Exploring lived experiences of gunshot wound survivors: A key to ethnographically informed public health interventions for curbing firearm violence

INTRO

The high rates of gun violence in the United States are a recognized public health concern with increased attention since the 1990's. The predominant studies used in gun violence research have been epidemiological approaches and quantitative analyses. This study, instead, examines lived experiences of gunshot wound survivors to better understand their situations. This study also compared the different census categories and their types of gunshot wound injuries. Ethnographic informed analyses may inform public health interventions to decrease firearm injuries.

METHODS

Data was collected through a series of semi-structured interviews at the emergency department of an urban, Level-1, academic trauma center. 96 patients with gunshot wounds (GSWs) from 2018-2022 were included in the study. Thematic analysis was conducted after coding interview responses.

RESULTS

There was a significant difference found between the 2 census categories (White and Minority populations). Those who self-identified as white had more self-inflicted GSWs (6) than other groups. Those who self-identified in the minority population had more GSWs as a result of an altercation (36) or as an innocent bystander (20). Interview data also demonstrated a trend in changing opinions about firearms in a group of participants with remote previous gunshot wounds (pGSW). When compared to the acute gunshot wound group (aGSW) the previous gunshot wound group (pGSW) responses showed support for increased gun safety and policies that limit firearm access.

CONCLUSION

Different injury patterns between census groups demonstrates that multiple public health approaches will be needed to decrease firearm violence. Ethnographically informed approaches, including the support of people with previous GSW injuries, may help craft those interventions to reduce injury. Matched peer support programs represent one potential intervention to decrease secondary injury and firearm violence.

Examining the impact of a crime gun intelligence center

With gun crime on the rise, efforts to curb this form of violence have captured the attention of government agencies and police departments alike. One form of such efforts is the proliferation of Crime Gun Intelligence Centers (CGICs) in police departments across the country. However, with only three non-peer-reviewed evaluations of these CGICs to date, our understanding of their effectiveness is limited. The present study aims to fill this gap by examining the impact of the Phoenix Police Department's (PPD) CGIC on clearance rates and prosecutorial outcomes for gun crimes. The data for this study come from PPD's Records Management System (RMS), computer-aided dispatch (CAD) system, impounded evidence, National Integrated Ballistics Information Network (NIBIN) lead data, and arrest data. Prosecutorial data were supplied by the Maricopa County Attorney's Office (MCAO). This study examined pretest and posttest differences that occurred over the study period. Difference-in-difference (DID) models were calculated to assess the impact of the CGIC on the outcome measures of interest. We found that from the year prior to the CGIC to 2 years post-CGIC, NIBIN inputs increased by 115%, NIBIN leads increased by 163%, timeliness of entry (of ballistics evidence) improved with 32% of processed items entered within 24-48 h in the second year of the CGIC compared with only 3% the year preceding the CGIC, and clearance rates for arrests increased significantly. These findings have implications for the continued adoption of CGIC, as well as the utility of NIBIN.

Exposure to Gun Violence: Associations with Anxiety, Depressive Symptoms, and Aggression among Male Juvenile Offenders

Objective: To examine whether at-risk male youth experience increases in anxiety, depressive symptoms, and aggression during years when they are exposed to gun violence, adjusting for relevant covariates.Method: Participants were 1,216 male, justice-involved adolescents who were recently arrested for the first time for a moderate offense. They were interviewed 9 times over 5 years. Fixed effects (within-individual) regression models were used to estimate concurrent associations between exposure to gun violence and three outcomes: depressive symptoms, anxiety symptoms, and aggression (both overall and separately for proactive and reactive aggression). The reverse direction (anxiety, depressive symptoms, and aggression predicting gun violence exposure) was also modeled.Results: After controlling for covariates, exposure to gun violence was significantly associated with increases in reactive aggression and, to a lesser extent, increases in proactive aggression. In addition, gun violence exposure was associated with increased anxiety but not depressive symptoms. We found no support for the reverse direction.Conclusions: At-risk males experienced significant increases in anxiety and aggression (particularly reactive aggression) during years when they are exposed to gun violence, even after accounting for several potential confounding factors. The greater impact on reactive aggression suggests that exposure to gun violence may affect self-regulation and/or social information processing. The analyses shed light on the less-visible damage wrought by gun violence and underscore the importance of mental health screening and treatment for youth who have been exposed to violence - especially gun violence - both to assist individual youths and to disrupt cycles of violence.

Response Variations to Survey Items About Firearms in the 2004 and 2017 Behavioral Risk Factor Surveillance System

PURPOSE

The aim of this investigation was to document the prevalence and correlates of refusing to answer a US federal health survey item about firearms in the household.

DESIGN

The cross-sectional analysis was conducted with 2004 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) survey data from Texas, Oregon, Idaho, California, Kansas, and Utah states whose surveys included items about firearms in the household.

PARTICIPANTS

Probability-based samples of adults over the age of 18 (n = 34 488 in 2017 BRFSS; n = 33 136 in 2004 BRFSS).

MEASURES

Dichotomized measure of whether respondents answered versus refused to answer "Are any firearms now kept in or around your home?"

ANALYSIS

Weighted multiple logistic regression was used to assess how sociodemographic and health-related characteristics were associated with item refusal.

RESULTS

Approximately 1.8% (95% CI: 1.6-2.1) of respondents in 2004 and 3.9% (95% CI: 3.4-4.5) of respondents in 2017 sample refused the firearms item (P < .01). Men were more likely than women (2004: adjusted odds ratio [aOR] = 1.81, 95% CI: 1.24-2.62; 2017: aOR = 1.60, 95% CI = 1.17-2.18) and Latino/a respondents were less likely than white respondents (2004: aOR = 0.24, 95% CI: 0.10-0.60; 2017: aOR = 0.21, 95% CI: 0.13-0.34) to refuse the firearms question. In 2004, refusal was more likely among older than younger respondents, but in 2017, age was not associated with refusal.

CONCLUSIONS

Refusal to firearm-related survey items along sociodemographic characteristics warrants further research. Community-informed strategies (eg, focus groups, cognitive testing, in-depth interviews) could improve the context and wording of firearm-related items to maximize response to these items in public health surveys.

Gun buyback programs: a venue to eliminate unwanted guns in the community

BACKGROUND

The United States has a high rate of death due to firearms, and gun buyback programs may mitigate these high death rates. Understanding the demographics, motivation, and geographic region of participants may improve program efficacy.

METHODS

Three Injury Free Coalition for Kids gun buyback programs, in collaboration with the local police, were studied: Phoenix, Arizona; Worcester, Massachusetts; and New Haven, Connecticut. Participants were defined as those who relinquished a firearm. A self-administered, anonymous, paper survey elicited information from participants regarding demographic data, formal training on the use of the firearm, how the firearm was acquired, potential child access, knowledge of others injured by a firearm, whether the firearm was stored unlocked, factors motivating the surrender of the firearm, and other factors. Survey results were entered into a composite database and analyzed for differences in location, race, sex, and other factors.

RESULTS

Participants (n = 301) were predominantly male (73.5%), white (80.9%), and older than 55 years (59.0%). They lived an average of 19.0 miles from the event by zip codes and had an average median household income of $65,731. More than half (54.5%) did not purchase the firearm, acquiring it through inheritance, gift, or random find. Most (74.8%) had previous firearms training and were relinquishing for safety reasons (68.3%). Those relinquishing firearms for safety reasons were less likely to have purchased the firearm (odds ratio [OR], 2.46, p <0.05), less likely to have any formal training (OR, 5.92; p < 0.01), and less likely to keep the firearm locked (OR, 3.50; p < 0.01). Women were less likely to have purchased the firearm (OR, 0.50; p < 0.05). Fifty-three percent of those turning in firearms reported having at least one more firearm at home; designated themselves to be white, compared with all other groups combined (OR, 2.55; p < 0.05); more likely to report locking the firearm (OR, 0.11; p < 0.001); more interested in receiving a gun lock (OR, 0.15; p < 0.001); and more likely to know others who also own firearms (OR, 0.17; p < 0.001). In at least one of the cities participating in this study, as many as 30 percent of the weapons used in gun-wielding criminal acts were burglarized from the home of legal gun owners that had failed to secure them properly.

CONCLUSION

The gun buyback program is solely one prong of a multipronged approach in reducing firearm-based interpersonal violence. Additional research is necessary to determine effective methods to target individuals who would have the greatest impact on gun violence if they relinquished their weapons. Through the forging of relationships and enhancement of firearm knowledge among medical, law enforcement, judicial, and school communities, the prevention of intentional and unintentional firearm-related injuries will be able to be managed more effectively.

Outcomes related to the number and anatomic placement of gunshot wounds

OBJECTIVES

Firearm wounding patterns have changed, and patients more commonly present with multiple gunshot wounds (GSWs). We hypothesized that multiple GSW are associated with increased mortality risk and increased hospital length of stay (LOS).

METHODS

Medical charts were abstracted for patients with GSW during a 4-month period. GSW to each of six anatomic regions were quantified. Proportions, medians, and trends were compared, and relative risks of death were computed.

RESULTS

Among 111 patients, GSW per patient ranged from 1 to 12. Most (62%) patients sustained GSW to a single region. The median number of regions involved increased with the number of GSW (p < 0.01). Patients with multiple regions injured were more likely to die in the emergency department (16% vs. 12%, p < 0.05) or be admitted (72% vs. 52%, p < 0.01). Intensive care unit and hospital LOS increased (p < 0.05) with the number of regions involved.

CONCLUSIONS

Multiple GSW are associated with higher mortality, more intensive care unit days, and longer LOS. Changing wounding patterns seem to have increased morbidity and mortality associated with firearm injuries. These data have associated health policy implications.