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Kandeepan A, Lee J, Bagdure D, Garber N, Day J, Holloway A, Lichenstein R, Slattery J, Wolfe A, Wadsworth J, Moss J, Davie N, Foster C. Firearm screening in pediatric patients. Front Pediatr 2024; 12:1415612. [PMID: 38978836 PMCID: PMC11228932 DOI: 10.3389/fped.2024.1415612] [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: 04/10/2024] [Accepted: 06/05/2024] [Indexed: 07/10/2024] Open
Abstract
Introduction In the United States, firearm-related injuries are the leading cause of death among children and adolescents 1-19 years of age. Although many pediatricians believe addressing firearm safety is important and have guidance from organizations like the American Academy of Pediatrics, few routinely screen and counsel on firearm safety. The goal of this project was to screen all patients presenting to the pediatric emergency department, pediatric floor, and pediatric intensive care unit for the presence of firearms in the home, firearm storage practices, and whether they had previously received any firearm counseling by medical professionals. Methods A 13-item survey was administered to each participant. Items included demographic information, willingness to answer questions about firearms, practice of asking questions about firearms, previous counseling from medical professionals about the presence of firearms in the home and the presence of firearm in their personal home as well as storage practices. Results A total of 200 parents responded to the survey. Of those that responded to the survey, 171 (85.5%) did not have a firearm in the home and 28 (14%) did have a firearm in the home. 75% (n = 21) had never had a medical provider discuss firearm safety with them. 100% had never been asked by another parent about the presence of a firearm in their home when a child came over for a playdate. 39% (n = 11) of parents with a firearm in the home had asked other parents whether they have a firearm in the home where their child goes to play. Discussion Findings from our study highlight a significant lack of screening of our pediatric patients both in the inpatient and outpatient settings, with the majority reporting that they had never been asked by a medical provider about firearm safety. In addition, three quarters of parents with a firearm in the home reported that they did not mind answering questions about firearms yet none had been asked by other parents about firearms. Thus, although firearm possession and safety is considered to be a sensitive topic, many parents are willing to discuss it with their health care providers and other parents.
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Affiliation(s)
- Aarani Kandeepan
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Jessica Lee
- Department of Pediatrics, The Children's Hospital of Montefiore, New York, NY, United States
| | - Dayanand Bagdure
- Department of Pediatrics, Ochsner LSU Health, Shreveport, LA, United States
| | - Nan Garber
- Department of Pediatrics, West Virginia University, Morgantown, WV, United States
| | - Jenni Day
- Department of Nursing, University of Maryland, Baltimore, MD, United States
| | - Adrian Holloway
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Richard Lichenstein
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Joseph Slattery
- Department of Pediatrics, St. Josephs Hospital, Baltimore, MD, United States
| | - Alexa Wolfe
- Department of Pediatrics, University of Wisconsin, Madison, WI, United States
| | - Jenna Wadsworth
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Julianne Moss
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Nicole Davie
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Cortney Foster
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
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Tronzo A, Sweeney C, Picard B, Thompson KG. Firearm safety counseling in pediatric primary care. Nurse Pract 2024; 49:9-11. [PMID: 38662488 DOI: 10.1097/01.npr.0000000000000179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
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Galante N, Blandino A, Disegna M, Franceschetti L, Casali MB. Intentional child and adolescent homicides in Milan (Italy): A 30-year interdisciplinary study. Leg Med (Tokyo) 2024; 68:102433. [PMID: 38467102 DOI: 10.1016/j.legalmed.2024.102433] [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: 10/28/2023] [Revised: 02/06/2024] [Accepted: 03/05/2024] [Indexed: 03/13/2024]
Abstract
This study aims to discuss the forensic and criminological implications of child homicides in the territory of Milan, Italy. The authors present a retrospective study on all the cases of child and adolescent homicides, that were observed at the Institute of Legal Medicine of Milan (Italy) in the last 30 years (from January 1991 to December 2020). A total of 46 child homicides were collected, focusing on the sociological features, by highlighting peculiar cases, risk factors, potential changing social trends, and comparing our cases with the current literature. The analysis revealed a statistically significant relationship (p < 0.05) for male adolescents and indicated that adolescent homicides were more frequently perpetrated in extrafamilial contexts. In contrast, neonaticides and infanticides were mainly committed at home. Furthermore, the Fisher's Exact test revealed that child murders were mainly committed by immigrants in the Milan district after 2005 (p < 0.05). The two main causes of death were due to sharp and firearm injuries. While the relationship between homicide clusters and homicides committed by sharp objects was not significant, adolescent homicides were mainly committed using firearms (p < 0.05). The present study may help to identify risk factors for homicides against child and adolescent. Consequently, policies that identify, prevent, and minimize this extreme violence should be designed to interrupt the vicious circle of such dreadful murderous events. Child and adolescent homicides deserve additional focus and better education for healthcare professionals and further research should be carried out to develop therapeutic and caring strategies.
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Affiliation(s)
- Nicola Galante
- Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133 Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 37, 20133 Milan, Italy.
| | | | - Marta Disegna
- Department of Management and Engineering (DTG), University of Padua, Via Stradella San Nicola 3, 36100 Vicenza, Italy
| | - Lorenzo Franceschetti
- Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133 Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 37, 20133 Milan, Italy
| | - Michelangelo Bruno Casali
- Institute of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133 Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Via Luigi Mangiagalli 37, 20133 Milan, Italy
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Kemal S, Jones-Robinson L, Rak K, Otoo C, Barrera L, Sheehan K. Exploring Firearm Access, Carriage, and Possession among Justice-Involved Youth. J Community Health 2024:10.1007/s10900-024-01356-3. [PMID: 38581624 DOI: 10.1007/s10900-024-01356-3] [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] [Accepted: 03/13/2024] [Indexed: 04/08/2024]
Abstract
Firearm carriage and possession predicts youth firearm violence victimization and perpetration. This study describes self-reported factors associated with firearm access, carriage, and possession among justice-involved youth. We conducted an exploratory, mixed-methods study. Participants were recruited from May 2022 to February 2023 from the Juvenile Justice Collaborative, a diversion program for justice-involved youth. We used online anonymous surveys to investigate exposures related to firearm access, carriage, and possession. We performed semi-structured interviews using the phenomenology framework. We used descriptive statistics to examine firearm exposures by participant demographics. We performed qualitative analyses using an iterative approach with constant comparison to identify key themes. We completed 28 surveys and 5 interviews. Most survey participants identified as male (57%) and Black (61%) with a median age of 18 years. Interview participants described the socialization and cultural normalization of firearms, most prominently among peers. Survey participants reported whether they had ever carried (25%) or possessed (21%) a firearm. Survey and interview participants endorsed protection in the context of increasing violence exposure over time as the primary motivation for firearm possession. Interview participants describe accessing firearms primarily through social networks while survey participants also reported access from strangers (25%) and licensed sellers/gun dealers (18%). In conclusion, justice-involved youth believe firearm carriage and possession may be needed for protection due to increasing violence exposure. Further investigation is necessary to determine interventions that may decrease firearm access, carriage, and possession among justice-involved youth.
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Affiliation(s)
- Samaa Kemal
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, Illinois, United States.
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.
| | - Lauren Jones-Robinson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Kevin Rak
- Patrick M. Magoon Institute for Healthy Communitiese, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Cassandra Otoo
- Patrick M. Magoon Institute for Healthy Communitiese, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Leonardo Barrera
- Mary Ann and J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Karen Sheehan
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, Illinois, United States
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Patrick M. Magoon Institute for Healthy Communitiese, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
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Sokol RL, Lee D, Rowhani-Rahbar A, Pelletier K, Zimmerman M, Carter PM. Associations between experiencing violence, owning a firearm for protection and firearm storage: a nationally representative analysis of US caregivers of teens. Inj Prev 2024; 30:27-32. [PMID: 37678904 PMCID: PMC10840900 DOI: 10.1136/ip-2023-044901] [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: 03/20/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To study the interaction between violence exposure and motivations for firearm ownership in their associations with firearm storage among caregivers of teens in the United States. METHODS In June-July 2020, we conducted a national survey of 2924 caregivers of US teens. We estimated multivariable logistic regressions among caregivers who owned a firearm (n=1095) to evaluate associations between the exposures of community violence, interpersonal violence, and firearm ownership motivations (protection motivations vs non-protection motivations) and the outcome of firearm storage patterns (locked and unloaded vs unlocked and/or loaded). We assessed for a potential interaction between violence exposures and motivations for firearm ownership in their associations with firearm storage. RESULTS We observed no associations between community (adjusted OR [aOR]: 0.86; 95% CI [0.55 to 1.36]) or interpersonal violence exposure (aOR: 0.60; 95% CI [0.22 to 1.65]) and firearm storage behaviours, and these associations did not vary according to firearm ownership motivations (relative excess risk due to interaction: -0.09 [-1.90 to 1.73]; -2.04 [-6.00 to 1.92]). Owning a firearm for protection was associated with increased odds of storing at least one firearm unlocked and/or loaded (aOR: 3.48; 95% CI [2.11 to 5.75]), and this association persisted across all strata of violence exposures (aORs: 1.51-3.98; 95% CIs [0.52 to 8.31]-[1.96 to 8.08]). CONCLUSIONS The motivation to own a firearm for protection was associated with storing a firearm unlocked and/or loaded. The results suggest the associations between violence exposure and firearm storage are more complicated than anticipated because (1) exposure to violence was not associated with firearm storage practices and (2) motivations for firearm ownership do not appear to explain why people differ in firearm storage following violence exposure.
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Affiliation(s)
- Rebeccah Lyn Sokol
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Lee
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, MI, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Karissa Pelletier
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, MI, USA
| | - Marc Zimmerman
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Patrick M Carter
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, MI, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Thulin EJ, French A, Messman E, Masi R, Heinze JE. Firearm-Related Tips in a Statewide School Anonymous Reporting System. Pediatrics 2024; 153:e2023063861. [PMID: 38229535 DOI: 10.1542/peds.2023-063861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
- Elyse J Thulin
- Addiction Center, Psychiatry, Michigan Medicine, Ann Arbor, Michigan
- The Michigan Institute for Data Science
- Prevention Research Center
- Sandy Hook Promise Foundation, Newtown, Connecticut
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan
| | - Alex French
- Sandy Hook Promise Foundation, Newtown, Connecticut
| | - Elizabeth Messman
- Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Rachel Masi
- Sandy Hook Promise Foundation, Newtown, Connecticut
- Rachel A. Masi, Ph.D. PLLC Clinical Psychology Practice, New York, New York
| | - Justin E Heinze
- Prevention Research Center
- Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Glasser NJ, Baker NA, Pollack HA, Hussaini SS, Tung EL. Age Trends And State Disparities In Firearm-Related Suicide In The US, 1999-2020. Health Aff (Millwood) 2023; 42:1551-1558. [PMID: 37931189 DOI: 10.1377/hlthaff.2023.00399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Using data from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System, we analyzed trends in firearm suicide across the life course, comparing age-related trends over time (2015-20 versus 1999-2014) and stratified by differences in state firearm policy environments. Overall, we found stable trends in firearm suicide rates across the life course, although with higher overall rates across all age groups in 2015-20 versus in 1999-2014. Ages 14-16 was the only age group with an accelerating life-course trend in firearm suicide rates in 2015-20 versus in 1999-2014. The state policy environment was associated with significant differences in firearm suicide, with an average of 4.62 more deaths per 100,000 people per year in states with less- versus more-strict environments. This was in contrast to nonfirearm suicides, for which we observed no consistent differences between states. The largest overall differences in firearm suicide between states occurred in adulthood through middle age. These findings can inform further research on health care-based approaches to reducing firearm suicide, such as health care screening for firearm ownership, screening for suicide risk among firearm owners, and motivational interviewing to promote safe firearm storage.
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Rauk L, Rupp L, Hohl BC, Kondo MC, Ornelas L, Carter PM, Zimmerman MA. Lessons learned from local vacant land management organizations for engaging youth in greening. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 72:187-202. [PMID: 37327062 DOI: 10.1002/ajcp.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
Youth living in areas with high concentrations of vacant properties may be at particular risk for poor health outcomes given the associations between deteriorated vacant properties, poor mental health, and community violence. Vacant lot greening has emerged as a key strategy to mitigate the harms of deteriorated properties. Youth engagement in greening has documented benefits for youth, yet few organizations responsible for managing vacant properties currently engage youth. Further, few researchers have examined the best practices that organizations can employ to effectively engage youth in greening programs. The purpose of this study was to understand how high functioning vacant land management organizations with robust youth engagement capabilities engage youth in their greening work. Based on in-depth interviews with staff from vacant land management organizations, we explored three research questions: (1) what are their identified best practices for youth engagement?; (2) what are the major challenges that impede their youth engagement work?; (3) what solutions are these organizations employing to address these challenges? Findings from this study emphasize the important themes of engaging youth in vacant lot greening in areas of planning, leadership, and decision-making. Youth engagement in vacant lot greening may be a key mechanism for preventing violence through cultivating youth empowerment and development.
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Affiliation(s)
- Leigh Rauk
- UM Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Laney Rupp
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Bernadette C Hohl
- Perelman School of Medicine, Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle C Kondo
- USDA Forest Service, Northern Research Station, Philadelphia, Pennsylvania, USA
| | - Lexie Ornelas
- Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Patrick M Carter
- UM Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Marc A Zimmerman
- UM Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Melhado CG, Sullivan TM, Stephens CQ, Burd RS, Jensen AR. Functional impairment associated with nonfatal pediatric firearm injuries. Surgery 2023; 174:692-697. [PMID: 37301611 DOI: 10.1016/j.surg.2023.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/08/2023] [Accepted: 04/27/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Firearm injury is now the leading cause of death for children in the United States. Functional morbidity among survivors also contributes to the public health burden of firearm injury but has not been quantified in children. This study aimed to assess functional impairment among survivors of pediatric firearm injury. METHODS We analyzed an 8-year (2014-2022) retrospective cohort of children (0-18 years) treated for firearm injuries at 2 urban level 1 pediatric trauma centers. The Functional Status Scale was used to assess functional impairment among survivors at discharge and at follow-up. Functional impairment was defined using multisystem (Functional Status Scale ≥8) and single-system (Functional Status Scale = 7) definitions. RESULTS The cohort included 282 children with a mean age of 11.1 (standard deviation 4.5) years. In-hospital mortality was 7% (n = 19). Functional impairment (Functional Status Scale ≥8) was present in 9% (n = 24) of children at discharge and in 7% (n = 13/192) at follow-up. Mild impairment in a single domain (Functional Status Scale = 7) was seen in 42% (n = 110) of the cohort at discharge. This impairment persisted to follow-up in most (67%, n = 59/88) of these children. CONCLUSION Functional impairment at discharge after firearm injury is common among children surviving transport in these trauma centers. These data highlight the added value of non-mortality metrics in assessing the health burden of pediatric firearm injuries. The collective impact of mortality and functional morbidity should be considered when advocating for resources to protect children.
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Affiliation(s)
- Caroline G Melhado
- Division of Pediatric Surgery, University of California-San Francisco Benioff Children's Hospitals, and Department of Surgery, University of California-San Francisco, CA
| | - Travis M Sullivan
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Caroline Q Stephens
- Division of Pediatric Surgery, University of California-San Francisco Benioff Children's Hospitals, and Department of Surgery, University of California-San Francisco, CA
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Aaron R Jensen
- Division of Pediatric Surgery, University of California-San Francisco Benioff Children's Hospitals, and Department of Surgery, University of California-San Francisco, CA.
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Kwon EG, Nehra D, Hall M, Herrera-Escobar JP, Rivara FP, Rice-Townsend SE. The association between childhood opportunity index and pediatric hospitalization for firearm injury or motor vehicle crash. Surgery 2023; 174:356-362. [PMID: 37211510 DOI: 10.1016/j.surg.2023.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/01/2023] [Accepted: 04/09/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Community-level factors can profoundly impact children's health, including the risk of violent injury. This study's objective was to understand the relationship between the Childhood Opportunity Index and pediatric firearm injury owing to interpersonal violence compared with a motor vehicle crash. METHODS All pediatric patients (<18 years) who presented with an initial encounter with a firearm injury or motor vehicle crash between 2016 to 2021 were identified from 35 children's hospitals included in the Pediatric Health Information System database. The child-specific community-level vulnerability was determined by the Childhood Opportunity Index, a composite score of neighborhood opportunity level data specific to pediatric populations. RESULTS We identified 67,407 patients treated for injuries related to motor vehicle crashes (n = 61,527) or firearms (n = 5,880). The overall cohort had a mean age of 9.3 (standard deviation 5.4) years; 50.0% were male patients, 44.0% non-Hispanic Black, and were 60.8% publicly insured. Compared with motor vehicle crash injuries, patients with firearm-related injuries were older (12.2 vs 9.0 years), more likely to be male patients (77.7% vs 47.4%), non-Hispanic Black (63.5% vs 42.1%), and had public insurance (76.4 vs 59.3%; all P < .001). In multivariable analysis, children living in communities with lower Childhood Opportunity Index levels were more likely to present with firearm injury than those living in communities with a very high Childhood Opportunity Index. The odds increased as the Childhood Opportunity Index level decreased (odds ratio 1.33, 1.60, 1.73, 2.00 for high, moderate, low, and very low Childhood Opportunity Index, respectively; all P ≤ .001). CONCLUSION Children from lower-Childhood Opportunity Index communities are disproportionately impacted by firearm violence, and these findings have important implications for both clinical care and public health policy.
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Affiliation(s)
- Eustina G Kwon
- Department of General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Deepika Nehra
- Division of Trauma, Burn, and Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, WA
| | | | - Juan P Herrera-Escobar
- Division of Trauma, Burn, and Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, WA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Samuel E Rice-Townsend
- Department of General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA.
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Owens G, Nguyen A, Hershberger P, Conway K, Crawford T. Opportunities and Barriers to Screening and Counseling for Safe Firearm Storage. PRIMER (LEAWOOD, KAN.) 2023; 7:22. [PMID: 37791053 PMCID: PMC10544631 DOI: 10.22454/primer.2023.953811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Objectives Safety practices such as storing a firearm locked and unloaded are widely promoted although not universally applied. Educating patients about firearm safety practices is effective in increasing safe firearms storage behaviors; however, screening for safe firearm storage in practice remains low. The aim of this study was to evaluate whether our clinic population was at risk for firearm-related injuries and whether opportunities existed to study risk-mitigation interventions in future work. Methods The study was conducted at a suburban, midwestern academic family medicine clinic. Patients filled out paper surveys about firearm ownership and willingness to discuss firearms safety with clinicians. Health care personnel filled out paper or electronic surveys about their comfort level in discussing firearm safety with patients. Data then were collated and analyzed. Results We surveyed 160 patients (60% female, 80% White), and 40.6% of respondents reported living in a home with a firearm. Respondents who stored their firearm unsafely were more willing to discuss firearm safety than to change their storage behavior. Eighteen health care personnel responded to our health care personnel survey. Perceived barriers to asking about firearms included lack of time, knowledge, or educational materials. Having a screening policy was selected as the best opportunity for improvement. Conclusions Firearm owners appear willing to discuss firearm safety with their clinician, potentially representing an opportunity to promote risk-reduction through approaches such as motivational interviewing. In a busy outpatient setting, automating the firearm screening process could lessen the burden on clinicians.
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Affiliation(s)
- Grace Owens
- St Elizabeth Family Medicine Residency, Edgewood, KY
| | - Anh Nguyen
- Kaiser Permanente Los Angeles Medical Center Internal Medicine Residency, Los Angeles, CA
| | - Paul Hershberger
- Department of Family Medicine, Boonshoft School of Medicine, Dayton, OH
| | - Katharine Conway
- Department of Family Medicine, Boonshoft School of Medicine, Dayton, OH
| | - Timothy Crawford
- Department of Family Medicine, Boonshoft School of Medicine, Dayton, OH | Department of Population and Public Health Sciences, Boonshoft School of Medicine, Dayton, OH
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Kwon EG, Herrera-Escobar JP, Bulger EM, Rice-Townsend SE, Nehra D. Community-Level Social Vulnerability and Patterns of Adolescent Injury. ANNALS OF SURGERY OPEN 2023; 4:e287. [PMID: 37601470 PMCID: PMC10431479 DOI: 10.1097/as9.0000000000000287] [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: 10/17/2022] [Accepted: 04/09/2023] [Indexed: 08/22/2023] Open
Abstract
Objective To describe adolescent injuries by the community-level social vulnerability, focusing on injuries related to interpersonal violence. Background The Center for Disease Control and Prevention's social vulnerability index (SVI) is a tool used to characterize community-level vulnerability. Methods Injured adolescent trauma patients (13-17 years old) cared for at a large Level I trauma center over a 10-year period were identified. Injuries were classified by intent as either intentional or unintentional. Census tract level SVI was calculated by composite score and for 4 subindex scores (socioeconomic, household composition/disability, minority/language, housing type/transportation). Patients were stratified by SVI quartile with the lowest quartile designated as low-, the middle two quartiles as average-, and the highest quartile as high vulnerability. The primary outcome was odds of intentional injury. Demographic and injury characteristics were compared by SVI and intent. Multivariable logistic regression was used to estimate the adjusted odds of intentional injury associated with SVI. Results A total of 1993 injured adolescent patients (1676 unintentional and 317 intentional) were included. The composite SVI was higher in the intentional injury cohort (mean, SD: 66.7, 27.8 vs. 50.5, 30.2; P < 0.001) as was each subindex SVI. The high SVI cohort comprised 31% of the study population, 49% of intentional injuries, and 51% of deaths. The high SVI cohort had significantly increased unadjusted (odds ratio, 4.5; 95% confidence interval, 3.0-6.6) and adjusted (odds ratio, 1.8; 95% confidence interval, 1.6-2.8) odds of intentional injury. Conclusions Adolescents living in the highest SVI areas experience significantly higher odds of intentional injury. SVI and SVI subindex details may provide direction for community-level interventions to decrease the impact of violent injury among adolescents.
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Affiliation(s)
- Eustina G. Kwon
- From the Department of General and Thoracic Surgery, Seattle Children’s Hospital, University of Washington, Seattle, WA
| | - Juan P. Herrera-Escobar
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Eileen M. Bulger
- Division of Trauma, Burn, and Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, WA
| | - Samuel E. Rice-Townsend
- From the Department of General and Thoracic Surgery, Seattle Children’s Hospital, University of Washington, Seattle, WA
| | - Deepika Nehra
- Division of Trauma, Burn, and Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, WA
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Kaufman EJ, Richmond TS, Hoskins K. Youth Firearm Injury: A Review for Pediatric Critical Care Clinicians. Crit Care Clin 2023; 39:357-371. [PMID: 36898779 PMCID: PMC9662754 DOI: 10.1016/j.ccc.2022.09.010] [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] [Indexed: 11/16/2022]
Abstract
Firearms are now the leading cause of death among youth in the United States, with rates of homicide and suicide rising even more steeply during the SARS-CoV-2 pandemic. These injuries and deaths have wide-ranging consequences for the physical and emotional health of youth and families. While pediatric critical care clinicians must treat the injured survivors, they can also play a role in prevention by understanding the risks and consequences of firearm injuries; taking a trauma-informed approach to the care of injured youth; counseling patients and families on firearm access; and advocating for youth safety policy and programming.
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Affiliation(s)
- Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Penn Presbyterian Medical Center, MOB Suite 120, 51 North 39th Street, Philadelphia, PA 19104, USA
| | - Therese S Richmond
- University of Pennsylvania School of Nursing, Fagin Hall 330, 418 Curie Boulevard, Philadelphia, PA 19104, USA.
| | - Katelin Hoskins
- University of Pennsylvania School of Nursing, Fagin Hall 312, 418 Curie Boulevard, Philadelphia, PA 19104, USA
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Population-Based Assessment of Urban Versus Rural Child Fatalities From Firearms in a Midwestern State. J Surg Res 2023; 283:52-58. [PMID: 36370682 DOI: 10.1016/j.jss.2022.10.013] [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: 04/07/2022] [Revised: 08/22/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Several studies have evaluated differences in firearm injury patterns among children based on regionalization. However, many of these studies exclude patients who die before arriving at a trauma center. We therefore hypothesize that important population-based differences in pediatric firearm injuries may be uncovered with the inclusion of both prehospital firearm mortalities and patients treated at a tertiary children's hospital. METHODS Patients less than 15 y of age who sustained a firearms-related injury/death between the years 2012 and 2018 were identified in: (1) death certificates from the Office of Vital Statistics State of Indiana and (2) Riley Hospital for Children at Indiana University Health Trauma Registry. Counties of injury were classified as either urban, midsized, or rural based on the National Center for Health Statistic's population data. Significant variables in univariate analysis were then assessed using multivariate logistic regression models. RESULTS A total of 222 patients were identified. Median age of firearm injury survivors was 13 (interquartile range 7-14), while the median age of nonsurvivors was 14 (interquartile range 11-15), P = 0.040. The proportion of suicide was significantly higher in rural counties (P < 0.001). When controlling for shooter intent, patients from a rural or midsized county had statistically significant higher odds of dying before reaching a hospital than their urban counterpart (rural odds ratio [OR] 5.67 [95% confidence interval {CI} 2.23, 14.38]; midsized OR 6.53 [95% CI 2.43, 17.46]; P < 0.001). CONCLUSIONS Important differences exist between pediatric firearm injuries based on where they occur. Public health initiatives aimed at reducing pediatric firearm injury and death should not exclude rural pediatrics patients.
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Drake SA, McDaniel M, Pepper C. A scoping review of nursing education for firearm safety. NURSE EDUCATION TODAY 2023; 121:105713. [PMID: 36657319 DOI: 10.1016/j.nedt.2023.105713] [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: 09/30/2022] [Revised: 12/03/2022] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Firearm violence, whether intentional or accidental, affects families worldwide. Nurses often encounter firearm-related injury and death with little knowledge or preparation for dealing with firearm safety issues. OBJECTIVES The aim was to locate published research on nurse education in firearm safety and examine the preparation of nurses to deal with issues of firearm safety as a deterrent toward decreasing violence. The review included nurse perceptions of barriers and facilitators related to firearm safety in clinical situations. DESIGN A literature scoping review for article identification, examination, and reporting was structured on the extended form of Arksey and O'Malley's 5-step design framework. DATA SOURCES Databases CINAHL, MEDLINE, Sociological Abstracts, PsychInfo, and ERIC were searched for articles in English language published between 2010 and 2021 that included nurses in the studies' samples. REVIEW METHODS Searches were managed via Covidence®, a literature screening and data extraction tool. Two independent reviewers screened the articles retrieved from the databases by title, abstract, and full-text review. Data from selected articles were extracted onto a spreadsheet and critically appraised for eligibility. RESULTS A search of healthcare databases resulted in identification of 645 articles, of which 15 met inclusion criteria. Seven of the 15 articles addressed nurse firearm safety preparation, and seven related to counseling firearm safety for suicide prevention. Main barriers included lack of standardized guidelines, inadequate knowledge, and discomfort discussing firearm safety with patients and families. CONCLUSIONS The scoping review findings show a noticeable gap: nurse education addressing firearm safety is, for all purposes, non-existent. A need exists for evidence-based training within academic curricula and across acute and behavioral healthcare settings.
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Affiliation(s)
- Stacy A Drake
- Texas A&M University College of Nursing, Stacy Drake Consulting, LLC, 3404 Rivers Edge Drive, Perrysburg, OH 43551, United States of America.
| | - Mary McDaniel
- Texas A&M University College of Nursing, United States of America
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16
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Schwebel DC. The forgotten facet of firearms safety: Unintentional gun injuries and deaths in the United States. Front Public Health 2023; 11:1137725. [PMID: 37033015 PMCID: PMC10076623 DOI: 10.3389/fpubh.2023.1137725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
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17
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Tarragona-Camacho A, López-Morales J, Romo-Avilés N. A qualitative insight at gender-based violence among young alcohol consumers in leisure contexts. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:60-67. [PMID: 36538977 DOI: 10.1016/j.enfcle.2022.10.007] [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: 11/02/2021] [Accepted: 10/25/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To know the characteristics of gender violence that underlies among adolescents in the context of leisure, their behavior and how they overcome these conflicts in leisure contexts where the consume alcohol. METHOD Qualitative study, with an ethnographic and feminist approach, with the participation of young people aged 16-22, frequenters of nightlife contexts and alcohol consumers, residents of two Andalusian provinces and one of Castilla-La Mancha. The participants were selected through intentional sampling and interviewed in depth. RESULTS Adolescents frequently suffer from gender-based violence in leisure contexts that they assume normally as part of the role of having fun, while they use their own protection strategies to minimize risks. The abuse of alcohol and other drugs increases the possibility that a gender violence event take place. CONCLUSION Gender-based violence among young people in the context of leisure, presents special characteristics that it is necessary to know in order to design preventive policies. The most vulnerable are young women who consume alcohol intensively. They usually go to the hospital emergency department for being unconscious due to alcohol consumption.
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Affiliation(s)
- Alicia Tarragona-Camacho
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain
| | - Juan López-Morales
- Departamento de Trabajo Social y Servicios Sociales, Facultad de Trabajo Social, Universidad de Granada, Granada, Spain.
| | - Nuria Romo-Avilés
- Departamento de Antropología Social, Facultad de Filosofía y Letras, Universidad de Granada, Granada, Spain
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18
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Brunson RK, Wade BA, Hitchens BK. Examining risky firearm behaviors among high-risk gun carriers in New York City. Prev Med 2022; 165:107179. [PMID: 35933002 DOI: 10.1016/j.ypmed.2022.107179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/01/2022] [Accepted: 07/30/2022] [Indexed: 11/24/2022]
Abstract
Precarious firearm conduct among inexperienced gun possessors has the potential to intensify firearm-related fatalities and injuries. The current study involves face-to-face interviews with 51 high-risk (and prohibited) residents of Brooklyn and the Bronx, NY, each of whom have either been shot or shot at. We analyze study participants' lived experiences regarding urban gun violence (including as victims and perpetrators), firearm handling, sharing, and improper storage. Despite claiming to be knowledgeable about firearm fundamentals, the vast majority of respondents acknowledged never having received professional instruction, but rather "figured it out" by "playing around" with available guns. These informal methods were shaped by respondents' desire to arm themselves despite inadequate access to firearm training. Study participants also described routinely stashing firearms in unsecure, easily accessible locations. Our study findings have important implications for informing community-based harm reduction and safety strategies among persons within high-risk networks.
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Affiliation(s)
- Rod K Brunson
- Department of Criminology & Criminal Justice, University of Maryland, USA.
| | - Brian A Wade
- Crime and Justice Policy Lab, University of Pennsylvania, USA
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Tarragona-Camacho A, López-Morales J, Romo-Avilés N. Una mirada cualitativa a la violencia de género entre jóvenes consumidores de alcohol en contextos de ocio. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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20
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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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21
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Cunningham RM, Lee D, Carter PM. The Role of Academic Medical Centers in the Prevention of Violence and Firearm-Related Morbidity and Mortality. JAMA 2022; 328:1195-1196. [PMID: 36166011 DOI: 10.1001/jama.2022.16897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This Viewpoint argues that academic medical centers should address firearm violence through clinical care, education of health care professionals, research, and public policy discussions.
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Affiliation(s)
- Rebecca M Cunningham
- UM Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
| | - Daniel Lee
- UM Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor
| | - Patrick M Carter
- UM Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
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22
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Firearms, Physicians, Families, and Kids: Finding Words that Work. J Pediatr 2022; 247:133-137. [PMID: 35605644 DOI: 10.1016/j.jpeds.2022.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/19/2022] [Accepted: 05/17/2022] [Indexed: 11/21/2022]
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23
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Magee LA, Dennis Fortenberry J, Aalsma MC, Gharbi S, Wiehe SE. Healthcare utilization and mental health outcomes among nonfatal shooting assault victims. Prev Med Rep 2022; 27:101824. [PMID: 35656226 PMCID: PMC9152773 DOI: 10.1016/j.pmedr.2022.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Victims of nonfatal shooting (NFS) assaults suffer from emotional and physical trauma; however, little is understood about clinical care utilization patterns among victims. This study examines the healthcare utilization and mental health outcomes before and after an index NFS victimization. A longitudinal dataset of police and clinical data were linked at the individual level to define a cohort of NFS victims with one or more clinical encounter in the 24-months preceding an index NFS injury (N = 2,681) in Indianapolis, Indiana between 2005 and 2018. Mental health was defined using ICD diagnosis codes from any emergency department, inpatient, or outpatient encounter and clinical care utilization was the number of unique encounters within the 24-months preceding and following an index NFS injury. Multivariable logistic regression was conducted to examine factors associated with a mental health diagnosis in the post injury period. Analyses were conducted in October 2021-March 2022. Overall clinical care utilization (Mean: pre = 277.7 (SD 235.3) vs. post = 333.9 (SD 255.1), p < 0.001) and mental health prevalence (14.4% pre vs. 18.8% post, p < 0.001) increased in the 24-months following an index NFS compared to the prior 24-months. Preinjury mental health utilization increased the odds of receiving a mental health diagnosis in the 24-months following an index NFS injury - particularly for Black victims (Odds Ratio 1.69, 95% CI 1.01, 2.85). The findings indicate missed opportunities within the healthcare system to connect NFS victims with needed mental health services, as well as the importance of premorbid connection to mental health care.
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Affiliation(s)
- Lauren A. Magee
- O’Neill School of Public and Environmental Affairs, Indiana University Purdue University – Indianapolis, 801 W. Michigan Street, Indianapolis, IN 46204, USA
| | - J. Dennis Fortenberry
- Department of Adolescent Medicine, Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46204, USA
| | - Matthew C. Aalsma
- Department of Pediatrics, Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46204, USA
| | - Sami Gharbi
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46204, USA
| | - Sarah E. Wiehe
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46204, USA
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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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25
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Ruch DA, Steelesmith DL, Brock G, Boch SJ, Quinn CR, Bridge JA, Campo JV, Fontanella CA. Mortality and Cause of Death Among Youths Previously Incarcerated in the Juvenile Legal System. JAMA Netw Open 2021; 4:e2140352. [PMID: 34940865 PMCID: PMC8703246 DOI: 10.1001/jamanetworkopen.2021.40352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/26/2021] [Indexed: 11/15/2022] Open
Abstract
Importance More than 50 000 youths are incarcerated in the United States on any given day, and youth incarceration has been linked to lasting adverse outcomes, including early mortality. Improving our understanding of the factors associated with early mortality among incarcerated youths can inform appropriate prevention strategies. Objective To examine mortality rates and causes of death among youths previously incarcerated in the juvenile legal system. Design, Setting, and Participants This retrospective longitudinal population-based cohort study compared mortality rates between youths aged 11 to 21 years incarcerated from 2010 to 2017 with same-aged nonincarcerated Medicaid-enrolled youths in the state of Ohio. Data from January 2017 to December 2019 were collected from juvenile incarceration, Medicaid, and death certificate information in Ohio. Exposure Incarceration in the state of Ohio's juvenile legal system. Main Outcomes and Measures Number, characteristics, and causes of deaths. Poisson regression incidence rate ratios (IRRs) compared mortality rates between previously incarcerated and Medicaid-enrolled youths. Results Among 3645 incarcerated youths, 3398 (93.2%) were male, 2155 (59.1%) Black, 1307 (35.9%) White, and 183 (5.0%) other race and ethnicity. Overall, 113 youths (3.1%) died during the study period. Homicide was the leading cause of death in formerly incarcerated youths (homicide: 63 [55.8%]; legal intervention [ie, death due to injuries inflicted by law enforcement]: 3 [2.7%]). All-cause mortality rates were significantly higher among previously incarcerated youths than Medicaid-enrolled youths (adjusted IRR [aIRR], 5.91; 95% CI, 4.90-7.13) in every demographic subgroup. Compared with Medicaid-enrolled youths, mortality rates for previously incarcerated youths were highest for homicide (aIRR, 11.02; 95% CI, 8.54-14.22), overdose (aIRR, 4.32; 95% CI, 2.59-7.20), and suicide (aIRR, 4.30; 95% CI, 2.22-8.33). Formerly incarcerated Black youths had a significantly higher risk of homicide (aIRR, 14.24; 95% CI, 4.45-45.63) but a lower risk of suicide (aIRR, 0.18; 95% CI, 0.04-0.89) and overdose (aIRR, 0.31; 95% CI, 0.10-0.99) than White youths who were incarcerated. Previously incarcerated youths aged 15 to 21 years were significantly more likely to die than youths aged 22 to 29 years, irrespective of cause of death (aIRR for youths aged 22-29 years, 0.09; 95% CI, 0.06-0.14). Conclusions and Relevance In this study, youths with a history of incarceration were significantly more likely to experience early mortality compared with nonincarcerated Medicaid-enrolled youths. Delinquency and violence prevention strategies that incorporate a culturally informed approach and consider sex and developmental level are critical.
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Affiliation(s)
- Donna A. Ruch
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Danielle L. Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - Samantha J. Boch
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | - Jeffrey A. Bridge
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - John V. Campo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia A. Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
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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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27
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Cohen JS, Donnelly K, Patel SJ, Badolato GM, Boyle MD, McCarter R, Goyal MK. Firearms Injuries Involving Young Children in the United States During the COVID-19 Pandemic. Pediatrics 2021; 148:peds.2020-042697. [PMID: 33850026 DOI: 10.1542/peds.2020-042697] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Increased rates of firearm ownership, school closures, and a suspected decrease in supervision during the coronavirus disease 2019 (COVID-19) pandemic place young children at increased risk of firearm injuries. We measured trends in firearm injuries in children and inflicted by children discharging a firearm during the pandemic and correlated these changes with a rise in firearm acquisition. METHODS In this cross-sectional study with an interrupted time series analysis, we used multiyear data from the Gun Violence Archive. We compared trends in (1) firearm injuries in children younger than 12 years old and (2) firearm injuries inflicted by children younger than 12 years old during the pre-COVID-19 period (March to August in the years 2016-2019) and during the first 6 months of the COVID-19 pandemic (March 2020 to August 2020). Linear regression models were developed to evaluate the relationship between firearm injuries and new firearm acquisitions. RESULTS There was an increased risk of (1) firearm injuries in young children (relative risk = 1.90; 95% confidence interval 1.58 to 2.29) and (2) firearm injuries inflicted by young children (relative risk = 1.43; 95% confidence interval 1.14 to 1.80) during the first 6 months of the COVID-19 pandemic as compared to the pre-COVID-19 study period. These increased incidents correlate with an increase in new firearm ownership (P < .03). CONCLUSIONS There has been a surge in firearm injuries in young children and inflicted by young children during the first 6 months of the COVID-19 pandemic. There is an urgent and critical need for enactment of interventions aimed at preventing firearm injuries and deaths involving children.
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Affiliation(s)
- Joanna S Cohen
- Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia.,Departments of Pediatrics.,Emergency Medicine, School of Medicine and Health Sciences
| | - Katie Donnelly
- Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia.,Departments of Pediatrics.,Emergency Medicine, School of Medicine and Health Sciences
| | - Shilpa J Patel
- Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia.,Departments of Pediatrics.,Emergency Medicine, School of Medicine and Health Sciences
| | - Gia M Badolato
- Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia
| | - Meleah D Boyle
- Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia
| | - Robert McCarter
- Departments of Pediatrics.,Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia .,Departments of Pediatrics.,Emergency Medicine, School of Medicine and Health Sciences
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Borthwell RM, Olanrewaju S, Putnam BA, Kim DY, Chong VE. Recovery of Pediatric Patients After Firearm Injury: Can Health Systems Do More? Am Surg 2021; 87:1644-1650. [PMID: 34132616 DOI: 10.1177/00031348211024227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Firearm injuries are the second leading cause of death among youth in the United States. Nonfatal firearm injuries far outnumber fatalities, yet data detailing the recovery and post-injury needs of pediatric patients after hospital discharge are limited. This study evaluated health system support of pediatric patients after firearm injury, from acute hospitalization to outpatient follow-up. METHODS We conducted a retrospective chart review of patients <18 years who presented to an urban level 1 trauma center between 2014 and 2019. Cases were categorized as accidental or intentional (stratified as assault-related or "crossfire" injuries). Outcomes included biopsychosocial assessment (BA) utilization, trauma psychology service consultation, and linkage to outpatient services. RESULTS Among 115 patients, 94% were victims of community violence. Black (50%) and Latinx (44%) patients were disproportionately affected, as were males aged 15-16 years (71%). Overall mortality was 8%. Biopsychosocial assessment and trauma psychology consultations occurred in 43% and 20% of cases, respectively. Of eligible patients, 71% received referral to post-hospitalization support services. The most commonly identified needs were counseling, gang intervention, and help with the carceral system. CONCLUSION Health systems should support long-term recovery of pediatric patients after firearm injury, particularly addressing social and structural determinants of health. Inpatient-to-outpatient linkages should be strengthened, and prospective follow-up is needed.
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Affiliation(s)
- Rachel M Borthwell
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA, USA.,The Lundquist Institute, Torrance, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Samuel Olanrewaju
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Brant A Putnam
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA, USA.,The Lundquist Institute, Torrance, CA, USA
| | - Dennis Y Kim
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA, USA.,The Lundquist Institute, Torrance, CA, USA
| | - Vincent E Chong
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA, USA.,The Lundquist Institute, Torrance, CA, USA
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Bottiani JH, Camacho DA, Lindstrom Johnson S, Bradshaw CP. Annual Research Review: Youth firearm violence disparities in the United States and implications for prevention. J Child Psychol Psychiatry 2021; 62:563-579. [PMID: 33797082 PMCID: PMC9993333 DOI: 10.1111/jcpp.13392] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Research has identified the United States (U.S.) as a global outlier in its firearm ownership rates, with a correspondingly higher risk of youth firearm violence compared to other countries. The relative extent of disparities in youth firearm violence within the U.S. has been less clear. Little is known about factors in the social ecology driving these disparities and whether current firearm violence prevention approaches sufficiently address them. METHOD Applying a health disparities framework, we synthesized epidemiological, sociological, and prevention science literatures, emphasizing structural inequalities in youth sociocultural positionality in life course developmental context. We also highlighted findings from national injury data and other studies regarding the magnitude and impacts of youth firearm violence disparities. RESULTS The burden of firearm violence varied markedly at intersections of gender, race, place, developmental stage, and homicidal or suicidal intent. Firearm homicide among Black boys and young men (ages 15-24) was at outlier levels - many times greater than the rates of any other demographic group, developmental stage, or violence intent, particularly in urban settings. Recent research has operationalized structural racism and implicated historically racialized spaces as a root cause of this disparity. In contrast, elevated firearm suicide rates were found among Native and White boys and young men in rural settings; firearm-related cultural attitudes and gender socialization were points of consideration to explain these disparities. We highlighted research-based youth firearm violence preventive interventions, and emphasized gaps in efforts focused on structural and sociocultural factors. CONCLUSIONS More explicit attention to reducing firearm homicide among Black boys and young men and firearm suicide among Native and rural White boys and young men is urgently needed and has potential to substantially lower overall rates of firearm violence in the U.S.
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Affiliation(s)
- Jessika H Bottiani
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Daniel A Camacho
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | | | - Catherine P Bradshaw
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
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Carter PM, Zimmerman MA, Cunningham RM. Addressing Key Gaps in Existing Longitudinal Research and Establishing a Pathway Forward for Firearm Violence Prevention Research. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:367-384. [PMID: 34086512 PMCID: PMC8186821 DOI: 10.1080/15374416.2021.1913741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The main purpose of this article and this special section is to encourage greater attention to the key gaps that exist in our understanding of the epidemiology of adolescent firearm violence and to provide a pathway forward for future longitudinal research that will inform prevention efforts. This increased attention is especially salient given: (a) firearms are the leading cause of death for adolescents and emerging adults in the United States, with the majority of these deaths due to interpersonal violence; (b) significant health and social disparities with regards to the populations that are most affected by interpersonal firearm violence have been documented; and, (c) limitations in federal research funding during the past 30 years have created a deficit of knowledge about key risk and protective factors necessary to inform evidence-based prevention efforts. We discuss the implications of the articles in this special edition for existing and novel prevention programs. We also identify key considerations for future epidemiological research, including the need for a greater focus on collecting longitudinal data among nationally representative samples enriched with subgroups of at-risk youth, the need to examine the role of protective factors and mediating variables within existing and novel theoretical models of firearm risk behaviors, the need to examine key factors across all levels of the socio-ecological model, and the need to incorporate novel and innovative research designs, methods and analyses.
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Affiliation(s)
- Patrick M Carter
- Firearm Safety among Children and Teens Consortium, University of Michigan School of Medicine
- Department of Emergency Medicine, University of Michigan School of Medicine
- Department of Health Behavior/Health Education, University of Michigan School Public Health
- Youth Violence Prevention Center, University of Michigan School of Public Health
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine
| | - Marc A Zimmerman
- Firearm Safety among Children and Teens Consortium, University of Michigan School of Medicine
- Department of Health Behavior/Health Education, University of Michigan School Public Health
- Youth Violence Prevention Center, University of Michigan School of Public Health
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine
| | - Rebecca M Cunningham
- Firearm Safety among Children and Teens Consortium, University of Michigan School of Medicine
- Department of Emergency Medicine, University of Michigan School of Medicine
- Department of Health Behavior/Health Education, University of Michigan School Public Health
- Youth Violence Prevention Center, University of Michigan School of Public Health
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine
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Shulman EP, Beardslee J, Fine A, Frick PJ, Steinberg L, Cauffman E. Exposure to Gun Violence: Associations with Anxiety, Depressive Symptoms, and Aggression among Male Juvenile Offenders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:353-366. [PMID: 33830838 DOI: 10.1080/15374416.2021.1888742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To examine whether at-risk male youth experience increases in anxiety, depressive symptoms, and aggression during years when they are exposed to gun violence, adjusting for relevant covariates.Method: Participants were 1,216 male, justice-involved adolescents who were recently arrested for the first time for a moderate offense. They were interviewed 9 times over 5 years. Fixed effects (within-individual) regression models were used to estimate concurrent associations between exposure to gun violence and three outcomes: depressive symptoms, anxiety symptoms, and aggression (both overall and separately for proactive and reactive aggression). The reverse direction (anxiety, depressive symptoms, and aggression predicting gun violence exposure) was also modeled.Results: After controlling for covariates, exposure to gun violence was significantly associated with increases in reactive aggression and, to a lesser extent, increases in proactive aggression. In addition, gun violence exposure was associated with increased anxiety but not depressive symptoms. We found no support for the reverse direction.Conclusions: At-risk males experienced significant increases in anxiety and aggression (particularly reactive aggression) during years when they are exposed to gun violence, even after accounting for several potential confounding factors. The greater impact on reactive aggression suggests that exposure to gun violence may affect self-regulation and/or social information processing. The analyses shed light on the less-visible damage wrought by gun violence and underscore the importance of mental health screening and treatment for youth who have been exposed to violence - especially gun violence - both to assist individual youths and to disrupt cycles of violence.
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Affiliation(s)
| | - Jordan Beardslee
- Department of Psychological Science, University of California, Irvine
| | - Adam Fine
- Criminology & Criminal Justice, Arizona State University
| | - Paul J Frick
- Department of Psychology, Louisiana State University.,Faculty of Education and the Arts, Australian Catholic University
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Manley NR, Huang DD, Lewis RH, Bee T, Fischer PE, Croce MA, Magnotti LJ. Caught in the crossfire: 37 Years of firearm violence afflicting America's youth. J Trauma Acute Care Surg 2021; 90:623-630. [PMID: 33405467 DOI: 10.1097/ta.0000000000003060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Publicly available firearm data are difficult to access. Trauma registry data are excellent at documenting patterns of firearm-related injury. Law enforcement data excel at capturing national violence trends to include both circumstances and firearm involvement. The goal of this study was to use publicly available law enforcement data from all 50 states to better define patterns of firearm-related homicides in the young. METHODS All homicides in individuals 25 years or younger in the United States over a 37-year period ending in 2016 were analyzed: infant, 1 year or younger; child, 1 to 9 years old; adolescent, 10 to 19 years old; and young adult, 20 to 25 years old. Primary data files were obtained from the Federal Bureau of Investigation and comprised the database. Data analyzed included homicide type, situation, circumstance, month, firearm type, and demographics. Rates of all homicides and firearm-related homicides per 1 million population and the proportion of firearm-related homicides (out of all homicides) were stratified by year and compared over time using simple linear regression. RESULTS A total of 171,113 incidents of firearm-related homicide were analyzed (69% of 246,437 total homicides): 5,313 infants, 2,332 children, 59,777 adolescents, and 103,691 young adults. Most (88%) were male and Black (59%) with a median age of 20 years. Firearm-related homicides peaked during the summer months of June, July, and August (median, 1,156 per year; p = 0.0032). Rates of all homicides (89 to 53 per 1 million population) and firearm-related homicides (56 to 41 per 1 million population) decreased significantly from 1980 to 2016 (β = -1.12, p < 0.0001 and β = -0.57, p = 0.0039, respectively). However, linear regression analysis identified a significant increase in the proportion of firearm-related homicides (out of all homicides) from 63% in 1980 to 76% in 2016 (β = 0.33, p < 0.0001). CONCLUSION For those 25 years or younger, the proportion of firearm-related homicides has steadily and significantly increased over the past 37 years, with 3 of 4 homicides firearm related in the modern era. Despite focused efforts, reductions in the rate of firearm-related homicides still lag behind those for all other methods of homicide by nearly 50%. That is, while the young are less likely to die from homicide, for those unfortunate victims, it is more likely to be due to a firearm. This increasing role of firearms in youth homicides underscores the desperate need to better direct prevention efforts and firearm policy if we hope to further reduce firearm-related deaths in the young. LEVEL OF EVIDENCE Epidemiological study, level III.
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Affiliation(s)
- Nathan R Manley
- From the Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
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Wasserman RC, Fiks AG. The Future(s) of Pediatric Primary Care. Acad Pediatr 2021; 21:414-424. [PMID: 33130066 DOI: 10.1016/j.acap.2020.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
Pediatric primary care (PPC) arose in the early 20th century as the fusion of acute and chronic pediatric illness care with preventive elements borrowed from public and maternal and child health. Well-established and thriving by the 1930s, PPC saw major changes in childhood morbidity and mortality in the latter half of the 20th century with the recognition of the "new morbidity" of school, behavior, and social problems. At the same time, PPC experienced changes in its workforce, which became increasingly female and added nurse practitioners and physician assistants as practitioners. Independent practice, previously the dominant business model, decreased in prominence at the end of the 20th century as health systems bought practices and other sites morphed into federally qualified health centers. In the present century, electronic health records (EHRs) have brought profound changes in PPC workflows and practitioner experience. In addition, disruptive market competition such as retail clinics and corporate telemedicine providers coupled with changes in health insurance from fee-for-service to value-based payment further challenge the care model and economics of PPC. Finally, recognition of family social circumstances as major determinants of children's health presents another challenge to the status quo. As such, although one PPC future may resemble its present state, a more innovative future is likely to include clinics and practices more oriented toward and linked to communities and directed at the social determinants of health. In addition, the rise in physical, behavioral, and social problems in practice call for a growing focus on wellness, including sleep, nutrition, and activity, that promises to reorient the PPC future in productive new directions. The half-way technology of current EHR systems will ideally be spun into electronic hubs that facilitate teamwork between PPC, specialists, and community groups. Research and practice improvement strategies including involvement in "learning health systems" will be critical to making PPC effective in an evolving society. Although threatened by 21st century forces and hard-to-anticipate change, PPC is ideally positioned to build upon its core functions to create multidisciplinary teams that reach into the community, promoting a holistic wellness for children consistent with the broadest definition of health.
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Affiliation(s)
- Richard C Wasserman
- Larner College of Medicine, University of Vermont (RC Wasserman), Charlotte, Vt.
| | - Alexander G Fiks
- Children's Hospital of Philadelphia, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, and the Possibilities Project, Roberts Center for Pediatric Research (AG Fiks), Philadelphia, Pa
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Gowda C, Hardy RY, Traylor S, Liu GC. Trends in healthcare utilisation for firearm-related injuries among a cohort of publicly insured children in Ohio. J Epidemiol Community Health 2021; 75:906-909. [PMID: 33637614 DOI: 10.1136/jech-2020-215940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/18/2021] [Accepted: 02/14/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine healthcare utilisation for all firearm-related injuries among publicly insured children. METHODS A retrospective analysis of firearm injury medical claims among paediatric (<21 years) Medicaid beneficiaries in Ohio from 2010 to 2018. Factors associated with unintentional and intentional firearm injury were explored using multivariable logistic regression. Average annual patient healthcare costs were determined in 2019 US$. RESULTS There were 1061 firearm injury-related claims (853 (80%) unintentional; 154 (15%) intentional; 54 (5%) unknown) occurring in 663 children over 2 736 517 available person-years. From 2010 to 2018, yearly total firearm claims rose from 19.7 to 31.3 per 100 000 persons (p=0.033). Urban children experienced a non-significant increase in firearm claims rate over time (26.1 vs 35.0/100 000; p=0.066) while the claims rate nearly tripled among those in rural areas (8.4 vs 24.0/100 000; p=0.012). Younger age, females and rural residence were associated with reduced odds of injury claims. The average annual costs for emergency department and inpatient visits, respectively, were $260 and $5735. CONCLUSION Risk and type of firearm injury claims among low-income children in Ohio varies by age, sex and residence. Prevention programmes should be tailored based on these demographics.
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Affiliation(s)
- Charitha Gowda
- Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Rose Y Hardy
- Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Gilbert C Liu
- Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Schwebel DC, Long DL, Gowey M, Severson J, He Y, Trullinger K. Study protocol: developing and evaluating an interactive web platform to teach children hunting, shooting and firearms safety: a randomized controlled trial. BMC Public Health 2021; 21:308. [PMID: 33549072 PMCID: PMC7866873 DOI: 10.1186/s12889-021-10345-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Firearms injuries present a major pediatric public health challenge in the United States. This study protocol describes research to develop and then conduct a randomized clinical trial to evaluate ShootSafe, an interactive, engaging, educational website to teach children firearms safety. ShootSafe has three primary goals: (a) teach children basic knowledge and skills needed to hunt, shoot, and use firearms safely; (b) help children learn and hone critical cognitive skills of impulse control and hypothetical thinking needed to use firearms safely; and (c) alter children's perceptions about their own vulnerability and susceptibility to firearms-related injuries, the severity of those injuries, and their perceived norms about peer behavior surrounding firearms use. ShootSafe will accomplish these goals through a combination of interactive games plus short, impactful testimonial videos and short expert-led educational videos. METHODS Following website development, ShootSafe will be evaluated through a randomized controlled trial with 162 children ages 10-12, randomly assigning children to engage in ShootSafe or an active control website. Multiple self-report, computer-based, and behavioral measures will assess functioning at baseline, immediately following training, and at 4-month follow-up. Four sets of outcomes will be considered: firearms safety knowledge; cognitive skills in impulse control and hypothetical thinking; perceptions about firearms safety; and simulated behavior when handling, storing and transporting firearms. Training in both conditions will comprise two 45-min sessions. DISCUSSION If results are as hypothesized, ShootSafe offers potential as a theory-based program to teach children firearms safety in an accessible, engaging and educational manner. Translation into practice is highly feasible. TRIAL REGISTRATION The study protocol was registered on 11/10/20 at clinicaltrials.gov ( NCT04622943 ).
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Affiliation(s)
- David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, AL, 35294, USA.
| | - D Leann Long
- Department of Biostatistics, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, USA
| | - Marissa Gowey
- Department of Pediatrics, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, AL, 35294, USA
| | | | - Yefei He
- Digital Artefacts, Iowa City, IA, USA
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Bleyer A, Siegel SE, Thomas CR. Increasing Rate of Unintentional Firearm Deaths in Youngest Americans: Firearm Prevalence and Covid-19 Pandemic Implication. J Natl Med Assoc 2021; 113:265-277. [PMID: 33446333 DOI: 10.1016/j.jnma.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The United States has had, by far, the world's greatest civilian ownership of firearms. An even greater ownership occurred during the Covd-19 pandemic, mostly of handguns and including many new owners. The U.S. has also had the least progress of the 41 highest sociodemographic countries ranked by the Institute for Health Metrics and Evaluation in reducing the unintentional firearm mortality rate in young children. This study characterized the unintentional firearm mortality trends in American 1-4 year-olds by sex and race/ethnicity and evaluated the trends in the context of firearm prevalence in the U.S. METHODS Mortality data for 1999-2018 were obtained from the U.S. Centers for Disease Control and Prevention and the Institute for Health Metrics and Evaluation, firearm injury and mortality data for 2016-2020 from Everytown for Gun Safety #NotAnAccident database, firearm background check data for 1999-2020 from the National Instant Criminal Background Check System, and civilian firearm prevalence for 2017 from the Small Arms Survey. RESULTS In American 1-4 year-olds, the rate of unintentional firearm deaths during 1999-2018 increased exponentially at an average annual percent rate of 4.9 (p < 0.001) and was greatest in non-Hispanic black children. Unintentional firearm deaths had the most rapid increase of all evaluable causes of death in the age group. The unintentional firearm death rate increase was correlated with the concurrent rate of firearm background checks and handgun permits issued (each p < 0.001) and in non-Hispanic white children with handgun prevalence in their families (p = 0.03). Globally, the unintentional firearm death rate was also correlated with firearm prevalence (p = 0.02). CONCLUSIONS An increase in fatal firearm accidents in the United States death rate among 1-4 year-olds is directly associated with the steadily increasing prevalence of firearms. The acceleration of firearm deaths and injuries among young Americans, especially among non-Hispanic black children, requires urgent solutions to address firearm prevalence and access. The problem is expected to become even more urgent as a result of the record high firearm sales that occurred in the United States during the 2020 coronavirus pandemic.
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Affiliation(s)
- Archie Bleyer
- Knight Cancer Institute and Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA; McGovern Medical School, University of Texas, Houston, TX, USA.
| | | | - Charles R Thomas
- Department of Radiation Medicine and Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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Sokol RL, Carter PM, Goldstick J, Miller AL, Walton MA, Zimmerman MA, Cunningham RM. Within-Person Variability in Firearm Carriage Among High-Risk Youth. Am J Prev Med 2020; 59:386-393. [PMID: 32430221 PMCID: PMC7483893 DOI: 10.1016/j.amepre.2020.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Youth who carry firearms-and peers that surround them-are at increased risk for violent injuries. Because firearm carriage behaviors can change over time within an individual, it is important to identify individual and social-contextual determinants that explain this within-person variability in carriage. METHODS The authors identified individual and social-contextual determinants of firearm carriage in the past 6 months using multilevel logistic models on 5 waves of panel data from the Flint Youth Injury Study (n=597; ages 14-24 years), collected in 2009-2011 and analyzed in 2019. RESULTS Regarding within-person effects, when an individual had more positive peer affiliations than their average, their odds of carrying a firearm decreased (OR=0.88; 95% CI=0.81, 0.96). Conversely, an individual's odds of carrying a firearm increased when they had more negative peer affiliations (OR=1.08, 95% CI=1.02, 1.14), experienced more victimization (OR=1.03, 95% CI=1.01, 1.05), perceived greater community violence (OR=1.12, 95% CI=1.05, 1.21), or exhibited greater retaliatory attitudes (OR=1.10, 95% CI=1.01, 1.19) than their average. CONCLUSIONS Peer affiliations, victimization, community violence perceptions, and retaliatory attitudes explain within-person variability in firearm carriage. Strategies for reducing carriage among youth should consider individual- and environmental-level interventions to address these individual and social-contextual determinants.
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Affiliation(s)
- Rebeccah L Sokol
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Patrick M Carter
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jason Goldstick
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Alison L Miller
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Marc A Zimmerman
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, School of Public Health, University of Michigan, Ann Arbor, Michigan; Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan
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Haviland MJ, Rowhani-Rahbar A, Rivara FP. Age, period and cohort effects in firearm homicide and suicide in the USA, 1983–2017. Inj Prev 2020; 27:344-348. [DOI: 10.1136/injuryprev-2020-043714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/30/2022]
Abstract
BackgroundRates of firearm homicide and suicide have varied over time. These variations are due to a number of factors including temporal trends, age, birth year and gender. We sought to conduct an age–period–cohort analysis to understand the intersection of these factors with firearm homicide and suicide.MethodsWe used data on firearm homicide and suicide for the years 1983–2017 from the Centers for Disease Control and Prevention’s Web-based Injury Statistics Query and Reporting System for this analysis. We restricted our analysis on firearm homicide to persons aged 10–44 years and our analysis on firearm suicide to persons aged 50–84 years, as these age groups are most at risk of each outcome. We calculated annual incidence rates for both outcomes per 100 000 population, overall and by gender.ResultsAcross all age groups, rates of firearm homicide increased dramatically in the late 1980s and early 1990s. The peak age for firearm homicide varied across cohorts, although it was generally between ages 15 and 29 years. Rates of firearm homicide were substantially higher among men than women, regardless of age, period or cohort. Firearm suicide rates varied significantly by gender. Among men, older cohorts had higher firearm suicide rates, although the rate of firearm suicide increased with age across all cohorts. Among women, firearm suicide rates were also highest among older cohorts; however, firearm suicide rates decreased or remained relatively constant with age.ConclusionThere are important differences in rates of firearm homicide and suicide with respect to gender, age, period and cohort.
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Culyba AJ. It Is Time We Start Asking: Handgun Carrying Among Youth in Rural Contexts. J Adolesc Health 2020; 66:383-384. [PMID: 32199517 DOI: 10.1016/j.jadohealth.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Alison J Culyba
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Cunningham RM, Ranney ML, Goldstick JE, Kamat SV, Roche JS, Carter PM. Federal Funding For Research On The Leading Causes Of Death Among Children And Adolescents. Health Aff (Millwood) 2019; 38:1653-1661. [PMID: 31589521 PMCID: PMC7039655 DOI: 10.1377/hlthaff.2019.00476] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Firearm injuries are the second-leading cause of death for US children and adolescents (ages 1-18). This analysis quantified the federal dollars granted to research for the leading US causes of death for this age group in 2008-17. Several federal data sources were queried. On average, in the study period, $88 million per year was granted to research motor vehicle crashes, the leading cause of death in this age group. Cancer, the third-leading cause of mortality, received $335 million per year. In contrast, $12 million-only thirty-two grants, averaging $597 in research dollars per death-went to firearm injury prevention research among children and adolescents. According to a regression analysis, funding for pediatric firearm injury prevention was only 3.3 percent of what would be predicted by mortality burden, and that level of funding resulted in fewer scientific articles than predicted. A thirtyfold increase in firearm injury research funding focused on this age group, or at least $37 million per year, is needed for research funding to be commensurate with the mortality burden.
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Affiliation(s)
- Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan School of Medicine, in Ann Arbor
| | - Megan L. Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, in Providence, Rhode Island
| | - Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan School of Medicine
| | - Sonia V. Kamat
- Department of Emergency Medicine, University of Michigan School of Medicine
| | - Jessica S. Roche
- Department of Emergency Medicine, University of Michigan School of Medicine
| | - Patrick M. Carter
- Department of Emergency Medicine, University of Michigan School of Medicine
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Promoting Safe Firearm Storage in an Urban Neighborhood: The Views of Parents Concerning the Role of Health Care Providers. J Community Health 2019; 45:338-341. [PMID: 31549353 DOI: 10.1007/s10900-019-00748-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pediatric clinics are uniquely positioned to assess and advocate for the health and safety of Chicago's children in relation to accidental firearm-related injury and death. The best means of counseling families should be tailored to the individual community and patient population. We aimed to determine rates of firearm ownership and attitudes towards counseling about firearms in a community on the west side of Chicago with high rates of gun violence. An anonymous survey about gun ownership was administered at a federally qualified health center. The survey was completed by 206 adults with children less than 18 living in the home. A minority of participants (8.3%; n = 17) indicated that a gun was kept in or around the home. The majority of firearm owners reported using safe storage practices. However, just over half of the gun owners and non-gun owners had a favorable opinion of counseling about firearm safety in healthcare settings. Other strategies in addition to physician counseling will be required to promote safe firearm storage in this neighborhood with high rates of community violence.
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Cunningham RM, Carter PM, Zimmerman M. The Firearm Safety Among Children and Teens (FACTS) Consortium: defining the current state of the science on pediatric firearm injury prevention. J Behav Med 2019; 42:702-705. [PMID: 31367935 PMCID: PMC7139852 DOI: 10.1007/s10865-019-00077-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/26/2019] [Indexed: 12/14/2022]
Abstract
Five teams of FACTS researchers conducted a series of rigorous scoping reviews of the existing published scientific literature from the fields of medicine, public health, psychology, behavioral health, and criminology from January of 1985 through April of 2018 utilizing the Preferred Reporting Items for Scoping Reviews (Tricco et al., Ann Intern Med 169:467-473, 2018) framework to guide the search strategy, study selection, data abstraction, and analysis process. These scoping reviews characterize the existing scientific literature in five key areas related to Firearm Injury Prevention among children and adolescents (age 0-17): (1) Adolescent Firearm Carriage; (2) Risk and Protective Factors for Firearm Injury; (3) Primary Prevention Initiatives; (4) Long-term consequences and secondary prevention of negative outcomes after a firearm injury; and, (5) Effects of existing law and policy interventions on pediatric firearm outcomes. In this special issue of the Journal of Behavioral Medicine, we present these five scoping review articles.
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Affiliation(s)
- Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
- FACTS Consortium, 2800 Plymouth Rd., Bldg 10-G080, Ann Arbor, MI, 48109, USA.
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- FACTS Consortium, 2800 Plymouth Rd., Bldg 10-G080, Ann Arbor, MI, 48109, USA
| | - Mark Zimmerman
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- FACTS Consortium, 2800 Plymouth Rd., Bldg 10-G080, Ann Arbor, MI, 48109, USA
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Cunningham RM, Carter PM, Ranney ML, Walton M, Zeoli AM, Alpern ER, Branas C, Beidas RS, Ehrlich PF, Goyal MK, Goldstick JE, Hemenway D, Hargarten SW, King CA, Massey L, Ngo Q, Pizarro J, Prosser L, Rowhani-Rahbar A, Rivara F, Rupp LA, Sigel E, Savolainen J, Zimmerman MA. Prevention of Firearm Injuries Among Children and Adolescents: Consensus-Driven Research Agenda from the Firearm Safety Among Children and Teens (FACTS) Consortium. JAMA Pediatr 2019; 173:780-789. [PMID: 31180470 PMCID: PMC6901804 DOI: 10.1001/jamapediatrics.2019.1494] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Firearm injuries are the second leading cause of death among US children and adolescents. Because of the lack of resources allocated to firearm injury prevention during the past 25 years, research has lagged behind other areas of injury prevention. Identifying timely and important research questions regarding firearm injury prevention is a critical step for reducing pediatric mortality. OBJECTIVE The Firearm Safety Among Children and Teens (FACTS) Consortium, a National Institute for Child Health and Human Development-funded group of scientists and stakeholders, was formed in 2017 to develop research resources for the field, including a pediatric-specific research agenda for firearm injury prevention to assist future researchers and funders, as well as to inform cross-disciplinary evidence-based research on this critical injury prevention topic. EVIDENCE REVIEW A nominal group technique process was used, including 4 key steps (idea generation, round-robin, clarification, and voting and consensus). During idea generation, stakeholders and workgroups generated initial research agenda topics after conducting scoping reviews of the literature to identify existing gaps in knowledge. Agenda topics were refined through 6 rounds of discussion and survey feedback (ie, round-robin, and clarification steps). Final voting (using a 5-point Likert scale) was conducted to achieve consensus (≥70% of consortium ranking items at 4 or 5 priority for inclusion) around key research priorities for the next 5 years of research in this field. Final agenda questions were reviewed by both the stakeholder group and an external panel of research experts not affiliated with the FACTS Consortium. Feedback was integrated and the final set of agenda items was ratified by the entire FACTS Consortium. FINDINGS Overall, 26 priority agenda items with examples of specific research questions were identified across 5 major thematic areas, including epidemiology and risk and protective factors, primary prevention, secondary prevention and sequelae, cross-cutting prevention factors, policy, and data enhancement. CONCLUSIONS AND RELEVANCE These priority agenda items, when taken together, define a comprehensive pediatric-specific firearm injury prevention research agenda that will guide research resource allocation within this field during the next 5 years.
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Affiliation(s)
- Rebecca M Cunningham
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Patrick M Carter
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Megan L Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Maureen Walton
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor
| | - April M Zeoli
- School of Criminal Justice, Michigan State University, East Lansing
| | - Elizabeth R Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Peter F Ehrlich
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor
| | - Monika K Goyal
- Children's National Medical Center, The George Washington University, Washington, DC
| | - Jason E Goldstick
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - David Hemenway
- Department of Health Policy and Management, T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts
| | - Stephen W Hargarten
- Department of Emergency Medicine, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee
| | - Cheryl A King
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor
| | - Lynn Massey
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Quyen Ngo
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Jesenia Pizarro
- School of Criminology and Criminal Justice, Arizona State University, Phoenix
| | - Lisa Prosser
- Child Health Evaluation and Research Center, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
- Departments of Pediatrics, School of Medicine, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Fredrick Rivara
- Departments of Pediatrics, School of Medicine, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Laney A Rupp
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
| | - Eric Sigel
- Section of Adolescent Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Jukka Savolainen
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Marc A Zimmerman
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
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