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Cohen JS, Howard MB, McDonald EM, Ryan LM. A Call to Action: Addressing Socioeconomic Disparities in Childhood Unintentional Injury Risk. Pediatrics 2024; 153:e2023063445. [PMID: 38439733 DOI: 10.1542/peds.2023-063445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 03/06/2024] Open
Affiliation(s)
- Joanna S Cohen
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Beth Howard
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eileen M McDonald
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leticia Manning Ryan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Kwon EG, Nehra D, Hall M, Herrera-Escobar JP, Rivara FP, Rice-Townsend SE. The association between childhood opportunity index and pediatric hospitalization for firearm injury or motor vehicle crash. Surgery 2023; 174:356-362. [PMID: 37211510 DOI: 10.1016/j.surg.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/01/2023] [Accepted: 04/09/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Community-level factors can profoundly impact children's health, including the risk of violent injury. This study's objective was to understand the relationship between the Childhood Opportunity Index and pediatric firearm injury owing to interpersonal violence compared with a motor vehicle crash. METHODS All pediatric patients (<18 years) who presented with an initial encounter with a firearm injury or motor vehicle crash between 2016 to 2021 were identified from 35 children's hospitals included in the Pediatric Health Information System database. The child-specific community-level vulnerability was determined by the Childhood Opportunity Index, a composite score of neighborhood opportunity level data specific to pediatric populations. RESULTS We identified 67,407 patients treated for injuries related to motor vehicle crashes (n = 61,527) or firearms (n = 5,880). The overall cohort had a mean age of 9.3 (standard deviation 5.4) years; 50.0% were male patients, 44.0% non-Hispanic Black, and were 60.8% publicly insured. Compared with motor vehicle crash injuries, patients with firearm-related injuries were older (12.2 vs 9.0 years), more likely to be male patients (77.7% vs 47.4%), non-Hispanic Black (63.5% vs 42.1%), and had public insurance (76.4 vs 59.3%; all P < .001). In multivariable analysis, children living in communities with lower Childhood Opportunity Index levels were more likely to present with firearm injury than those living in communities with a very high Childhood Opportunity Index. The odds increased as the Childhood Opportunity Index level decreased (odds ratio 1.33, 1.60, 1.73, 2.00 for high, moderate, low, and very low Childhood Opportunity Index, respectively; all P ≤ .001). CONCLUSION Children from lower-Childhood Opportunity Index communities are disproportionately impacted by firearm violence, and these findings have important implications for both clinical care and public health policy.
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Affiliation(s)
- Eustina G Kwon
- Department of General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Deepika Nehra
- Division of Trauma, Burn, and Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, WA
| | | | - Juan P Herrera-Escobar
- Division of Trauma, Burn, and Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, WA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Samuel E Rice-Townsend
- Department of General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA.
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Buck-Atkinson J, McCarthy M, Stanley IH, Harnke B, Anestis MD, Bryan CJ, Baker JC, Betz ME. Firearm locking device preferences among firearm owners in the USA: a systematic review. Inj Epidemiol 2023; 10:33. [PMID: 37415242 DOI: 10.1186/s40621-023-00436-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Preventing firearm-involved injuries is a critical public health priority. Firearm locking devices can prevent firearm injuries, such as suicide and unintentional shootings, as well as theft. Various firearm locking devices exist; however, little is known about firearm owners' preferred locking devices for secure firearm storage. In this systematic review, we examined existing literature on preferred locking devices for secure storage of personal firearms among United States (US) firearm owners with the purpose of understanding practical implications and needs for future research. METHODS We searched 8 major databases, as well as the grey literature, for English-language sources published on or before January 24, 2023, that empirically examined firearm locking device preferences. Following PRISMA guidelines, coders independently screened and reviewed 797 sources using pre-determined criteria. Overall, 38 records met inclusion criteria and were included in this review. RESULTS The majority of studies measure and report on participant use of various types of locking devices, but few go on to measure preference between device options and the attributes and features that may contribute to an individual's preference. Included studies suggest that a preference for larger devices, such as lockboxes and gun safes, may exist among US firearm owners. CONCLUSIONS Review of included studies suggests that current prevention efforts may not be aligned with firearm owners' preferences. Additionally, findings from this systematic review emphasize the need for additional methodological rigorous research to understand firearm locking device preferences. Expanded knowledge in this area will result in actionable data and foundational best practices for programming that encourages behavior change concerning secure storage of personal firearms to prevent injury and death.
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Affiliation(s)
- Jessica Buck-Atkinson
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA.
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA.
| | - Megan McCarthy
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA
| | - Ian H Stanley
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Center for COMBAT Research, Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, 12950 E Montview Blvd, Aurora, CO, 80045, USA
| | - Michael D Anestis
- Rutgers School of Public Health, New Jersey Gun Violence Research Center, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
- School of Public Health, The State University of New Jersey, 683 Hoes Lane West, Rutgers, Piscataway, NJ, 08854, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH, 43214, USA
| | - Justin C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH, 43214, USA
| | - Marian E Betz
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
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Burch C, Webb A, Jorge E, King B, Nichols M, Monroe K. Safe at home: prevention of pediatric unintentional injuries. Inj Epidemiol 2023; 10:30. [PMID: 37400908 PMCID: PMC10318633 DOI: 10.1186/s40621-023-00442-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/22/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Unintentional injuries are the leading cause of death in children in the United States. Studies have shown that parent adherence to safety guidelines is improved when education is provided in conjunction with safety equipment. METHODS This study surveyed parents about specific injury prevention behaviors regarding medication and firearm storage and provided education and safety equipment for safe practice of these behaviors. The project took place in a pediatric emergency department (PED) and partnered with the hospital foundation and the school of medicine. Inclusion criteria were families visiting a freestanding PED in a tertiary care center. Participants completed a survey conducted by a medical student approximately 5 min in length. The student then provided each family with a medication lock box (if children ≤ 5 years old lived in the home), firearm cable lock, and education for safe storage of medications and firearms in the home. RESULTS The medical student researcher spent a total of 20 h in the PED from June to August 2021. 106 families were approached to participate in the study, of which 99 agreed to participate (93.4%). A total of 199 children were reached with ages ranging from less than 1 year old to 18 years old. A total of 73 medication lockboxes and 95 firearm locks were distributed. The majority (79.8%) of survey participants were the mother of the patient and 97.0% of participants lived with the patient > 50% of the time. For medication storage, 12.1% of families store medications locked and 71.7% reported never receiving medication storage education from a healthcare professional. Regarding firearms, 65.2% of participants who reported having at least 1 firearm in the home stored firearms locked and unloaded with various methods of storage. 77.8% of firearm owners reported storing ammunition in a separate location from the firearm. Of all participants surveyed, 82.8% reported never receiving firearm storage education from a healthcare professional. CONCLUSIONS The pediatric ED is an excellent setting for injury prevention and education. Many families are not storing medications and firearms safely, demonstrating a clear opportunity to increase knowledge in families with young children.
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Affiliation(s)
- Coleman Burch
- University of Alabama Heersink School of Medicine, Birmingham, USA
| | - Alicia Webb
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama Heersink School of Medicine, Birmingham, USA
| | - Eric Jorge
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama Heersink School of Medicine, Birmingham, USA
| | - Bill King
- University of Alabama Heersink School of Medicine, Birmingham, USA
| | - Michele Nichols
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama Heersink School of Medicine, Birmingham, USA
| | - Kathy Monroe
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama Heersink School of Medicine, Birmingham, USA
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Bond AE, Moceri-Brooks J, Rodriguez TR, Semenza D, Anestis MD. Determining who healthcare providers screen for firearm access in the United States. Prev Med 2023; 169:107476. [PMID: 36870571 DOI: 10.1016/j.ypmed.2023.107476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Healthcare providers are well positioned to screen for firearm access to reduce risk of suicides, yet there is a limited understanding of how often and for whom firearm access screening occurs. The present study examined the extent to which providers screen for firearm access and sought to identify who has been screened in the past. The representative sample included 3510 residents from five US states who reported whether they have been asked about their access to firearms by a healthcare provider. The findings demonstrate that most participants have never been asked by a provider about firearm access. People who have been asked were more likely to be White, male, and firearm owners. Those with children under 17 years old in the home, that have been in mental health treatment, and report a history of suicidal ideation were more likely to be screened for firearm access. Although there are interventions for mitigating firearm related risks in healthcare settings, many providers may be missing the opportunity to implement these because they do not ask about firearm access.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; Department of Psychology, Rutgers University, United States of America; Department of Sociology, Anthropology, and Criminal Justice, Rutgers University - Camden, United States of America.
| | - Jayna Moceri-Brooks
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; School of Public Health, Rutgers University, United States of America
| | - Taylor R Rodriguez
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; Department of Psychology, Rutgers University, United States of America
| | - Daniel Semenza
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; Department of Sociology, Anthropology, and Criminal Justice, Rutgers University - Camden, United States of America
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; School of Public Health, Rutgers University, United States of America
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Pulliam K, Gardner D, Edmunds P, Moody S, Aldridge N, Lyons S, Jenkins T, Kotagal M, Brown RL, Falcone RA. Partnering with high-risk communities to successfully reduce pediatric injury over time. J Pediatr Surg 2022:S0022-3468(22)00777-1. [PMID: 36670000 DOI: 10.1016/j.jpedsurg.2022.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Injury is the leading cause of childhood morbidity and mortality. Injury prevention (IP) initiatives are often created in isolation from the communities most affected. We hypothesized that the use of a comprehensive approach to injury prevention through community partnerships will result in a measurable reduction in pediatric injuries. METHODS The IP program at our free-standing level 1 pediatric trauma center developed partnerships within eight targeted high-risk communities. IP coordinators and community partners implemented programs driven by community-specific injury data and community input. Programs focused on home, bike, playground, pedestrian, and child passenger safety. Program components included in-home education with free safety equipment and installation; free bike helmet fittings and distribution; community playground builds; and car seat classes with education, free car seat distribution and installation. Using trauma registry data, we compared injuries rates in targeted communities with non-intervention communities county-wide over an eight-year period. RESULTS Between 2012 and 2019, nearly 4000 families received home safety equipment and education through community partnerships. Approximately 2000 bike helmets, 900 car/booster seats, in addition to safety messages and education were provided across the intervention communities. Over this 8-year time period, the injury rates significantly decreased by 28.4%, across the eight targeted high-risk communities, compared to a 10.9% reduction in non-intervention communities across the county. CONCLUSIONS Effective injury prevention can be achieved through partnerships, working in solidarity with community members to address actual areas of concern to them. Sharing data, seeking ongoing community input, continuously reviewing learnings, and implementing identified changes are crucial to the success of such partnerships. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kasiemobi Pulliam
- Department of Surgery, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati 45267, OH, USA.
| | - Dawne Gardner
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center 3333 Burnet Avenue, Cincinnati 45229, OH, USA
| | - Patrick Edmunds
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center 3333 Burnet Avenue, Cincinnati 45229, OH, USA
| | - Suzanne Moody
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center 3333 Burnet Avenue, Cincinnati 45229, OH, USA
| | - Nichole Aldridge
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center 3333 Burnet Avenue, Cincinnati 45229, OH, USA
| | - Stephanie Lyons
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center 3333 Burnet Avenue, Cincinnati 45229, OH, USA
| | - Todd Jenkins
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center 3333 Burnet Avenue, Cincinnati 45229, OH, USA
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center 3333 Burnet Avenue, Cincinnati 45229, OH, USA
| | - Rebeccah L Brown
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center 3333 Burnet Avenue, Cincinnati 45229, OH, USA
| | - Richard A Falcone
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center 3333 Burnet Avenue, Cincinnati 45229, OH, USA
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