpatient mental health specialty clinics of Kaiser Permanente Washington, an integrated health insurance provider and care delivery system. Main Outcomes and Measures Electronic health records were used to identify patients who completed a standardized self-reported mental health monitoring questionnaire after a single question about firearm access was added from January 1, 2016, through December 31, 2019. Primary analyses evaluated response (answered vs not answered) and reported access (yes vs no) among those who answered, separately for patients seen in primary care and mental health. These analyses also evaluated associations between patient characteristics and reported firearm access. Data analysis took place from February 2020 through May 2021. Results Among patients (n = 128 802) who completed a mental health monitoring questionnaire during the study period, 74.4% (n = 95 875) saw a primary care clinician and 39.3% (n = 50 631) saw a mental health specialty clinician. The primary care and mental health samples were predominantly female (63.1% and 64.9%, respectively) and White (75.7% and 77.0%), with a mean age of 42.8 and 51.1 years. In primary care, 83.4% of patients answered the question about firearm access, and 20.9% of patients who responded to the firearm question reported having access. In mental health, 91.8% of patients answered the question, and 15.3% reported having access. Conclusions and Relevance In this cross-sectional study of adult patients receiving care for mental health and substance use, most patients answered a question about firearm access on a standardized mental health questionnaire. These findings provide a critical foundation to help advance understanding of the utility of standardized firearm access assessment and to inform development of practice guidelines and recommendations. Responses to standard firearm access questions used in combination with dialogue and decision-making resources about firearm access and storage may improve suicide prevention practices and outcomes.
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Affiliation(s)
- Julie E. Richards
- Health Research Institute, Kaiser Permanente Washington, Seattle
- Department of Health Services, University of Washington, Seattle
| | - Elena Kuo
- Health Research Institute, Kaiser Permanente Washington, Seattle
| | | | - Jennifer F. Bobb
- Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Kayne D. Mettert
- Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington School of Public Health, Seattle
- Harborview Injury Prevention and Research Center, Seattle, Washington
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Rebecca Parrish
- Department of Mental Health & Wellness, Kaiser Permanente Washington, Seattle
| | - Ursula Whiteside
- NowMattersNow.org, Seattle, Washington
- Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | | | - Gregory E. Simon
- Health Research Institute, Kaiser Permanente Washington, Seattle
- Department of Mental Health & Wellness, Kaiser Permanente Washington, Seattle
- Psychiatry and Behavioral Sciences, University of Washington, Seattle
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35
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Goldstick JE, Kaufman EJ, Delgado MK, Jay J, Carter PM. Commentary: Reducing youth firearm violence and the associated health disparities requires enhanced surveillance and modern behavioral intervention strategies - a commentary on Bottiani et al. (2021). J Child Psychol Psychiatry 2021; 62:580-583. [PMID: 33817792 PMCID: PMC8437141 DOI: 10.1111/jcpp.13421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
Youth firearm injury is a worsening public health crisis, and the risks are not distributed evenly. Bottiani et al. skillfully explicated those health disparities, described sociological factors underlying them, and explored avenues for prevention. We supplement their analysis by detailing problems and solutions related to a critical barrier to firearm violence prevention - the nonexistence both of reliable 'gold standard' nonfatal firearm injury surveillance data, and systems for near real-time surveillance of firearm injuries at granular spatial scales that would enable to optimization of rapid response protocols and neighborhood-based prevention programs. We conclude with a discussion of modern, scalable, behavioral intervention approaches that could be leveraged to fill the largely absent evidence base resulting from the documented underfunding of youth firearm violence prevention research.
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Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan,
Ann Arbor, MI, USA,Injury Prevention Center, University of Michigan, Ann
Arbor, MI, USA,Department of Health Behavior and Health Education,
University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Elinore J. Kaufman
- Division of Traumatology, Surgical Critical Care, and
Emergency Surgery, University of Pennsylvania Perelman School of Medicine,
Philadelphia, PA, USA
| | - M. Kit Delgado
- Department of Biostatistics and Epidemiology, University of
Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Department of Emergency Medicine, University of
Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jonathan Jay
- Department of Community Health Sciences, Boston University
School of Public Health, Boston, MA, USA
| | - Patrick M. Carter
- Department of Emergency Medicine, University of Michigan,
Ann Arbor, MI, USA,Injury Prevention Center, University of Michigan, Ann
Arbor, MI, USA,Department of Health Behavior and Health Education,
University of Michigan School of Public Health, Ann Arbor, MI, USA
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