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Doucette ML, Meyerson NS, Crifasi CK, Wagner E, Webster DW. Firearm injury hospitalizations and handgun purchaser licensing laws: longitudinal evaluation of state-level purchaser licensure requirements on firearm violence, 2000-2016. Inj Epidemiol 2024; 11:39. [PMID: 39180063 PMCID: PMC11342609 DOI: 10.1186/s40621-024-00522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/19/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Handgun purchaser licensing (HPL) laws mandate individuals to obtain a license from law enforcement before buying a firearm. Research indicates these laws effectively reduce various forms of fatal firearm violence, including homicides, suicides, and mass shootings. Our study sought to assess the impact of HPL laws on non-fatal firearm violence. METHODS Utilizing the augmented synthetic control method (ASCM), we estimated the average treatment effect on the treated (ATT) resulting from a full repeal of an HPL law in Missouri (2007), a partial repeal in Michigan (2012), and an adoption on HPL law in Maryland (2013) on firearm injury hospitalizations. We utilized RAND's healthcare cost and utilization project-based dataset from 2000 to 2016 for our outcome variable. We conducted in-time placebo testing and leave-one-out donor pool testing as sensitivity analyses. RESULTS Maryland's adoption was associated with a statistically significant 32.3% reduction in firearm-related injury hospitalization (FIH) rates (ATT = - 0.497, standard error (SE) = 0.123); Missouri's repeal was associated with a statistically significant 35.7% increase in FIH rates (ASCM = 0.456, SE = 0.155); and Michigan's partial repeal showed no statistically significant associations with FIH rates (ATT = - 0.074, SE = 0.129). Sensitivity analyses confirm the robustness of the estimated HPL effects. DISCUSSION HPL laws appear to be protective against hospitalizations for nonfatal firearm injuries. These findings align with prior research indicating that HPL laws are effective in reducing fatal firearm violence. States without such licensing systems ought to consider these robust policies as a means to address firearm violence.
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Affiliation(s)
- Mitchell L Doucette
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA.
| | - Nicholas S Meyerson
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA
| | - Cassandra K Crifasi
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA
| | - Elizabeth Wagner
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA
| | - Daniel W Webster
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA
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Price JH, Khubchandani J. Fatal Firearm Violence Among American Indians and Alaska Natives. J Community Health 2024; 49:492-498. [PMID: 38127297 DOI: 10.1007/s10900-023-01300-x] [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] [Accepted: 10/20/2023] [Indexed: 12/23/2023]
Abstract
There is a dearth of population-based studies regarding firearm-related deaths and years of potential life lost among American Indians and Alaska Natives (AI/AN). Using the Centers for Disease Control and Prevention's (CDC) We Based Injury Statistics Query and Reporting System (WISQARS) data for the three most recent years (2018-2020), we analyzed the demographic characteristics of AI/ANs who succumbed to firearm violence. AI/ANs averaged almost 500 firearm-related deaths per year. The majority of these deaths were observed among individuals 20-39 years of age (53%), males (84.4%), and in the West (55.3%). A plurality of these firearm-related deaths were suicides (48.9%) followed by homicides (43.5%). During the 3-year study period, the age-adjusted firearm death rate increased almost 5 times the growth of the AI/AN population. Also, a staggering 67,050 years of potential life were lost before the age of 80 years (YPLL80) during this period. Firearm suicides were responsible for the largest proportion of YPLL80s (48.5%). Traditional legal interventions [e.g., child access prevention (CAP) laws and extreme risk protection orders (ERPO)], if expanded to more states could potentially help reduce AI/AN firearm mortality. None of the 10 states with the highest firearm mortality of AI/AN have ERPOs and 8 of the 10 do not have CAP laws. Also, a renewed focus on cultural continuity and indigenous protective factors is essential to ameliorate the level of firearm violence in AI/ANs.
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Kim KV, Rehm J, Kaplan MS, Lange S. Relationship Between Alcohol Use and Firearm-Involved Suicide: Findings From the National Violent Death Reporting System, 2003-2020. Am J Prev Med 2024; 66:832-839. [PMID: 38000484 DOI: 10.1016/j.amepre.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Acute alcohol intoxication is a contributing factor in firearm-involved suicides. However, knowledge of the relationship between alcohol intoxication and firearm-involved suicide by age and sex (defined herein as the biological sex of the decedent) is limited. The purpose of the current study was to evaluate the sex- and age group-specific relationship between alcohol intoxication and firearm-involved suicide. METHODS Data from the National Violent Death Reporting System, 2003-2020, on suicide decedents (18+ years of age) were utilized. Age-group- and sex-specific multivariate binary logistic regression analyses were conducted. Statistical analyses were performed in 2023. RESULTS Alcohol intoxication (i.e., having a blood alcohol concentration of 0.08 g/dL or more) was significantly associated with using a firearm as the method of suicide for young (18-34 years; relative risk (RR)=1.31, 95% CI: 1.22-1.40) and middle-aged (35-64 years; RR=1.34, 95% CI: 1.27-1.39) females but not among older females (65+ years; RR=1.01, 95% CI: 0.87-1.17). Among males, the association was significant for all age-groups (young: RR=1.28, 95% CI: 1.25-1.30; middle-aged: RR=1.17, 95% CI: 1.15-1.19; and older: RR=1.04, 95% CI: 1.01-1.07). CONCLUSIONS Among males of all ages and young and middle-aged females, alcohol intoxication was associated with increased risk of suicide by firearm-an extremely lethal method that accounts for a majority of suicides in the U.S.-compared to their non-intoxicated counterparts. Interventions targeting excessive alcohol consumption may be effective in reducing suicide mortality rates.
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Affiliation(s)
- Kawon V Kim
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Silver D, Bae JY, Macinko J. Protocol for creating a dataset of U.S. state alcohol-related firearm laws 2000-2022. PLoS One 2024; 19:e0299248. [PMID: 38451933 PMCID: PMC10919691 DOI: 10.1371/journal.pone.0299248] [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] [Received: 01/27/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Firearms are a major source of preventable morbidity and mortality in the United States, contributing to over 48,000 deaths in 2022 and generating societal costs in excess of $500 billion. A body of work has examined the relationship between US state level firearm laws and health outcomes, generally finding that some firearm regulations are associated with lower firearm-related mortality. Alcohol has been identified as an additional risk factor for both homicides and suicide and stronger state alcohol laws have been associated with lower rates of suicide. To date, there are no empirical studies that have investigated the impact of laws over a long period of time that target the intersection of alcohol and firearm. One reason for this may be because there is no existing dataset that includes the range of these state laws over time. This study describes the protocol for collecting, coding and operationalizing these legal data.
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Affiliation(s)
- Diana Silver
- New York University School of Global Public Health, New York, NY, United States of America
| | - Jin Yung Bae
- New York University School of Global Public Health, New York, NY, United States of America
| | - James Macinko
- UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States of America
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Nicosia N, Smart R, Schell TL. Effects of restricting alcohol sales on fatal violence: Evidence from Sunday sales bans. Drug Alcohol Depend 2023; 253:110982. [PMID: 37980844 DOI: 10.1016/j.drugalcdep.2023.110982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Homicides and suicides are the second- and third-leading causes of death among young people (aged 10-24) in the US. While a substantial share of these deaths involve alcohol, evidence is needed on whether specific alcohol policies, such as day-based sales restrictions, help prevent these deaths. METHODS We constructed total and firearm-related homicide and suicide counts by state, year, and day-of-week from the Multiple Cause of Death Micro-data 1990-2019. Repeals of Sunday bans were taken from the Alcohol Policy Information System. Two-way fixed effects Poisson models with standard errors clustered at state-level and population offset control for state, year and day-of-the-week fixed effects and state time-varying covariates. RESULTS Repealing Sunday bans is associated with an increase in homicides (IRR=1.125; 95% confidence interval [CI]:1.02-1.24) and firearm homicides (IRR=1.17; 95% CI:1.03-1.33). Analyses by day-of-the-week show significant associations with homicides not only on Sundays, but also other days, consistent with delays in death. There was no significant relationship for suicides. CONCLUSION Restricting alcohol availability may prove a useful policy tool to reduce homicides, given that day-based restrictions are associated with changes in deaths rather than only shifting across days-of-the-week.
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Schoen N, Matichak D, Armstrong V, Sedighim S, Lew E, Jagid J, Bullock MR, Richardson A. The Cost of Gunshot Wounds to the Head: An Unevenly Distributed Burden. World Neurosurg 2023; 172:e201-e211. [PMID: 36610644 DOI: 10.1016/j.wneu.2022.12.130] [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: 09/28/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite the significant clinical consequences and socioeconomic costs of gunshot wounds to the head (GSWH), studies examining prehospital risk factors, geospatial patterns, and economic cost are lacking. METHODS A retrospective analysis was performed for patients with GSWH (single or multiple injuries) presenting to the level one Ryder Trauma Center (hospital patients) as well as the Miami-Dade County Medical Examiner (ME) Department, from October 2013 to October 2015. In addition, ME data were queried from the previous decade (2008-2017) to analyze longitudinal trends. RESULTS A total of 402 consecutive patients met the inclusion criteria: 297 (74%) presented to the ME and 105 (26%) presented to the hospital. GSWH in our cohort had a case fatality rate of 89%, predominantly affecting males, whites, and individuals who committed suicide, with a mean age of 41.9 ± 20.6 years. Hospital patients were more likely to be black males from low socioeconomic status (SES) regions involved in assault. Older white males were overrepresented in patients attempting and completing suicide and thus comprised a higher percentage of ME cases. Geospatial analysis of hospital patient injury zip codes shows that GSWH are significantly clustered in low-income urban centers with greater poverty rates. In Miami-Dade County, the economic burden of GSWH, as measured by total health care costs and lifetime productivity losses, was estimated to be $11,867,415 and $246,179,498, respectively. CONCLUSIONS In the first analysis of GSWH with the inclusion of both hospital and ME data in a representative urban setting, our findings show prehospital risk factors and the unequal distribution of the significant economic costs of GSWH.
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Affiliation(s)
- Nathan Schoen
- Department of General Surgery, University of Miami Hospitals and Clinics, Miami, Florida, USA; Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - David Matichak
- Miller School of Medicine, University of Miami, Miami, Florida, USA.
| | | | - Shaina Sedighim
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Emma Lew
- Miami-Dade County Medical Examiner Department, Miami, Florida, USA
| | - Jonathan Jagid
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - M Ross Bullock
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Angela Richardson
- Department of Neurosurgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
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Doucette ML, McCourt AD, Crifasi CK, Webster DW. Impact of Changes to Concealed-Carry Weapons Laws on Fatal and Nonfatal Violent Crime, 1980-2019. Am J Epidemiol 2023; 192:342-355. [PMID: 36104849 DOI: 10.1093/aje/kwac160] [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: 11/19/2021] [Revised: 08/18/2022] [Accepted: 09/09/2022] [Indexed: 11/12/2022] Open
Abstract
The United States faces rapidly rising rates of violent crime committed with firearms. In this study, we sought to estimate the impact of changes to laws that regulate the concealed carrying of weapons (concealed-carry weapons (CCW) laws) on violent crimes committed with a firearm. We used augmented synthetic control models and random-effects meta-analyses to estimate state-specific effects and the average effect of adopting shall-issue CCW permitting laws on rates of 6 violent crimes: homicide with a gun, homicide by other means, aggravated assault with a gun, aggravated assault with a knife, robbery with a gun, and robbery with a knife. The average effects were stratified according to the presence or absence of several shall-issue permit provisions. Adoption of a shall-issue CCW law was associated with a 9.5% increase in rates of assault with a firearm during the first 10 years after law adoption and was associated with an 8.8% increase in rates of homicide by other means. When shall-issue laws allowed violent misdemeanants to acquire CCW permits, the laws were associated with higher rates of gun assaults. It is likely that adoption of shall-issue CCW laws has increased rates of nonfatal violent crime committed with firearms. Harmful effects of shall-issue laws are most clear when provisions intended to reduce risks associated with civilian gun-carrying are absent.
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Kester L, Holena DN, Hynes AM, Kaufman EJ, Brahmbhatt T, Sanchez S, Byrne JP, Dechert T, Seamon M, Scantling DR. Preventing the most common firearm deaths: Modifiable factors related to firearm suicide. Surgery 2023; 173:544-552. [PMID: 36396492 DOI: 10.1016/j.surg.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/21/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND More than 20,000 firearm suicides occur every year in America. Firearm restrictive legislation, firearm access, demographics, behavior, access to care, and socioeconomic metrics have been correlated to firearm suicide rates. Research to date has largely evaluated these contributors singularly. We aimed to evaluate them together as they exist in society. We hypothesized that state firearm laws would be associated with reduced firearm suicide rates. METHODS We acquired the 2013 to 2016 data for firearm suicide rates from The Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research. Firearm laws were obtained from the State Firearms Law Database. Depression rates and access to care were obtained from the Behavioral Risk Factor Surveillance System and Occupational Employment and Wage Statistics program. Population demographics, poverty, and access to social support were obtained from the American Community Survey. Firearm access estimates were retrieved from the National Instant Criminal Background Check System. We used a univariate panel linear regression with fixed effect for state and firearm suicide rates as the outcome. We created a final multivariable model to determine the adjusted associations of these factors with firearm suicide rates. RESULTS In univariate analysis, firearm access, heavy drinking behavior, demographics, and access to care correlated to increased firearm suicide rates. The state proportion identifying as white and the proportion of those in poverty receiving food benefits correlated to decreased firearm suicide rates. In multivariable regression, only heavy drinking (β, 0.290; 95% confidence interval, 0.092-0.481; P = .004) correlated to firearm suicides rates increases. CONCLUSIONS During our study, few firearm laws changed. Heavy drinking behavior association with firearm suicide rates suggests an opportunity for interventions exists in the health care setting.
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Affiliation(s)
- Louis Kester
- Division of Trauma and Acute Care Surgery, The Boston University School of Medicine/Boston Medical Center, MA. https://twitter.com/lou_was
| | - Daniel N Holena
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin Department of Surgery, Milwaukee, WI. https://twitter.com/daniel_holena
| | - Allyson M Hynes
- Department of Emergency Medicine, The University of New Mexico, Albuquerque, NM. https://twitter.com/elinorejkaufman
| | - Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, The University of Pennsylvania Department of Surgery, Philadelphia, PA
| | - Tejal Brahmbhatt
- Division of Trauma and Acute Care Surgery, The Boston University School of Medicine/Boston Medical Center, MA. https://twitter.com/tejalsb
| | - Sabrina Sanchez
- Division of Trauma and Acute Care Surgery, The Boston University School of Medicine/Boston Medical Center, MA. https://twitter.com/sesanchezmd
| | - James P Byrne
- Division of Traumatology, Johns Hopkins Hospital, Surgical Critical Care and Emergency Surgery, Baltimore, MD. https://twitter.com/dctrjbyrne
| | - Tracey Dechert
- Division of Trauma and Acute Care Surgery, The Boston University School of Medicine/Boston Medical Center, MA. https://twitter.com/traceydechert
| | - Mark Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, The University of Pennsylvania Department of Surgery, Philadelphia, PA. https://twitter.com/markseamonmd
| | - Dane R Scantling
- Division of Trauma and Acute Care Surgery, The Boston University School of Medicine/Boston Medical Center, MA.
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Pallin R, Wright MA, Tomsich EA, Wintemute GJ, Stewart S, Kagawa RMC. Prior Drug-Related Criminal Charges and Risk for Intimate Partner Violence Perpetration Among Authorized Purchasers of Handguns in California. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP23352-NP23373. [PMID: 35333106 DOI: 10.1177/08862605221078811] [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: 06/14/2023]
Abstract
Intimate partner violence (IPV) is a considerable public health problem in the US, and evidence suggests that both drugs and firearms contribute to the risk of IPV and its severity. This study uses a retrospective, longitudinal cohort design to explore the association between past arrests, charges incurred in the legal process, and convictions for drug-related crimes, and risk of future arrest for IPV among legal handgun purchasers. The cohort included all legal purchasers of handguns in California in 2001 between the ages of 21 and 49 (n = 79,678), 156 of whom had pre-purchase drug charges and post-purchase IPV charges. We used Cox proportional hazards regression with age at time of handgun purchase, sex, and race/ethnicity, and an array of community characteristics as covariates. Over the study period (2001-2013), in comparison to handgun purchasers who had no charges or convictions prior to their index purchase, risk for future IPV arrest was increased for purchasers whose only prior charges were drug-related (aHR = 3.4 [95% CI: 2.4-4.9]) and purchasers who had both prior drug- and non-drug related charges (aHR = 4.9 [95% CI: 4.1-6.0]). The magnitude of the risk ratio was greater when multiple drug types were involved and when the person had been charged with both the use and sale of drugs. Our findings suggest that, among legal handgun purchasers, prior drug charges are associated with future risk of IPV arrests or convictions. Given the established link between firearm access and IPV severity and fatality, these findings may inform the development and enforcement of policies that reduce firearm access for those at elevated risk of perpetrating intimate partner violence.
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Affiliation(s)
- Rocco Pallin
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, 8789University of California, Davis, Sacramento, CA, USA
| | - Mona A Wright
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, 8789University of California, Davis, Sacramento, CA, USA
| | - Elizabeth A Tomsich
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, 8789University of California, Davis, Sacramento, CA, USA
| | - Garen J Wintemute
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, 8789University of California, Davis, Sacramento, CA, USA
| | - Susan Stewart
- Department of Population Health and Reproduction, School of Veterinary Medicine and Department of Public Health Sciences, School of Medicine, 8789University of California, Davis, Sacramento, CA, USA
| | - Rose M C Kagawa
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, 8789University of California, Davis, Sacramento, CA, USA
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Sathya C, Harrison L, Dauber K, Kapoor S. A mixed methods protocol to implement universal firearm injury risk screening and intervention among youth and adults in emergency departments across a large US health system. Implement Sci Commun 2022; 3:124. [PMID: 36424643 PMCID: PMC9694908 DOI: 10.1186/s43058-022-00371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Firearm injury is a leading cause of preventable death in the USA. Healthcare providers are uniquely poised to focus on firearm safety and injury prevention from an apolitical harm reduction lens; however, few providers and healthcare settings incorporate firearm injury prevention strategies into usual care. We outline the first protocol to determine how to implement universal Firearm Injury and Mortality Prevention (FIMP) strategies that identify and address firearm access and violence risk in healthcare settings as part of routine care using the Consolidated Framework for Implementation Research (CFIR) to inform implementation and evaluation. METHODS The components of our FIMP strategy, including universal screening, intervention for patients at risk, and resources, will be developed from existing evidence-based strategies for firearm access and violence risk (intervention characteristics). The implementation process will include components of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use, adapted to FIMP (implementation process). To engage stakeholders, harmonize language, and garner support, an Executive Advisory Board (EAB) will be formed, consisting of the site- and system-level stakeholders (inner setting) and community stakeholders, including influential figures such as local religious and spiritual leaders, individuals with lived experience, and community-based organizations (outer setting). Pre-implementation surveys will identify the characteristics of individuals and guide the development of education prior to implementation. Patient-level screening data will be analyzed to identify the risk factors, implementation will be evaluated using mixed methods, and a limited-efficacy study will evaluate whether strategies were successful in driving behavior change. DISCUSSION This study protocol has breakthrough and methodological innovations, by addressing FIMP as part of usual care to directly mitigate firearm injury risk among youth, adults, and household members (e.g., children) and by using rigorous methods to inform healthcare industry implementation of FIMP strategies. The expected outcomes of this study protocol will provide a solid basis for larger-scale dissemination and evaluation of implementation, effectiveness, and usability across broader pediatric and adult healthcare settings. This project will advance the implementation science and have a positive impact on the health of our patients and communities by preventing firearm injury and mortality and shifting the paradigm to view FIMP through a public health lens.
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Affiliation(s)
- Chethan Sathya
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Center for Gun Violence Prevention, Northwell Health, New Hyde Park, NY, USA.
| | - Laura Harrison
- Addiction Services, Emergency Medicine Service Line, Northwell Health, 1111 Marcus, Suite M15, New Hyde Park, NY, 1104211042, USA
| | - Katherine Dauber
- Institute for Health System Science, Feinstein Institutes, Northwell Health, New Hyde Park, USA
| | - Sandeep Kapoor
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Gun Violence Prevention, Northwell Health, New Hyde Park, NY, USA
- Addiction Services, Emergency Medicine Service Line, Northwell Health, 1111 Marcus, Suite M15, New Hyde Park, NY, 1104211042, USA
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Balayssac D, Pereira B, Julien E, Chennell P, Brousse G, Laporte C, Authier N, Vennat B. Attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco), estimation of harmfulness and knowledge of these substances, and continuing education: A pilot cross-sectional study. ANNALES PHARMACEUTIQUES FRANÇAISES 2022; 80:897-905. [PMID: 35667462 DOI: 10.1016/j.pharma.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco). MATERIAL AND METHODS The attitudes were assessed thanks to the Attitude to Mental Illness Questionnaire (AMIQ) for heroin, alcohol and tobacco-related disorders in three independent groups of pharmacists. Estimation of substance-related harmfulness, knowledge of substance-related disorders and activities/needs for continuing education on substance-related disorders were also recorded. RESULTS Thirty-five pharmacists were included (heroin: 11, alcohol: 10 and tobacco: 14). AMIQ scores for heroin-related disorder were negative and lower than for alcohol (P<0.01) and tobacco (P<0.001). AMIQ scores for alcohol-related disorder were lower than for tobacco (P<0.05). The estimation of heroin-related harmfulness was higher than for alcohol and tobacco (P<0.001). The estimations of knowledge of substance-related disorders were lower for opioid and alcohol than for tobacco (P<0.001). AMIQ scores and the needs for continuing education on each associated addiction showed a positive relation (P<0.01). CONCLUSION Pharmacists had a negative attitude toward heroin and alcohol-related disorders. A positive attitude toward patients with a substance-related disorder was associated with a need for continuing education. Efforts should be made to change attitudes and to promote continuing education on heroin and alcohol-related disorders.
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Affiliation(s)
- D Balayssac
- Inserm U1107, NEURO-DOL, direction de la recherche clinique et de l'innovation, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France.
| | - B Pereira
- Direction de la recherche clinique et de l'innovation, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - E Julien
- Université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - P Chennell
- Service de pharmacie, CNRS, Sigma Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - G Brousse
- EA7280, service de psychiatrie B et d'addictologie, UFR de médicine, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - C Laporte
- Département de médecine générale, EA7280, UFR de médicine, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - N Authier
- Inserm U1107, NEURO-DOL, service de pharmacologie médicale, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - B Vennat
- ACCePPT, UFR de pharmacie, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
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Cerdá M, Hamilton AD, Tracy M, Branas C, Fink D, Keyes KM. Would restricting firearm purchases due to alcohol- and drug-related misdemeanor offenses reduce firearm homicide and suicide? An agent-based simulation. Inj Epidemiol 2022; 9:17. [PMID: 35681243 PMCID: PMC9185952 DOI: 10.1186/s40621-022-00381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Substance-related interactions with the criminal justice system are a potential touchpoint to identify people at risk for firearm violence. We used an agent-based model to simulate the change in firearm violence after disqualifying people from owning a firearm given prior alcohol- and drug-related misdemeanors.
Methods We created a population of 800,000 agents reflecting a 15% sample of the adult New York City population. Results Disqualification from purchasing firearms for 5 years after an alcohol-related misdemeanor conviction reduced population-level rates of firearm homicide by 1.0% [95% CI 0.4–1.6%] and suicide by 3.0% [95% CI 1.9–4.0%]. Disqualification based on a drug-related misdemeanor conviction reduced homicide by 1.6% [95% CI 1.1–2.2%] and suicide by 4.6% [95% CI 3.4–5.8%]. Reductions were generally 2 to 8 times larger for agents meeting the disqualification criteria. Conclusions Denying firearm access based on a history of drug and alcohol misdemeanors may reduce firearm violence among the high-risk group. Enactment of substance use-related firearms denial criteria needs to be balanced against concerns about introducing new sources of disenfranchisement among already vulnerable populations.
Supplementary Information The online version contains supplementary material available at 10.1186/s40621-022-00381-x.
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Affiliation(s)
- Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA. .,Department of Population Health, Grossman School of Medicine, NYU Langone Health, 180 Madison Avenue, Room 416, New York, NY, 10016, USA.
| | - Ava D Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Charles Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Reported firearm access among patients admitted to a dual diagnosis medically-assisted withdrawal unit over five years. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100034. [PMID: 36845895 PMCID: PMC9949337 DOI: 10.1016/j.dadr.2022.100034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/28/2022] [Accepted: 02/20/2022] [Indexed: 11/23/2022]
Abstract
Background Up to one-third of firearm-related suicides were carried out by individuals who had consumed alcohol shortly before their death. Despite the critical role of firearm access screening in suicide risk assessment, few studies have examined firearm access among patients with substance use disorders. This study examines the rates of firearm access among those admitted to a co-occurring diagnosis unit over a five year period. Methods All patients admitted to a co-occurring disorders inpatient unit from 2014 to mid-2020 were included. An analysis contrasting the differences among patients reporting firearms was performed. A multivariable logistic regression model using factors from initial admission were chosen based on clinical relevance, past firearms research, and statistical significance on bivariate analysis was used. Results Over the study period there were 7332 admissions representing 4055 patients. Documentation of firearm access was completed in 83.6% of admissions. Firearm access was reported in 9.4% of admissions. Patients reporting firearm access were more likely to report never having suicidal ideation (p = 0.001), be married (p = <0.001), and report no past history of suicide attempts (p = <0.001). The full logistic regression model revealed that being married (OR: 2.29 and p < 0.0001) and employed (OR: 1.51 and p = 0.024) were factors associated with firearms access. Conclusions This is one of the largest reports assessing factors associated with firearm access among those admitted to a co-occurring disorders unit. Firearm access rates in this population appear lower than rates in the general population. The roles employment and marital status play in firearm access deserve future attention.
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Alcohol and drug offenses and suicide risk among men who purchased a handgun in California: A cohort study. Prev Med 2021; 153:106821. [PMID: 34599927 DOI: 10.1016/j.ypmed.2021.106821] [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: 02/09/2021] [Revised: 09/10/2021] [Accepted: 09/26/2021] [Indexed: 11/21/2022]
Abstract
Firearm access is a risk factor for firearm suicide; substance use may confer additional risk. In this retrospective cohort study, we estimated the associations between prior alcohol and drug charges at the time of handgun purchase and subsequent suicide among men in California. The sample comprised all men who legally purchased a handgun in California in 2001 and who were age ≥ 21 at the time of acquisition (N = 101,377), identified in the California Department of Justice (CA DOJ) Dealer's Record of Sale database. Exposures included alcohol and drug criminal charges and convictions accrued January 1, 1990 until the first ('index') handgun acquisition in 2001, recorded in the CA DOJ Criminal History Information System. Outcomes included suicide and firearm suicide occurring after the index purchase and before January 1, 2016. A total of 1907 purchasers had alcohol charges, 1248 had drug charges, and 304 had both; 594 purchasers died by suicide (516 by firearm suicide). Compared with those with neither alcohol nor drug charges, those with alcohol charges had 2.20 times the hazard of suicide (95% confidence interval [CI], 1.39-3.46) and 2.22 times the hazard of firearm suicide (95% CI, 1.36-3.62). Risk was most elevated among those with more recent charges and those with 2 or more charges, and in the time period closest to the purchase. The associations for drug charges and the combination of alcohol and drug charges were not distinguishable from the null. Firearm owners with alcohol offenses may benefit from intervention to reduce firearm access and alcohol use.
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Malathesh BC, Kumar CN, Kandasamy A, Moirangthem S, Math SB, Murthy P. Legal, Social, and Occupational Problems in Persons with Alcohol Use Disorder: An Exploratory Study. Indian J Psychol Med 2021; 43:234-240. [PMID: 34345099 PMCID: PMC8287396 DOI: 10.1177/0253717620956466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Very few studies have examined the extent and nature of legal, social, and occupational problems among persons who have SUDs. This study was aimed at studying the prevalence and patterns of the aforementioned problems among individuals with alcohol use disorders (AUDs) and their relationship with the quantity of alcohol consumed and other variables. METHODS We conducted a cross-sectional study of adult patients with a diagnosis of AUDs admitted to the deaddiction unit of a tertiary care facility in India, using a semistructured questionnaire prepared for this study. RESULTS The mean age (SD) of the 91 subjects (95.6% males) was 40.3 years (8.5). Majority of them (92.3%) had started alcohol consumption before the age of 25 years. Common problems reported were work absenteeism (83.5%), a major altercation with spouse (69.3%), assaulting someone while intoxicated (53.8%), and driving under the influence of alcohol (59.3%). Significant association was found between being unemployed and having a police complaint lodged against them (chi-square = 5.7, P = 0.01). Quantity of alcohol consumed per day was significantly more among those who had a history of work absenteeism (Z = 2.27, P = 0.01), major altercation with spouse (Z = 2.25, P = 0.02) and assaulted someone under intoxication (Z = 2.33, P = 0.02). CONCLUSION The quantity of alcohol consumed is significantly more in those who had several legal, social, and occupational problems when compared to those who did not have, highlighting the need for routine assessment of the aforementioned problems among patients of AUDs. Treatment of AUDs should be multidisciplinary, with targeted interventions tailored to the aforementioned problems. Doing so will go a long way in reducing the harm to patients and the community at large.
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Affiliation(s)
- Barikar C Malathesh
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Arun Kandasamy
- Center for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Forensic Psychiatry services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Tessler RA, Haviland MJ, Bowen A, Bowen D, Rivara FP, Rowhani-Rahbar A. Association of state-level intoxicated driving laws with firearm homicide and suicide. Inj Prev 2021; 28:32-37. [PMID: 33687929 DOI: 10.1136/injuryprev-2020-044052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine if an association exists between the number of driving under the influence (DUI) convictions required to activate federal firearms prohibitions and annual firearm homicide and suicide rates by state. METHODS Ecological cross-sectional study of all US states from 2013 to 2017. We collected DUI law data from Thomson Reuters Westlaw database and firearm mortality data from the Centers for Disease Control and Prevention Vital Statistics programme. RESULTS Five states had laws such that one or two DUI convictions could result in prohibitions to firearms access according to federal law. Four states had no legal framework that would restrict firearms access because of DUI convictions; the remaining states could activate federal restrictions at three or more DUI convictions. Firearm-specific homicide (victimisations) rates were 19% lower among women in states where federal restrictions of firearms access occurred after one or two DUI offences (incidence rate ratio (IRR) 0.81; 95% CI 0.64 to 1.01) and 18% lower in states with firearm prohibitions after three or more offences (IRR 0.82; 95% CI 0.71 to 0.95) compared with the states with no legal framework for prohibiting firearms after DUI convictions. There was no association between number of DUI activations and overall, or firearm-specific, suicide among the entire population (men and women) or among only women, or only men. CONCLUSIONS DUI penalties that activate federal firearms prohibitions may be one pathway to reduce firearm homicide of female victims.
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Affiliation(s)
- Robert A Tessler
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA .,The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Miriam Joan Haviland
- The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Andrew Bowen
- The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Deidre Bowen
- The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,School of Law, Seattle University, Seattle, Washington, USA
| | - Frederick P Rivara
- The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Alcohol policies, firearm policies, and suicide in the United States: a lagged cross-sectional study. BMC Public Health 2021; 21:366. [PMID: 33641667 PMCID: PMC7919072 DOI: 10.1186/s12889-021-10216-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol and firearms are commonly involved in suicide in the United States. State alcohol and firearm policies may impact alcohol and firearm related suicide, yet little is known about these relationships. This study examines relationships between state alcohol and firearm policies and suicides involving alcohol, guns, or both, and explores interactive policy associations. METHODS Alcohol policies were assessed with the Alcohol Policy Scale. Firearm policies were assessed using the Gun Law Scorecard from Giffords Law Center. Suicide data from the National Violent Death Reporting System in 2015 covered 22 states. State- and individual-level GEE Poisson and logistic regression models assessed relationships between policies and firearm- and/or alcohol-involved suicides with a 1-year lag. RESULTS In 2015, there were 8996 suicide deaths with blood alcohol concentration test results in the 22 included states. Of those deaths, alcohol and/or firearms were involved in 5749 or 63.9%. Higher alcohol and gun law scores were associated with reduced incidence rates and odds of suicides involving either alcohol or firearms (adjusted incidence rate ratios [IRR] 0.72 (95% CI 0.63, 0.83) for alcohol policies, 0.86 (95% CI 0.82, 0.90) for firearm policies). Relationships were similar for suicides involving both alcohol and firearms, and there was an interactive effect, such that states with restrictive policies for both had the lowest rates of suicides involving alcohol or guns. CONCLUSIONS More restrictive alcohol and firearm policies are associated with lower rates and odds of suicides involving alcohol or firearms, and alcohol and firearms, and may be a promising means by which to reduce suicide.
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Bowen AG, Tessler RA, Bowen D, Haviland MJ, Rowhani-Rahbar A, Rivara FP. Relation of Driving Under the Influence Laws to Access to Firearms Across US States. Am J Public Health 2020; 111:253-258. [PMID: 33351655 DOI: 10.2105/ajph.2020.305995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To determine differences among US states in how driving under the influence of alcohol (DUI) laws activate federal firearm possession and purchase prohibitions.Methods. We performed primary legislative research to characterize DUI laws in each state. The primary outcome was the number of DUI convictions an individual must be convicted of in each state to activate the federal firearm possession and purchase prohibition. We also determined the time interval in which previous DUI convictions count for future proceedings.Results. Forty-seven states had DUI laws that activated the federal prohibition of firearm possession and purchase for a threshold number of repeated DUIs. Variation exists among states in the number of convictions (1-4) and length of liability period (5 years-lifetime) required to prohibit firearm possession and purchase.Conclusions. Variation in state laws on DUI results in differences in determining who is federally prohibited from possessing and purchasing firearms. Future research should explore whether these federal prohibitions arising from DUI convictions are enforced and whether an association exists between stricter DUI policies and reduction in firearm crimes, injuries, and deaths.
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Affiliation(s)
- Andrew G Bowen
- All authors are with the Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Seattle, WA. Robert A. Tessler is also with Department of Surgery, University of Pittsburgh, Pittsburgh, PA. Deirdre Bowen is also with Seattle University School of Law, Seattle. Ali Rowhani-Rahbar and Frederick P. Rivara are also with University of Washington, School of Public Health, Department of Epidemiology, and University of Washington, School of Medicine, Department of Pediatrics, Seattle
| | - Robert A Tessler
- All authors are with the Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Seattle, WA. Robert A. Tessler is also with Department of Surgery, University of Pittsburgh, Pittsburgh, PA. Deirdre Bowen is also with Seattle University School of Law, Seattle. Ali Rowhani-Rahbar and Frederick P. Rivara are also with University of Washington, School of Public Health, Department of Epidemiology, and University of Washington, School of Medicine, Department of Pediatrics, Seattle
| | - Deirdre Bowen
- All authors are with the Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Seattle, WA. Robert A. Tessler is also with Department of Surgery, University of Pittsburgh, Pittsburgh, PA. Deirdre Bowen is also with Seattle University School of Law, Seattle. Ali Rowhani-Rahbar and Frederick P. Rivara are also with University of Washington, School of Public Health, Department of Epidemiology, and University of Washington, School of Medicine, Department of Pediatrics, Seattle
| | - Miriam J Haviland
- All authors are with the Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Seattle, WA. Robert A. Tessler is also with Department of Surgery, University of Pittsburgh, Pittsburgh, PA. Deirdre Bowen is also with Seattle University School of Law, Seattle. Ali Rowhani-Rahbar and Frederick P. Rivara are also with University of Washington, School of Public Health, Department of Epidemiology, and University of Washington, School of Medicine, Department of Pediatrics, Seattle
| | - Ali Rowhani-Rahbar
- All authors are with the Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Seattle, WA. Robert A. Tessler is also with Department of Surgery, University of Pittsburgh, Pittsburgh, PA. Deirdre Bowen is also with Seattle University School of Law, Seattle. Ali Rowhani-Rahbar and Frederick P. Rivara are also with University of Washington, School of Public Health, Department of Epidemiology, and University of Washington, School of Medicine, Department of Pediatrics, Seattle
| | - Frederick P Rivara
- All authors are with the Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Seattle, WA. Robert A. Tessler is also with Department of Surgery, University of Pittsburgh, Pittsburgh, PA. Deirdre Bowen is also with Seattle University School of Law, Seattle. Ali Rowhani-Rahbar and Frederick P. Rivara are also with University of Washington, School of Public Health, Department of Epidemiology, and University of Washington, School of Medicine, Department of Pediatrics, Seattle
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Balayssac D, Pereira B, Cuq P, Douris J, Ferrari L, Boutet-Robinet E, Lechevrel M, Demeilliers C, Rat P, Coudoré F, Verron E, Lacarelle B, Guitton J, Courtois A, Allorge D, Pain S, Guerbet M, Collin A, Vennat B, Brousse G, Authier N, Laporte C. Perception of pharmacy students toward opioid-related disorders and roles of community pharmacists: A French nationwide cross-sectional study. Subst Abus 2020; 42:706-715. [PMID: 33320801 DOI: 10.1080/08897077.2020.1850607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Community pharmacists are among the frontline health professionals who manage patients with an opioid-related disorder (ORD). Pharmacists frequently have a negative attitude toward these patients, which could have a negative impact on their management. However, education on ORD may improve the attitude of future healthcare professionals. This cross-sectional study aimed to assess French pharmacy students' perceptions of ORD. Methods: This online survey was performed by emails sent to French pharmacy schools (between January 14, 2019 and May 31, 2019). The primary outcome was the perception (visual analogic scale) of ORD as a disease, the roles of community pharmacies (delivery of opioid agonist therapy-OAT and harm reduction kits), and the efficacy of OAT. The secondary outcomes assessed professional experience, university experience of and education on ORD, and the individual characteristics of students. Results: Among the 1,994 students included, 76.3% perceived ORD as a disease and felt that it was normal for pharmacists to deliver OAT (78.9%) and harm reduction kits (74.6%). However, only 46.9% perceived OAT as being effective. Multivariable analyses showed that females had a more positive perception in recognizing ORD as a disease. The progression through university years increased the positive perception of ORD as a disease and the delivery of OAT and harm reduction kits by pharmacists. Education on substance-related disorders had no impact on any scores. Students who had already delivered OAT had a negative perception of their efficacy. The students who had already performed pharmacy jobs or traineeships had a negative perception of harm reduction kit delivery. Conclusion: Education on substance-related disorders had no impact on students' perceptions. It seemed that the maturity acquired through university years had a stronger impact on the students' perceptions of ORD. Efforts must be made to improve our teaching methods and reinforce the confidence of students in the roles of community pharmacists.
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Affiliation(s)
- David Balayssac
- Inserm U1107, NEURO-DOL, Université Clermont Auvergne, CHU Clermont-Ferrand, France
| | - Bruno Pereira
- Délégation à la recherche clinique et à l'innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Cuq
- Faculté de Pharmacie, Institut des Biomolécules Max Mousseron (IBMM), UMR 5247, CNRS, ENSCM, Université de Montpellier, Montpellier, France
| | - Juliette Douris
- UFR de Pharmacie, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Luc Ferrari
- Institut Jean Lamour, UMR 7198 CNRS, Université de Lorraine, Nancy, France
| | - Elisa Boutet-Robinet
- Toxalim (Research Centre in Food Toxicology), INRAE, ENVT, INP-Purpan, UPS, Université de Toulouse, Toulouse, France
| | | | - Christine Demeilliers
- Environnement et Prédiction de la Santé des Populations, Laboratoire TIMC-IMAG (UMR-CNRS 5525), Université Grenoble-Alpes, La Tronche, France
| | - Patrice Rat
- Faculté de Pharmacie de Paris, CNRS UMR-8038 CiTCoM, Université de Paris, Paris, France
| | - François Coudoré
- Lab neuropharmacologie, CESP UMR-S1178, Université Paris-Saclay, Chatenay Malabry, Laboratoire de Microbiologie Clinique et Plateforme de dosage des anti-infectieux, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Elise Verron
- UFR pharmacie, département E2M, CNRS 6230, Université de Nantes, Nantes, France
| | - Bruno Lacarelle
- SMARTc Unit, Centre de Recherche en Cancérologie de Marseille, Inserm U1068, Assistance Publique des Hôpitaux de Marseille, Laboratoire de Pharmacocinétique et Toxicologie, Université Aix Marseille, Marseille, France
| | - Jérôme Guitton
- Laboratoire de Toxicologie, ISPBL, Faculté de Pharmacie de Lyon, Université Lyon 1, Lyon, France
| | - Arnaud Courtois
- CHU de Bordeaux, Centre Antipoison et de Toxicovigilance de Nouvelle Aquitaine, Université de Bordeaux, Bordeaux, France
| | - Delphine Allorge
- CHU Lille, Institut Pasteur de Lille, ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Université de Lille, Lille, France
| | - Stéphanie Pain
- Laboratoire de Neurosciences Expérimentales et Cliniques - LNEC, INSERM U-1084, CHU Poitiers, Centre d'Addictovigilance, Pharmacologie clinique et vigilances, Université de Poitiers, Poitiers, France
| | - Michel Guerbet
- UNIROUEN, UNICAEN, ABTE, Normandie University, Rouen, France
| | - Aurore Collin
- Inserm U1107, NEURO-DOL, Université Clermont Auvergne, CHU Clermont-Ferrand, France
| | - Brigitte Vennat
- ACCePPT, UFR de Pharmacie, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Georges Brousse
- EA7280, UFR de Médicine, CHU Clermont-Ferrand Service de Psychiatrie B et d'addictologie, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nicolas Authier
- Inserm U1107, NEURO-DOL, Université Clermont Auvergne, CHU Clermont-Ferrand, France
| | - Catherine Laporte
- Département de Médecine Générale, EA7280, UFR de Médicine, Université Clermont Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Shultz BN, Lye CT, D'Onofrio G, Gluck AR, Miller J, Kraschel KL, Ranney ML. Understanding the Role of Law in Reducing Firearm Injury through Clinical Interventions. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:146-154. [PMID: 33404303 DOI: 10.1177/1073110520979416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Firearm injury in the United States is a public health crisis in which physicians are uniquely situated to intervene. However, their ability to mitigate harm is limited by a complex array of laws and regulations that shape their role in firearm injury prevention. This piece uses four clinical scenarios to illustrate how these laws and regulations impact physician practice, including patient counseling, injury reporting, and the use of court orders and involuntary holds. Unintended consequences on clinical practice of laws intended to reduce firearm injury are also discussed. Lessons drawn from these cases suggest that physicians require more nuanced education on this topic, and that policymakers should consult front-line healthcare providers when designing firearm policies.
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Affiliation(s)
- Blake N Shultz
- Blake N. Shultz is a sixth-year medical student at Yale School of Medicine and a third-year law student at Yale Law School, in New Haven, CT. He is also a fellow at the Solomon Center for Health Law and Policy at Yale Law School. He received his B.A. from Cornell University (2015) in Ithaca, NY. Carolyn T. Lye is a fifth-year medical student at Yale School of Medicine and a second-year law student at Yale Law School in New Haven, CT. She received her BA from University of Pennsylvania (2016) in Philadelphia, PA. Gail D'Onofrio, M.D., M.S., is Professor and Chair of Emergency Medicine at Yale School of Medicine and Professor in the School of Public Health. She is also the Chief of Emergency Services for Yale New Haven Hospital. Abbe R. Gluck, J.D., is Professor of Law and the Founding Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School and Professor of Medicine at Yale School of Medicine. Jonathan Miller, J.D., is the former Chief of the Public Protection and Advocacy Bureau at the Office of the Massachusetts Attorney General. Katherine Kraschel, J.D., is the Executive Director of the Solomon Center for Health Law and Policy as well as a Lecturer in Law, Clinical Lecturer in Law, and Research Scholar in Law at Yale Law School. She received her JD from Harvard Law School, and her BA from Mount Holyoke College. Megan L. Ranney, M.D., M.P.H., is an Associate Professor Emergency Medicine at Alpert Medical School and Directof of the Center for Digital Health at Brown University. She is also Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM Research)
| | - Carolyn T Lye
- Blake N. Shultz is a sixth-year medical student at Yale School of Medicine and a third-year law student at Yale Law School, in New Haven, CT. He is also a fellow at the Solomon Center for Health Law and Policy at Yale Law School. He received his B.A. from Cornell University (2015) in Ithaca, NY. Carolyn T. Lye is a fifth-year medical student at Yale School of Medicine and a second-year law student at Yale Law School in New Haven, CT. She received her BA from University of Pennsylvania (2016) in Philadelphia, PA. Gail D'Onofrio, M.D., M.S., is Professor and Chair of Emergency Medicine at Yale School of Medicine and Professor in the School of Public Health. She is also the Chief of Emergency Services for Yale New Haven Hospital. Abbe R. Gluck, J.D., is Professor of Law and the Founding Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School and Professor of Medicine at Yale School of Medicine. Jonathan Miller, J.D., is the former Chief of the Public Protection and Advocacy Bureau at the Office of the Massachusetts Attorney General. Katherine Kraschel, J.D., is the Executive Director of the Solomon Center for Health Law and Policy as well as a Lecturer in Law, Clinical Lecturer in Law, and Research Scholar in Law at Yale Law School. She received her JD from Harvard Law School, and her BA from Mount Holyoke College. Megan L. Ranney, M.D., M.P.H., is an Associate Professor Emergency Medicine at Alpert Medical School and Directof of the Center for Digital Health at Brown University. She is also Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM Research)
| | - Gail D'Onofrio
- Blake N. Shultz is a sixth-year medical student at Yale School of Medicine and a third-year law student at Yale Law School, in New Haven, CT. He is also a fellow at the Solomon Center for Health Law and Policy at Yale Law School. He received his B.A. from Cornell University (2015) in Ithaca, NY. Carolyn T. Lye is a fifth-year medical student at Yale School of Medicine and a second-year law student at Yale Law School in New Haven, CT. She received her BA from University of Pennsylvania (2016) in Philadelphia, PA. Gail D'Onofrio, M.D., M.S., is Professor and Chair of Emergency Medicine at Yale School of Medicine and Professor in the School of Public Health. She is also the Chief of Emergency Services for Yale New Haven Hospital. Abbe R. Gluck, J.D., is Professor of Law and the Founding Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School and Professor of Medicine at Yale School of Medicine. Jonathan Miller, J.D., is the former Chief of the Public Protection and Advocacy Bureau at the Office of the Massachusetts Attorney General. Katherine Kraschel, J.D., is the Executive Director of the Solomon Center for Health Law and Policy as well as a Lecturer in Law, Clinical Lecturer in Law, and Research Scholar in Law at Yale Law School. She received her JD from Harvard Law School, and her BA from Mount Holyoke College. Megan L. Ranney, M.D., M.P.H., is an Associate Professor Emergency Medicine at Alpert Medical School and Directof of the Center for Digital Health at Brown University. She is also Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM Research)
| | - Abbe R Gluck
- Blake N. Shultz is a sixth-year medical student at Yale School of Medicine and a third-year law student at Yale Law School, in New Haven, CT. He is also a fellow at the Solomon Center for Health Law and Policy at Yale Law School. He received his B.A. from Cornell University (2015) in Ithaca, NY. Carolyn T. Lye is a fifth-year medical student at Yale School of Medicine and a second-year law student at Yale Law School in New Haven, CT. She received her BA from University of Pennsylvania (2016) in Philadelphia, PA. Gail D'Onofrio, M.D., M.S., is Professor and Chair of Emergency Medicine at Yale School of Medicine and Professor in the School of Public Health. She is also the Chief of Emergency Services for Yale New Haven Hospital. Abbe R. Gluck, J.D., is Professor of Law and the Founding Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School and Professor of Medicine at Yale School of Medicine. Jonathan Miller, J.D., is the former Chief of the Public Protection and Advocacy Bureau at the Office of the Massachusetts Attorney General. Katherine Kraschel, J.D., is the Executive Director of the Solomon Center for Health Law and Policy as well as a Lecturer in Law, Clinical Lecturer in Law, and Research Scholar in Law at Yale Law School. She received her JD from Harvard Law School, and her BA from Mount Holyoke College. Megan L. Ranney, M.D., M.P.H., is an Associate Professor Emergency Medicine at Alpert Medical School and Directof of the Center for Digital Health at Brown University. She is also Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM Research)
| | - Jonathan Miller
- Blake N. Shultz is a sixth-year medical student at Yale School of Medicine and a third-year law student at Yale Law School, in New Haven, CT. He is also a fellow at the Solomon Center for Health Law and Policy at Yale Law School. He received his B.A. from Cornell University (2015) in Ithaca, NY. Carolyn T. Lye is a fifth-year medical student at Yale School of Medicine and a second-year law student at Yale Law School in New Haven, CT. She received her BA from University of Pennsylvania (2016) in Philadelphia, PA. Gail D'Onofrio, M.D., M.S., is Professor and Chair of Emergency Medicine at Yale School of Medicine and Professor in the School of Public Health. She is also the Chief of Emergency Services for Yale New Haven Hospital. Abbe R. Gluck, J.D., is Professor of Law and the Founding Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School and Professor of Medicine at Yale School of Medicine. Jonathan Miller, J.D., is the former Chief of the Public Protection and Advocacy Bureau at the Office of the Massachusetts Attorney General. Katherine Kraschel, J.D., is the Executive Director of the Solomon Center for Health Law and Policy as well as a Lecturer in Law, Clinical Lecturer in Law, and Research Scholar in Law at Yale Law School. She received her JD from Harvard Law School, and her BA from Mount Holyoke College. Megan L. Ranney, M.D., M.P.H., is an Associate Professor Emergency Medicine at Alpert Medical School and Directof of the Center for Digital Health at Brown University. She is also Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM Research)
| | - Katherine L Kraschel
- Blake N. Shultz is a sixth-year medical student at Yale School of Medicine and a third-year law student at Yale Law School, in New Haven, CT. He is also a fellow at the Solomon Center for Health Law and Policy at Yale Law School. He received his B.A. from Cornell University (2015) in Ithaca, NY. Carolyn T. Lye is a fifth-year medical student at Yale School of Medicine and a second-year law student at Yale Law School in New Haven, CT. She received her BA from University of Pennsylvania (2016) in Philadelphia, PA. Gail D'Onofrio, M.D., M.S., is Professor and Chair of Emergency Medicine at Yale School of Medicine and Professor in the School of Public Health. She is also the Chief of Emergency Services for Yale New Haven Hospital. Abbe R. Gluck, J.D., is Professor of Law and the Founding Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School and Professor of Medicine at Yale School of Medicine. Jonathan Miller, J.D., is the former Chief of the Public Protection and Advocacy Bureau at the Office of the Massachusetts Attorney General. Katherine Kraschel, J.D., is the Executive Director of the Solomon Center for Health Law and Policy as well as a Lecturer in Law, Clinical Lecturer in Law, and Research Scholar in Law at Yale Law School. She received her JD from Harvard Law School, and her BA from Mount Holyoke College. Megan L. Ranney, M.D., M.P.H., is an Associate Professor Emergency Medicine at Alpert Medical School and Directof of the Center for Digital Health at Brown University. She is also Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM Research)
| | - Megan L Ranney
- Blake N. Shultz is a sixth-year medical student at Yale School of Medicine and a third-year law student at Yale Law School, in New Haven, CT. He is also a fellow at the Solomon Center for Health Law and Policy at Yale Law School. He received his B.A. from Cornell University (2015) in Ithaca, NY. Carolyn T. Lye is a fifth-year medical student at Yale School of Medicine and a second-year law student at Yale Law School in New Haven, CT. She received her BA from University of Pennsylvania (2016) in Philadelphia, PA. Gail D'Onofrio, M.D., M.S., is Professor and Chair of Emergency Medicine at Yale School of Medicine and Professor in the School of Public Health. She is also the Chief of Emergency Services for Yale New Haven Hospital. Abbe R. Gluck, J.D., is Professor of Law and the Founding Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School and Professor of Medicine at Yale School of Medicine. Jonathan Miller, J.D., is the former Chief of the Public Protection and Advocacy Bureau at the Office of the Massachusetts Attorney General. Katherine Kraschel, J.D., is the Executive Director of the Solomon Center for Health Law and Policy as well as a Lecturer in Law, Clinical Lecturer in Law, and Research Scholar in Law at Yale Law School. She received her JD from Harvard Law School, and her BA from Mount Holyoke College. Megan L. Ranney, M.D., M.P.H., is an Associate Professor Emergency Medicine at Alpert Medical School and Directof of the Center for Digital Health at Brown University. She is also Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM Research)
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Pallin R, Charbonneau A, Wintemute GJ, Kravitz-Wirtz N. California Public Opinion On Health Professionals Talking With Patients About Firearms. Health Aff (Millwood) 2020; 38:1744-1751. [PMID: 31589535 DOI: 10.1377/hlthaff.2019.00602] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medical and public health organizations have recommended that health professionals discuss firearm safety with patients at risk for gun-related injury, yet few health professionals do so. Concerns that patients may view conversations about firearms as inappropriate have been reported in prior studies. Using state-representative data from the 2018 California Safety and Wellbeing Survey, this study found that most Californians report gun safety conversations with health professionals to be at least sometimes appropriate when these conversations involved a patient who had a known risk factor for firearm-related harm (depending on the risk factor, 83.7-90.2 percent among all respondents and 70.0-91.2 percent among firearm owners). Majorities of respondents also found intervention by health professionals for those at imminent risk to be at least sometimes appropriate (depending on the intervention, 84.0-89.9 percent among all respondents and 82.6-91.0 percent among firearm owners). These findings can inform health policy and education on clinical strategies for preventing firearm-related harm.
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Affiliation(s)
- Rocco Pallin
- Rocco Pallin ( rspallin@ucdavis. edu ) is a research data analyst in the Violence Prevention Research Program, Department of Emergency Medicine, University of California (UC) Davis School of Medicine, in Sacramento
| | - Amanda Charbonneau
- Amanda Charbonneau is a postdoctoral fellow in the Violence Prevention Research Program
| | - Garen J Wintemute
- Garen J. Wintemute is the Baker-Teret Chair in Violence Prevention and a professor of emergency medicine at UC Davis. He directs the Violence Prevention Research Program and the University of California Firearm Violence Research Center
| | - Nicole Kravitz-Wirtz
- Nicole Kravitz-Wirtz is a professional researcher in the Violence Prevention Research Program
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22
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Racial inequality in the trauma of women: A disproportionate decade. J Trauma Acute Care Surg 2020; 89:254-262. [PMID: 32251262 DOI: 10.1097/ta.0000000000002697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Historically, women have been largely underrepresented in the body of medical research. Given the paucity of data regarding race and trauma in women, we aimed to evaluate the most common types of traumas incurred by women and analyze temporal racial differences. METHODS A 10-year review (2007-2016) of the National Trauma Data Bank was conducted to identify common mechanisms of injuries among women. Trends of race, intent of injury, and firearm-related assaults were assessed using the Cochran-Armitage Trend test. Multivariable multinomial logistic regressions were utilized to examine the association between race and trauma subtypes. RESULTS Of the 2,082,768 women identified as a trauma during this study period, the majority presented due to an unintentional intent (94.5%), whereas fewer presented secondary to an assault (4.4%) or self-inflicted injury (1.1%). While racioethnic minority women encompassed a small percentage of total traumas (19%), they accounted for roughly three fifths of assault-related traumas (p < 0.001). Though total assaults decreased by 20.8% during the study period, black and Hispanic women saw a disproportionately smaller decrease of 15.1% and 15.8%, respectively. On regression analysis, compared with white women, black women had more than four times the odds of being an assault-related trauma compared with unintentional trauma (odds ratio, 4.48; 95% confidence interval, 4.41-4.55). On subset analysis, firearm-related assault was 17.3 times more prevalent among black women (white, 0.3% vs. black: 5.2%; p < 0.001). In fact, history of alcohol abuse was found to be an effect modifier of the association of race/ethnicity and firearm-related trauma. CONCLUSION Compelling data highlight a disproportionate trend in the assault-related trauma of minority women. Specifically, minority women, especially those with a history of alcohol abuse, were at increased risk of being involved in a firearm assault. Further studies are essential to help mitigate disparities and subsequently develop preventative services for this diverse population. LEVEL OF EVIDENCE Epidemiological, Level III.
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23
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Kagawa RMC, Stewart S, Wright MA, Shev AB, Pear VA, McCort CD, Pallin R, Asif-Sattar R, Sohl S, Kass PH, Cerdá M, Gruenewald P, Studdert DM, Wintemute GJ. Association of Prior Convictions for Driving Under the Influence With Risk of Subsequent Arrest for Violent Crimes Among Handgun Purchasers. JAMA Intern Med 2020; 180:35-43. [PMID: 31566654 PMCID: PMC6777266 DOI: 10.1001/jamainternmed.2019.4491] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Alcohol use is a risk factor for firearm-related violence, and firearm owners are more likely than others to report risky drinking behaviors. OBJECTIVE To study the association between prior convictions for driving under the influence (DUI) and risk of subsequent arrest for violent crimes among handgun purchasers. DESIGN In this retrospective, longitudinal cohort study, 79 678 individuals were followed up from their first handgun purchase in 2001 through 2013. The study cohort included all legally authorized handgun purchasers in California aged 21 to 49 years at the time of purchase in 2001. Individuals were identified using the California Department of Justice (CA DOJ) Dealer's Record of Sale (DROS) database, which retains information on all legal handgun transfers in the state. EXPOSURES The primary exposure was DUI conviction prior to the first handgun purchase in 2001, as recorded in the CA DOJ Criminal History Information System. MAIN OUTCOMES AND MEASURES Prespecified outcomes included arrests for violent crimes listed in the Crime Index published by the Federal Bureau of Investigation (murder, rape, robbery, and aggravated assault), firearm-related violent crimes, and any violent crimes. RESULTS Of the study population (N=79 678), 91.0% were males and 68.9% were white individuals; the median age was 34 (range, 21-49) years. The analytic sample for multivariable models included 78 878 purchasers after exclusions. Compared with purchasers who had no prior criminal history, those with prior DUI convictions and no other criminal history were at increased risk of arrest for a Crime Index-listed violent crime (adjusted hazard ratio [AHR], 2.6; 95% CI, 1.7-4.1), a firearm-related violent crime (AHR, 2.8; 95% CI, 1.3-6.4), and any violent crime (AHR, 3.3; 95% CI, 2.4-4.5). Among purchasers with a history of arrests or convictions for crimes other than DUI, associations specifically with DUI conviction remained. CONCLUSIONS AND RELEVANCE This study's findings suggest that prior DUI convictions may be associated with the risk of subsequent violence, including firearm-related violence, among legal purchasers of handguns. Although the magnitude was diminished, the risk associated with DUI conviction remained elevated even among those with a history of arrests or convictions for crimes of other types.
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Affiliation(s)
- Rose M C Kagawa
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Davis
| | - Susan Stewart
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento
| | - Mona A Wright
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Davis
| | - Aaron B Shev
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Davis
| | - Veronica A Pear
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Davis
| | - Christopher D McCort
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Davis
| | - Rocco Pallin
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Davis
| | - Rameesha Asif-Sattar
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Davis
| | - Sydney Sohl
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Davis
| | - Philip H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine and Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis
| | - Magdalena Cerdá
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Davis.,Department of Population Health, New York University, New York
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California
| | - David M Studdert
- Stanford Law School, Stanford University, Stanford, California.,Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Garen J Wintemute
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Davis
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24
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Cofresí RU, Bartholow BD, Piasecki TM. Evidence for incentive salience sensitization as a pathway to alcohol use disorder. Neurosci Biobehav Rev 2019; 107:897-926. [PMID: 31672617 PMCID: PMC6878895 DOI: 10.1016/j.neubiorev.2019.10.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/12/2022]
Abstract
The incentive salience sensitization (ISS) theory of addiction holds that addictive behavior stems from the ability of drugs to progressively sensitize the brain circuitry that mediates attribution of incentive salience (IS) to reward-predictive cues and its behavioral manifestations. In this article, we establish the plausibility of ISS as an etiological pathway to alcohol use disorder (AUD). We provide a comprehensive and critical review of evidence for: (1) the ability of alcohol to sensitize the brain circuitry of IS attribution and expression; and (2) attribution of IS to alcohol-predictive cues and its sensitization in humans and non-human animals. We point out gaps in the literature and how these might be addressed. We also highlight how individuals with different alcohol subjective response phenotypes may differ in susceptibility to ISS as a pathway to AUD. Finally, we discuss important implications of this neuropsychological mechanism in AUD for psychological and pharmacological interventions attempting to attenuate alcohol craving and cue reactivity.
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Affiliation(s)
- Roberto U Cofresí
- University of Missouri, Department of Psychological Sciences, Columbia, MO 65211, United States.
| | - Bruce D Bartholow
- University of Missouri, Department of Psychological Sciences, Columbia, MO 65211, United States
| | - Thomas M Piasecki
- University of Missouri, Department of Psychological Sciences, Columbia, MO 65211, United States
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25
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Wintemute GJ. Background Checks For Firearm Purchases: Problem Areas And Recommendations To Improve Effectiveness. Health Aff (Millwood) 2019; 38:1702-1710. [DOI: 10.1377/hlthaff.2019.00671] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Garen J. Wintemute
- Garen J. Wintemute is the Baker-Teret Chair in Violence Prevention and a professor of emergency medicine at the University of California Davis, in Sacramento. He directs the UC Davis Violence Prevention Research Program and the University of California Firearm Violence Research Center
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26
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Abstract
Suicide is one of the leading causes of liability against a psychiatrist treating adult patients. Reducing the risk of liability entails understanding the phenomenology of suicide, approaching suicide risk assessment from a clinical perspective, conceptualizing how malpractice cases unfold, examining the issues of foreseeability and proper risk assessment, and developing a risk management approach to mitigate against the potential for a bad outcome. The use of various suicide screening risk assessments in certain clinical contexts is a potentially useful first step in identifying the need for further risk assessment. In conducting a more detailed review of a patient's risk, nonsuicidal self-injury is typically distinguished from suicidal intent and action, although morbidity and mortality can also be associated with any deliberate self-injury. Understanding the concepts of means reduction and risk management planning are essential elements to assist in helping reduce risk. Special attention to risk reduction related to firearms has received increased attention in recent years. Proper assessment, and documentation thereof in clinical records can assist in reducing liability. This article reviews these basic elements for the general practitioner of adult psychiatry related to suicide risk, assessment, and liability surrounding patient suicide.
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Affiliation(s)
- Debra A Pinals
- Program in Psychiatry, Law, and Ethics, Department of Psychiatry, University of Michigan, Ann Arbor
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27
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Can Statewide Emergency Department, Hospital Discharge, and Violent Death Reporting System Data Be Used to Monitor Burden of Firearm-Related Injury and Death in Rhode Island? JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019. [DOI: 10.1097/phh.0000000000000744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Keyes KM, Shev A, Tracy M, Cerdá M. Assessing the impact of alcohol taxation on rates of violent victimization in a large urban area: an agent-based modeling approach. Addiction 2019; 114:236-247. [PMID: 30315599 PMCID: PMC6314891 DOI: 10.1111/add.14470] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/22/2018] [Accepted: 10/05/2018] [Indexed: 02/03/2023]
Abstract
AIMS To use simulation to estimate the impact of alcohol taxation on drinking, non-fatal violent victimization and homicide in New York City (NYC). We simulate the heterogeneous effects of alcohol price elasticities by income, level of consumption and beverage preferences, and examine whether taxation can reduce income inequalities in alcohol-related violence. DESIGN Agent-based modeling simulation. SETTING NYC, USA. PARTICIPANTS Adult population aged 18-64 years in the year 2000 in the 59 community districts of NYC. The population of 256 500 agents approximates a 5% sample of the NYC population. MEASUREMENTS Agents were parameterized through a series of rules that governed alcohol consumption and engagement in violence. Six taxation interventions were implemented based on extensive reviews and meta-analyses, increasing universal alcohol tax by 1, 5 and 10%, and beer tax by 1, 5 and 10%. FINDINGS Under no tax increase, approximately 12.2% [95% credible interval (prediction interval, PI) = 12.1-12.3%] were heavy drinkers. Taxation decreased the proportion of heavy drinkers; a 10% tax decreased heavy drinking to 9.6% (95% PI = 9.4-9.8). Beer taxes had the strongest effect on population consumption. Taxation influenced those in the lowest income groups more than the highest income groups. Alcohol-related homicide decreased from 3.22 per 100 000 (95% PI = 2.50-3.73) to 2.40 per 100 000 under a 10% universal tax (95% PI = 1.92-2.94). This translates into an anticipated benefit of ~1200 lives/year. CONCLUSION Reductions in alcohol consumption in a large urban environment such as New York City can be sustained with modest increases in universal taxation. Alcohol tax increases also have a modest effect on alcohol-related violent victimization. Taxation policies reduce income inequalities in alcohol-related violence.
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Affiliation(s)
- Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Aaron Shev
- Department of Emergency Medicine, School of Medicine, University of California at Davis, Sacramento, CA
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, State University of New York at Albany, Albany, NY
| | - Magdalena Cerdá
- Department of Emergency Medicine, School of Medicine, University of California at Davis, Sacramento, CA
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29
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Kalesan B, Zuo Y, Vasan RS, Galea S. Risk of 90-day readmission in patients after firearm injury hospitalization: a nationally representative retrospective cohort study. JOURNAL OF INJURY & VIOLENCE RESEARCH 2019. [PMID: 30686818 DOI: 10.5249/jivr.v11i1.979.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND National conversation has justifiably been concerned with firearm-related deaths and much less attention has been paid to the consequences of surviving a firearm injury. We assessed the risk of hospital readmission, length of stay (LOS) during hospitalization, and costs within 90-days after surviving an index firearm injury and compared these data with pedestrians and occupants involved in motor vehicle crash (MVC). METHODS Nationwide Readmission Database, a nationally representative readmission database from 2013 and 2014 was used to create a retrospective cohort study. The primary outcome was time-to-first all-cause readmission within 90-days after discharge from the index hospitalization. Secondary outcomes were LOS and hospitalization costs at index events and at 90-days. RESULTS There were 3,334 (10.5%), 3,818 (10.6%) and 24,672 (9.4%) firearm injury, pedestrian, and occupant MVC readmissions within 90-days. The risk of 90-day readmission among firearm was 20% (HR=1.20, 95%CI=1.09-1.32) and 34% (HR=1.34, 95%CI=1.26-1.44) greater than patients admitted after pedestrian and occupant MVC. The primary causes of firearm readmission were surgical complications, intestinal disorders and open wounds. The mean total costs were lower among patients after firearm injury versus occupant MVC hospitalizations ($9,357 versus $11,032, p=0.028) but mean total LOS was greater (4.48 versus 4.38 days, p=0.003). Medicaid-insured patients had longer LOS at a total lower cost during index hospitalization after firearm injury as compared to MVC occupant injury. Increased LOS and lower costs of 90-day readmissions among firearm patients versus occupant MVC were irrespective of insurance. CONCLUSIONS The patients surviving a firearm injury have a substantial risk of subsequent hospitalizations, higher than pedestrian or occupant MVC injuries. Medicaid is disproportionately burdened by the costs of treatment of firearm injury.
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Affiliation(s)
- Bindu Kalesan
- Department of Medicine and Community Health Science, Schools of Medicine and Public Health, Boston University, Boston, MA, USA.
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30
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Kalesan B, Zuo Y, Vasan RS, Galea S. Risk of 90-day readmission in patients after firearm injury hospitalization: a nationally representative retrospective cohort study. J Inj Violence Res 2019; 11:65-80. [PMID: 30686818 PMCID: PMC6420916 DOI: 10.5249/jivr.v11i1.979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/18/2017] [Indexed: 11/29/2022] Open
Abstract
Background: National conversation has justifiably been concerned with firearm-related deaths and much less attention has been paid to the consequences of surviving a firearm injury. We assessed the risk of hospital readmission, length of stay (LOS) during hospitalization, and costs within 90-days after surviving an index firearm injury and compared these data with pedestrians and occupants involved in motor vehicle crash (MVC). Methods: Nationwide Readmission Database, a nationally representative readmission database from 2013 and 2014 was used to create a retrospective cohort study. The primary outcome was time-to-first all-cause readmission within 90-days after discharge from the index hospitalization. Secondary outcomes were LOS and hospitalization costs at index events and at 90-days. Results: There were 3,334 (10.5%), 3,818 (10.6%) and 24,672 (9.4%) firearm injury, pedestrian, and occupant MVC readmissions within 90-days. The risk of 90-day readmission among firearm was 20% (HR=1.20, 95%CI=1.09-1.32) and 34% (HR=1.34, 95%CI=1.26-1.44) greater than patients admitted after pedestrian and occupant MVC. The primary causes of firearm readmission were surgical complications, intestinal disorders and open wounds. The mean total costs were lower among patients after firearm injury versus occupant MVC hospitalizations ($9,357 versus $11,032, p=0.028) but mean total LOS was greater (4.48 versus 4.38 days, p=0.003). Medicaid-insured patients had longer LOS at a total lower cost during index hospitalization after firearm injury as compared to MVC occupant injury. Increased LOS and lower costs of 90-day readmissions among firearm patients versus occupant MVC were irrespective of insurance. Conclusions: The patients surviving a firearm injury have a substantial risk of subsequent hospitalizations, higher than pedestrian or occupant MVC injuries. Medicaid is disproportionately burdened by the costs of treatment of firearm injury.
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Affiliation(s)
- Bindu Kalesan
- Department of Medicine and Community Health Science, Schools of Medicine and Public Health, Boston University, Boston, MA, USA.
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31
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TRANGENSTEIN PAMELAJ, CURRIERO FRANKC, WEBSTER DANIEL, JENNINGS JACKYM, LATKIN CARL, ECK RAIMEE, JERNIGAN DAVIDH. Outlet Type, Access to Alcohol, and Violent Crime. Alcohol Clin Exp Res 2018; 42:2234-2245. [PMID: 30256427 PMCID: PMC6214776 DOI: 10.1111/acer.13880] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/22/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND While there are overwhelming data supporting the association between alcohol outlet density and violent crime, there remain conflicting findings about whether on- or off-premise outlets have a stronger association. This inconsistency may be in part a result of the methods used to calculate alcohol outlet density and violent crime. This analysis uses routine activity theory and spatial access methods to study the association between access to alcohol outlets and violent crime, including type of outlet and type of crime in Baltimore, MD. METHODS The data in this analysis include alcohol outlets from 2016 (n = 1,204), violent crimes from 2012 to 2016 (n = 51,006), and markers of social disorganization, including owner-occupied housing, median annual household income, drug arrests, and population density. The analysis used linear regression to determine the association between access to alcohol outlets and violent crime exposure. RESULTS Each 10% increase in alcohol outlet access was associated with a 4.2% increase in violent crime exposure (β = 0.43, 95% CI 0.33, 0.52, p < 0.001). A 10% increase in access to off-premise outlets (4.4%, β = 0.45, 95% CI 0.33, 0.57, p < 0.001) and LBD-7 outlets (combined off- and on-premise outlets; 4.2%, β = 0.43, 95% CI 0.33, 0.52, p < 0.001) had a greater association with violent crime than on-premise outlets (3.0%, β = 0.31, 95% CI 0.20, 0.41, p < 0.001). CONCLUSIONS Access to outlets that allow for off-site consumption had a greater association with violent crime than outlets that only permit on-site consumption. The lack of effective measures to keep order in and around off-premise outlets could attract or multiply violent crime.
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Affiliation(s)
- PAMELA J TRANGENSTEIN
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608
- Boston University School of Public Health, Department of Health Law, Policy and Management, 715 Albany St, Boston, MA 02118
| | - FRANK C CURRIERO
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, Maryland 21205
| | - DANIEL WEBSTER
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Policy and Management, 624 N. Broadway St., Baltimore, MD 21205 USA
| | - JACKY M JENNINGS
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N. Broadway St., Baltimore, MD 21205 USA
| | - CARL LATKIN
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N. Broadway St., Baltimore, MD 21205 USA
| | - RAIMEE ECK
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N. Broadway St., Baltimore, MD 21205 USA
| | - DAVID H JERNIGAN
- Boston University School of Public Health, Department of Health Law, Policy and Management, 715 Albany St, Boston, MA 02118
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Richmond TS, Foman M. Firearm Violence: A Global Priority for Nursing Science. J Nurs Scholarsh 2018; 51:229-240. [PMID: 30215887 DOI: 10.1111/jnu.12421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE This purpose of this article is to frame firearm violence as a health and public health problem, to illustrate the magnitude of the problem, to examine factors that increase the risk to be injured by a firearm, or conversely, that confer protection, and to identify relevant priority areas for nursing science. ORGANIZING CONSTRUCT Firearm violence results in physical and psychological injuries and is a global health priority. Firearm violence is categorized as intentional (interpersonal and self-inflicted) and unintentional (interpersonal and self-inflicted) and accounts for an estimated 196,000 to 220,000 nonconflict deaths annually. METHODS We reviewed the theoretical and scientific literature to analyze the magnitude and geographic distribution of firearm violence, the factors associated with firearm injury, the consequences of firearm violence, and areas where nursing science can make an impact on prevention, outcomes, and recovery. FINDINGS Firearm violence is a significant public health problem that affects the health of individuals, families, and communities. The burdens and contributors to firearm violence vary worldwide, making it important to understand the local context of this global phenomenon. Relevant areas of inquiry span primary prevention focusing on individual and environmental risk factors; and focus on managing the physical and psychological consequences postinjury; and mitigating long-term consequences of firearm violence. CONCLUSIONS Reducing the global burden of firearm violence and improving the health and safety of individuals, families, and communities provide compelling reasons to integrate this area into nursing science. CLINICAL RELEVANCE The goals of nursing are to keep people healthy and safe and to help return those injured to their optimal levels of health and well-being. Understanding the factors that come together to injure people with a firearm in various physical, social, economic, and cultural environments positions nurses to both extend the dialogue beyond pro-gun versus anti-gun and to design and carry out rigorous studies to reduce firearm violence.
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Affiliation(s)
- Therese S Richmond
- Andrea B. Laporte Professor of Nursing, Associate Dean for Research & Innovation, Biobehavioral Health Sciences Department, School of Nursing, University of Pennsylvania, Penn Injury Science Center, Philadelphia, PA, USA
| | - Matthew Foman
- Research Assistant, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.,Student, History and Sociology of Science Department, School of Arts & Sciences, University of Pennsylvania, Philadelphia, PA, USA
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Stein MD, Kenney SR, Anderson BJ, Bailey GL. Loaded: Gun involvement among opioid users. Drug Alcohol Depend 2018; 187:205-211. [PMID: 29680676 PMCID: PMC5959793 DOI: 10.1016/j.drugalcdep.2018.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/26/2018] [Accepted: 03/08/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite ample research examining how alcohol use relates to gun involvement, little is known about the relationship between opioids and gun involvement. In the current study, we examined correlates of gun possession, accessibility, and related behaviors in an opioid dependent sample. METHODS Between October 2016 and April 2017, we surveyed persons entering a brief, inpatient opioid detoxification (n = 386) and 51 contemporaneous persons seeking alcohol detoxification at the same facility in Massachusetts and recorded their lifetime experiences with gun involvement. RESULTS Participants averaged 33 years of age, 74% were male, 83% were White, and 64% had a history of incarceration. Opioid users had significantly higher rates of gun involvement than persons in alcohol detoxification; for example, 31.3% (vs. 3.9%) had carried a gun for protection, 45.1% (vs. 25.5%) had been threatened with a gun, and 13.8% (vs. 2.0%) had shot at another person. Among persons misusing opioids, male and non-White respondents, and those with a history of incarceration or poorer self-control reported greater gun involvement. CONCLUSIONS Opioid users, both men and women, lead gun-involved lives.
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Affiliation(s)
- Michael D Stein
- Behavioral Medicine and Addictions Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, USA; Boston University School of Public Health, 715 Albany St., Boston, MA 02118, USA.
| | - Shannon R Kenney
- Behavioral Medicine and Addictions Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, USA; Boston University School of Public Health, 715 Albany St., Boston, MA 02118, USA
| | - Bradley J Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, USA
| | - Genie L Bailey
- Stanley Street Treatment and Resources, Inc., Fall River, MA 02720, USA; Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02912, USA
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Meel B. Twenty-three-year trend in firearm deaths in the Transkei subregion of South Africa (1993-2015). MEDICINE, SCIENCE, AND THE LAW 2018; 58:102-108. [PMID: 29504465 DOI: 10.1177/0025802418758802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background Firearm-related deaths are a serious public-health problem in South Africa, which has the second-highest rate of firearm-related deaths in the world. Objective The aim of this study was to examine the trend in firearm deaths in the Transkei subregion of South Africa. Method An autopsy record review study was conducted at the Forensic Pathology Laboratory at Mthatha over a period of 23 years (1993-2015). Results Over a 23-year period (1993-2015), 27,036 autopsies were performed at the Mthatha Forensic Pathology Laboratory on people who had died from unnatural causes. Of these, 3935 (14.2%) deaths were related to firearm injuries. The average gunshot death rate during the study period was 29/100,000 of the population annually. The majority (3236; 82%) were males, among whom the death rate was 24.4/100,000 of the population per year. The rate of gunshot deaths was 27/100,000 of the population in 1993, while in 2015 it was 12.8/100,000. About a third (1207; 31%) of victims were between 21 and 30 years of age. Conclusion The gunshot death rate is at an unacceptably high level in the Transkei subregion of South Africa, especially among young people.
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Affiliation(s)
- Banwari Meel
- Division of Forensic Medicine, Walter Sisulu University, South Africa
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Wolfson JA, Teret SP, Azrael D, Miller M. US Public Opinion on Carrying Firearms in Public Places. Am J Public Health 2017; 107:929-937. [PMID: 28426305 DOI: 10.2105/ajph.2017.303712] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To estimate US public opinion, overall and by gun ownership status, about the public places where legal gun owners should be allowed to carry firearms. METHODS We fielded an online survey among 3949 adults, including an oversample of gun owners and veterans, in April 2015. We used cross-tabulations with survey weights to generate nationally representative estimates. RESULTS Fewer than 1 in 3 US adults supported gun carrying in any of the specified venues. Support for carrying in public was consistently higher among gun owners than among non-gun owners. Overall, support for carrying in public was lowest for schools (19%; 95% confidence interval [CI] = 16.7, 21.1), bars (18%; 95% CI = 15.9, 20.6), and sports stadiums (17%; 95% CI = 15.0, 19.5). CONCLUSIONS Most Americans, including most gun owners, support restricting public places legal gun owners can carry firearms. These views contrast sharply with the current trend in state legislatures of expanding where, how, and by whom guns can be carried in public. Recent state laws and proposed federal legislation that would force states to honor out-of-state concealed carry permits are out of step with American public opinion.
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Affiliation(s)
- Julia A Wolfson
- Julia A. Wolfson is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Stephen P. Teret is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Matthew Miller and Deborah Azrael are with the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is also with Bouvé School of Health Sciences, Northeastern University, Boston
| | - Stephen P Teret
- Julia A. Wolfson is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Stephen P. Teret is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Matthew Miller and Deborah Azrael are with the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is also with Bouvé School of Health Sciences, Northeastern University, Boston
| | - Deborah Azrael
- Julia A. Wolfson is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Stephen P. Teret is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Matthew Miller and Deborah Azrael are with the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is also with Bouvé School of Health Sciences, Northeastern University, Boston
| | - Matthew Miller
- Julia A. Wolfson is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Stephen P. Teret is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Matthew Miller and Deborah Azrael are with the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is also with Bouvé School of Health Sciences, Northeastern University, Boston
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Wintemute GJ, Wright MA, Castillo-Carniglia A, Shev A, Cerdá M. Firearms, alcohol and crime: convictions for driving under the influence (DUI) and other alcohol-related crimes and risk for future criminal activity among authorised purchasers of handguns. Inj Prev 2017; 24:68-72. [DOI: 10.1136/injuryprev-2016-042181] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/14/2016] [Accepted: 12/30/2016] [Indexed: 11/03/2022]
Abstract
Firearm violence frequently involves alcohol, but there are no studies of misuse of alcohol and risk for future violence among firearm owners. We examined the association between prior convictions for alcohol-related crimes, chiefly driving under the influence (DUI), and risk of subsequent arrest among 4066 individuals who purchased handguns in California in 1977. During follow-up through 1991, 32.8% of those with prior alcohol-related convictions and 5.7% of those with no prior criminal history were arrested for a violent or firearm-related crime; 15.9% and 2.7%, respectively, were arrested for murder, rape, robbery or aggravated assault. Prior alcohol-related convictions were associated with a fourfold to fivefold increase in risk of incident arrest for a violent or firearm-related crime, a relative increase greater than that seen for age, sex or prior violence. Prior convictions for alcohol-related crime may be an important predictor of risk for future criminal activity among purchasers of firearms.
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Abstract
Gun violence and mental illness is a major area of media attention, especially because highly publicized mass shootings seem to have become more commonly reported in the press. Gun access also is undergoing a highly politicized debate in the United States. It is important for mental health practitioners to understand the background and context of laws related to firearms access, and to understand data related to risk of suicide and violence toward others caused by gun violence among persons with mental illness. In addition, clinically driven risk assessments with specific inquiry related to firearms can be important for identifying individuals for whom firearm-focused clinical risk mitigation may be warranted.
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Affiliation(s)
- Debra A Pinals
- Program in Psychiatry, Law, and Ethics, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Lisa Anacker
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
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Vaughn MG, Nelson EJ, Salas-Wright CP, DeLisi M, Qian Z. Handgun carrying among White youth increasing in the United States: New evidence from the National Survey on Drug Use and Health 2002-2013. Prev Med 2016; 88:127-33. [PMID: 27063946 DOI: 10.1016/j.ypmed.2016.03.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/13/2016] [Accepted: 03/28/2016] [Indexed: 11/19/2022]
Abstract
The objective of the present study was to examine trends and correlates of handgun carrying among adolescents ages 12-17 in the United States. Data was derived from the National Survey on Drug Use and Health (NSDUH) involving non-Hispanic White, African American, and Hispanic respondents ages 12-17 (n=197,313) and spanning the years 2002-2013. Logistic regression was used to examine significance of trend year and correlates of previous 12-month handgun carrying. The overall self-reported prevalence of handgun carrying was 3.4%. The prevalence of handgun carrying during 2004-2005 was significantly higher for African-Americans (4.39%) compared to non-Hispanic Whites (3.03%). However, by 2012-2013, non-Hispanic Whites (4.08%) completely diverged and reported carrying handguns significantly more than both African-American (2.96%) and Hispanic (2.82%) youth. Male gender and a number of externalizing behaviors were significant correlates of handgun carrying; however, we also found evidence of differential correlates with regard to such factors as drug selling, parental affirmation, and income by race/ethnicity. To our knowledge, this is the largest study of handgun carrying among youth in the United States. Findings indicate that although at historically low levels handgun carrying is on the rise but only among non-Hispanic Whites. Differential correlates among racial/ethnic groups suggest prevention programming and policies may need modifications depending on group and geographic locale targeted.
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Affiliation(s)
- Michael G Vaughn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, Tegeler Hall, 3550 Lindell Blvd., St. Louis, MO 63103, United States.
| | - Erik J Nelson
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104, United States.
| | - Christopher P Salas-Wright
- School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd D3500, Austin, TX 78712-0358, United States.
| | - Matt DeLisi
- Criminal Justice Studies, Iowa State University, 203A East Hall, Ames, IA 50011-1070, United States.
| | - Zhengmin Qian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104, United States.
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Chen D, Wu LT. Association Between Substance Use and Gun-Related Behaviors. Epidemiol Rev 2016; 38:46-61. [PMID: 26769722 DOI: 10.1093/epirev/mxv013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 01/23/2023] Open
Abstract
Gun-related violence is a public health concern. This study synthesizes findings on associations between substance use and gun-related behaviors. Searches through PubMed, Embase, and PsycINFO located 66 studies published in English between 1992 and 2014. Most studies found a significant bivariate association between substance use and increased odds of gun-related behaviors. However, their association after adjustment was mixed, which could be attributed to a number of factors such as variations in definitions of substance use and gun activity, study design, sample demographics, and the specific covariates considered. Fewer studies identified a significant association between substance use and gun access/possession than other gun activities. The significant association between nonsubstance covariates (e.g., demographic covariates and other behavioral risk factors) and gun-related behaviors might have moderated the association between substance use and gun activities. Particularly, the strength of association between substance use and gun activities tended to reduce appreciably or to become nonsignificant after adjustment for mental disorders. Some studies indicated a positive association between the frequency of substance use and the odds of engaging in gun-related behaviors. Overall, the results suggest a need to consider substance use in research and prevention programs for gun-related violence.
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Ladapo JA, Elliott MN, Kanouse DE, Schwebel DC, Toomey SL, Mrug S, Cuccaro PM, Tortolero SR, Schuster MA. Firearm Ownership and Acquisition Among Parents With Risk Factors for Self-Harm or Other Violence. Acad Pediatr 2016; 16:742-749. [PMID: 27426038 PMCID: PMC5077672 DOI: 10.1016/j.acap.2016.05.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/12/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Recent policy initiatives aiming to reduce firearm morbidity focus on mental health and illness. However, few studies have simultaneously examined mental health and behavioral predictors within families, or their longitudinal association with newly acquiring a firearm. METHODS Population-based, longitudinal survey of 4251 parents of fifth-grade students in 3 US metropolitan areas; 2004 to 2011. Multivariate logistic models were used to assess associations between owning or acquiring a firearm and parent mental illness and substance use. RESULTS Ninety-three percent of parents interviewed were women. Overall, 19.6% of families reported keeping a firearm in the home. After adjustment for confounders, history of depression (adjusted odds ratio [aOR], 1.36; 95% confidence interval [CI], 1.04-1.77), binge drinking (aOR 1.75; 95% CI, 1.14-2.68), and illicit drug use (aOR 1.75; 95% CI, 1.12-2.76) were associated with a higher likelihood of keeping a firearm in the home. After a mean of 3.1 years, 6.1% of parents who did not keep a firearm in the home at baseline acquired one by follow-up and kept it in the home (average annual likelihood = 2.1%). No risk factors for self-harm or other violence were associated with newly acquiring a gun in the home. CONCLUSIONS Families with risk factors for self-harm or other violence have a modestly greater probability of having a firearm in the home compared with families without risk factors, and similar probability of newly acquiring a firearm. Treatment interventions for many of these risk factors might reduce firearm-related morbidity.
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Affiliation(s)
- Joseph A. Ladapo
- Departments of Medicine and Population Health, New York University School of Medicine, New York, NY
| | | | | | | | - Sara L. Toomey
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Sylvie Mrug
- Department of Psychology, University of Alabama, Birmingham, AL
| | | | | | - Mark A. Schuster
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA
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Wintemute GJ, Kass PH, Stewart SL, Cerdá M, Gruenewald PJ. Alcohol, drug and other prior crimes and risk of arrest in handgun purchasers: protocol for a controlled observational study. Inj Prev 2015; 22:302-7. [PMID: 26498316 DOI: 10.1136/injuryprev-2015-041856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/07/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE Alcohol abuse is common in the USA and is a well-established risk factor for violence. Other drug use and criminal activity are risk factors as well and frequently occur together with alcohol abuse. Firearm ownership is also common; there are >50 million firearm owners in the USA. This study assesses the relationships between alcohol and drug abuse and future violence among firearm owners, which no prior research has done. DESIGN AND STUDY POPULATION This records-based retrospective cohort study will involve all persons who legally purchased handguns in California in 2001-approximately 116 000 individuals-with follow-up through the end of 2013. METHODS The principal exposures include prior convictions for alcohol-related and drug-related offenses. The primary outcome measure is an arrest following handgun purchase for a violent Crime Index offense: homicide, rape, robbery or aggravated assault. Subjects will be considered at risk for outcome events for only as long as their residence in California can be established independently of outcome events. Covariates include individual characteristics (eg, age, sex, criminal history, firearm purchase history) and community characteristics (eg, demographics, socioeconomic measures, firearm ownership and alcohol outlet density). We will employ survival analytic methods, expressing effects as HRs. DISCUSSION The results of this large-scale study are likely to be generalisable and to have important implications for violence prevention policies and programmes.
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Affiliation(s)
- Garen J Wintemute
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, California, USA
| | - Philip H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Susan L Stewart
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, California, USA
| | - Magdalena Cerdá
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, California, USA
| | - Paul J Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California, USA
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Affiliation(s)
- David Hemenway
- Department of Health Policy and Management, Harvard University, Boston, USA.
| | - Daniel W Webster
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore 21205, MD, USA.
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