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Knod JL, Sathya C, Griggs CL, Henry MC, Froehlich M, Zallen G, Coakley BA, Masiakos PT, Gow KW, Naik-Mathuria B. Promoting Firearm Injury Prevention and Advocacy as Pediatric Surgeons: A Call to Action From the APSA/AAP Advocacy Committee. J Pediatr Surg 2024; 59:1135-1141. [PMID: 38160188 DOI: 10.1016/j.jpedsurg.2023.11.013] [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: 09/07/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Firearm injuries have become the leading cause of death among American children. Here we review the scope of the problem, and the pivotal role pediatric surgeons have in preventing pediatric firearm injury. Specific methods for screening and counseling are reviewed, as well as how to overcome barriers. Community and hospital resources as well as organizational efforts are discussed. Finally, a path for surgeon advocacy is outlined as is a call to action for the pediatric surgeon, as we are uniquely poised to identify pediatric patients and deliver timely interventions to reduce the impact of firearm violence. LEVEL OF EVIDENCE: Level IV.
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Affiliation(s)
- J Leslie Knod
- Division of Pediatric Surgery, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, United States.
| | - Chethan Sathya
- Center for Gun Violence Prevention, Northwell Health, Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, 1111 Marcus, Suite M15, New Hyde Park, NY 11042, United States
| | - Cornelia L Griggs
- Harvard Medical School, Division of Pediatric Surgery, Massachusetts General Hospital, 55 Fruit Street GRB-11, Boston MA 02114, United States
| | - Marion C Henry
- University of Chicago, 5839 S. Maryland Ave/MC 4062/Suite A-426, Chicago, IL 60637, United States
| | - Mary Froehlich
- Kirk Kerkorian School of Medicine at UNLV, Department of General Surgery, 4505 South Maryland Pkwy, Las Vegas, NV 89154, United States
| | - Garret Zallen
- PeaceHealth Medical Center Springfield Oregon and Shriner's Hospital, Portland, OR, United States
| | - Brian A Coakley
- The Icahn School of Medicine at Mount Sinai, Division of Pediatric Surgery, Department of Surgery, 5 East 98th Street, 15th Floor, New York, NY 10029, United States
| | - Peter T Masiakos
- Harvard Medical School, Division of Pediatric Surgery, Massachusetts General Hospital, 55 Fruit Street GRB-11, Boston MA 02114, United States
| | - Kenneth W Gow
- University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, University of Texas Medical Branch, 301 University Blvd, Research Building 6, Suite 3.220, Galveston, TX 77555, United States
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2
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Goldstick JE, Carter PM, Whiteside L, Delgado MK, Cunningham RM. Association Between the SaFETy Score and Self-reported Firearm Violence Among Young Adults Presenting to Emergency Departments in Three Cities: A Cross-Sectional Study. Ann Intern Med 2024; 177:831-833. [PMID: 38648646 DOI: 10.7326/m24-0026] [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] [Indexed: 04/25/2024] Open
Affiliation(s)
- Jason E Goldstick
- Injury Prevention Center, Institute for Firearm Injury Prevention, Department of Emergency Medicine, and Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
| | - Patrick M Carter
- Injury Prevention Center, Institute for Firearm Injury Prevention, Department of Emergency Medicine, and Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
| | - Lauren Whiteside
- School of Medicine, Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - M Kit Delgado
- Penn Injury Science Center, and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca M Cunningham
- Injury Prevention Center, Institute for Firearm Injury Prevention, Department of Emergency Medicine, and Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
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Bernardin ME, Cutler KO. Emergency Department Usage Patterns Among Pediatric Victims of Gun Violence and Physical Assault. Pediatr Emerg Care 2024; 40:415-420. [PMID: 38048545 DOI: 10.1097/pec.0000000000003089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
OBJECTIVE Violent injuries are a common reason for pediatric emergency department (ED) visits, with gun violence being the leading cause of violent death among children. The objective of this study was to assess for patterns of pediatric ED usage that are associated with future ED visits for violent injuries. METHODS This case-control study included youths aged 6 to 19 years who presented to a pediatric ED over a 3-year period due to a physical assault (PA) or their first known gunshot wound (GSW). We compared them with age-, race-, and sex-matched youths presenting for nonviolent medical complaints. All previous ED visits were coded as (1) injuries due to a previous PA, (2) mental/behavioral health visits, (3) sexual/reproductive health visits, (4) sexual assault, or (5) concerns for child abuse. We used multivariate logistic regression to identify patterns of previous ED usage associated with future ED visits for injuries related to PA and/or GSW. RESULTS The PA and GSW groups used the ED for previous PAs, mental/behavioral health, sexual/reproductive health, sexual assault, and/or child abuse concerns on average 4 to 8 times as often as the control group. Previous ED visits for mental/behavioral health (odds ratio [OR] 5), sexual/reproductive health (OR 3), sexual assault (OR 9), and prior PA (OR 8) were predictive of a future ED visit for PA. Male sex (OR 6) and previous ED visits for PA (OR 5) were predictive of a future ED visit for GSW. Two percent of the PA group and 9% of the GSW group returned to the ED with a subsequent GSW in the following 16 to 40 months. CONCLUSIONS Emergency department visits due to interpersonal violence, mental/behavioral health, sexual/reproductive health, and sexual assault are associated with recurrent ED visits for violent injuries. Awareness of patterns of ED usage may aid in identifying patients at high risk for violence and increase opportunities for preventative interventions.
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Affiliation(s)
| | - Keven O Cutler
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, Columbia, MO
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Ballas SJ, Mufti A, Adames Ramos K, Cabral-Hernandez A, Rudolph-Math T, Thenor-Louis I, Wentlent Z, Izadyar S, Wallenstein K, Hagen K, Guzman-Curtis R, Northhardt T, Brenner J. Recommendations for the Clinician Role in Reducing Gun Violence. Psychol Rep 2024:332941241253592. [PMID: 38743484 DOI: 10.1177/00332941241253592] [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: 05/16/2024]
Abstract
There is a growing need for clear and definitive guidelines to prevent firearm violence in communities across the United States. Recommendations explore the utility and feasibility of universal screenings and recommend utilizing universal screening due to a lack of a clear risk to it. Providers should also work to create risk reduction plans with patients as well. Furthermore, recommendations for mental health care, counseling, and bystander training are made for institutions and their providers.
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Affiliation(s)
- Samantha J Ballas
- Medical Student, College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alina Mufti
- Medical Student, College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kenneth Adames Ramos
- Medical Student, College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Timothy Rudolph-Math
- Medical Student, College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Isabelle Thenor-Louis
- Medical Student, College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Zachariah Wentlent
- Medical Student, College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Shahram Izadyar
- Department of Neurology, Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kim Wallenstein
- Department of Surgery, Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kathryn Hagen
- Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Trina Northhardt
- Patient Safety Emergency Medicine Department, Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jay Brenner
- Medicine, Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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Lumbard DC, West MA, Cich IR, Hassan S, Shankar S, Nygaard RM. Pooled Analysis of Trauma Centers Better Predicts Risk Factors for Firearm Violence Reinjury. J Surg Res 2024; 297:1-8. [PMID: 38401378 DOI: 10.1016/j.jss.2024.01.046] [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: 01/26/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Many trauma centers use the first firearm injury admission as a reachable moment to mitigate reinjury. Understanding repeat firearm violence can be difficult in metropolitan areas with multiple trauma centers and laws that prohibit sharing private health information across health systems. We hypothesized that risk factors for repeat firearm violence could be better understood using pooled data from two major metropolitan trauma centers. METHODS Two level I trauma center registries were queried (2007-2017) for firearm injury admissions using International Classification of Diseases, Ninth and Tenth Revision (ICD9/10) Ecodes. A pseudo encryption tool allowed sharing of deidentified firearm injury and repeat firearm injury data without disclosing private health information. Factors associated with firearm reinjury admissions including, age, sex, race, payor, injury severity, intent, and discharge, were assessed by multivariable logistic regression. RESULTS We identified 2145 patients with firearm injury admissions, 89 of whom had a subsequent repeat firearm injury admission. Majority of repeat firearm admissions were assaulted (91%), male (97.8%), and non-Hispanic Black (86.5%). 31.5% of repeat firearm injury admissions were admitted to a different trauma center from their initial admission. Independent predictors of repeat firearm injuries were age (adjusted odds ratio [aOR] 0.94, P < 0.001), male sex (aOR 6.18, P = 0.013), non-Hispanic Black race (aOR 5.14, P = 0.007), or discharge against medical advice (aOR 6.64, P=<0.001). CONCLUSIONS Nearly a third of repeat firearm injury admissions would have been missed in the current study without pooled metropolitan trauma center data. The incidence of repeat firearm violence is increasing and those at the highest risk for reinjury need to be targeted for mitigating interventions.
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Affiliation(s)
- Derek C Lumbard
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota.
| | - Michaela A West
- Department of Surgery, North Memorial Health Hospital, Minneapolis, Minnesota
| | - Irena R Cich
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota
| | - Salma Hassan
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota
| | - Sruthi Shankar
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota
| | - Rachel M Nygaard
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota
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Martin SA, Bishop K, Choma EG, Koepke NM. Pediatric Firearm Violence in America. J Pediatr Health Care 2024; 38:413-419. [PMID: 38085199 DOI: 10.1016/j.pedhc.2023.10.009] [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: 08/19/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 05/04/2024]
Abstract
We have a firearm public health crisis in the United States, with firearm injuries being the leading cause of death in children. The state of pediatric firearm violence will be summarized through a synopsis of an expert panel of pediatric-focused advanced practice registered nurses. A review of related statistics, policy initiatives, programs, screening tools, and resources to support providers to intervene with patients, parents, and caregivers is summarized. Strategies to identify and intervene with all youth and families are described. All pediatric providers must take action against pediatric firearm violence and work to develop care strategies and health policy changes to combat this growing epidemic.
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Goyal A, Labellarte PZ, Hayes AA, Bicek J, Barrera L, Becker AB, Rowell B, Brewer AG. Screening for Youth Firearm Violence Exposure in Primary Care. AJPM FOCUS 2024; 3:100146. [PMID: 38089425 PMCID: PMC10711457 DOI: 10.1016/j.focus.2023.100146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Introduction The aim of this study was to assess a modified gun violence exposure tool at a pediatric clinic on the West Side of Chicago to identify youth at high risk of future gun violence. Methods A modified version of the SaFETy gun violence exposure tool, studied in a community pediatric primary care setting, was implemented from June to August 2021. Patients and pediatric clinicians were surveyed after pilot. Results Of 508 eligible patients, 341 youth (67.1%) completed the SaFETy tool. None had a SaFETy score ≥6, the threshold for immediate referral. Over a quarter (26.4%) of youth had scores of 1-5, and of those, 7.8% were referred at the clinician's discretion. Youth (n=84) participants randomly selected to complete an anonymous survey provided feedback about the SaFETY tool, reporting that the questions were easy to understand (92%). All 6 pediatric clinicians surveyed agreed that the tool helped to identify youth exposed to gun violence. Conclusions Screening for gun violence exposure among youth is logistically feasible in the pediatric outpatient setting. A more sensitive validated tool to stratify low-/medium-risk patients in the primary care setting is needed.
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Affiliation(s)
- Ansh Goyal
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Ashley A. Hayes
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - J.C. Bicek
- Lawndale Christian Health Center, Chicago, Illinois
| | - Leonardo Barrera
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Adam B. Becker
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bruce Rowell
- Lawndale Christian Health Center, Chicago, Illinois
| | - Audrey G. Brewer
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Sigel EJ, Ladika A, Mattson SA. Evaluating the function and psychometric properties of a violence risk screening tool in a community sample of adolescents. Aggress Behav 2024; 50:e22122. [PMID: 38268386 DOI: 10.1002/ab.22122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 01/26/2024]
Abstract
Youth violence continues to be widespread. Despite numerous evidence-based programs that reduce youth violence, objective ways to identify youth in need of services is lacking. Few screening tools are available that enables practitioners or community organizations to predict who may perpetrate serious violence. The Violence Injury Protection and Risk Screen (VIPRS) is a previously validated screening tool providing a framework to address youth violence. The purpose of this study is to evaluate the psychometric properties of the VIPRS in a community sample for use in multiple settings. Youth participating in a community-focused youth violence prevention intervention served as the study subjects. Households with youth ages 10-17 were eligible to participate. Study personnel verbally asked youth survey questions and recorded answers on a laptop. Multiple measures-including risk factors for violent behavior as well as, violence and delinquency scales, were asked. Eleven hundred youth participated. Mean age was 13.3; 53% female, 26% Black, 58% Hispanic, 11% more than 1 race. Twenty percent screened positive on the VIPRS-28% male versus 13% female (p = .000). Violence-related behaviors were common: 33% were in a physical fight, 27% experienced cyberbullying victimization, and 9% perpetrated a minor assault. The VIPRS demonstrated robust criterion validity with significant correlation to multiple violence measures (0.3-0.6). Scoring positive on the VIPRS conveyed increased odds of reporting other violent behaviors, such as perpetrating physical aggression (OR: 7 [95% CI: 5.1-11.5]). Overall, the VIPRS performed well in a community sample of youth further validating its psychometric functioning while demonstrating the potential for use in settings beyond healthcare.
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Affiliation(s)
- Eric J Sigel
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amanda Ladika
- IBS Center for the Study & Prevention of Violence, University of Colorado Boulder, Boulder, Colorado, USA
| | - Sabrina Arredondo Mattson
- IBS Center for the Study & Prevention of Violence, University of Colorado Boulder, Boulder, Colorado, USA
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9
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Lei L, Goldstick JE, Maust DT. Impact of firearm injury in children and adolescents on health care costs and use within a family. Prev Med 2023; 175:107681. [PMID: 37633600 PMCID: PMC10592083 DOI: 10.1016/j.ypmed.2023.107681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/29/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
In 2020, firearm injury became the leading cause of death in U.S. children and adolescents. This study examines sequelae of firearm injury among children and adolescents in terms of health care costs and use within a family over time using an event study design. Using data from a large U.S. commercial insurance company from 2013 to 2019, we identified 532 children and adolescents aged 1-19 years who experienced any firearm-related acute hospitalization or emergency department (ED) encounter and 1667 of their family members (833 parents and 834 siblings). Outcomes included total health care costs, any acute hospitalization and ED visits (yes/no), and number of outpatient management visits, each determined on a quarterly basis 2 years before and 3 years after the firearm injury. Among injured children and adolescents, during the first quarter after the firearm injury, quarterly total health care costs were $24,018 higher than pre-injury; probability of acute hospitalization and ED visits were 27.9% and 90.4% higher, respectively; and number of outpatient visits was 1.8 higher (p < .001 for all). Quarterly total costs continued to be elevated during the second quarter post-injury ($1878 higher than pre-injury, p < .01) and number of outpatient visits remained elevated throughout the first year post-injury (0.6, 0.4, and 0.3 higher in the second through fourth quarter, respectively; p < .05 for all). Parents' number of outpatient visits increased during the second and third years after the firearm injury (0.3 and 0.5 higher per quarter than pre-injury; p < .05). Youth firearm injury has long-lasting impact on health care within a family.
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Affiliation(s)
- Lianlian Lei
- Department of Psychiatry, University of Michigan, United States of America.
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, United States of America; Department of Emergency Medicine, University of Michigan, United States of America
| | - Donovan T Maust
- Department of Psychiatry, University of Michigan, United States of America; Institute for Healthcare Policy and Innovation, University of Michigan, United States of America; Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States of America
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Attridge MM, Heffernan ME, Bendelow A, Menker CG, Davis MM, Sheehan K. Adverse childhood experiences, child behavioral health needs, and family characteristics associated with the presence of a firearm in the home: a survey of parents in Chicago. Inj Epidemiol 2023; 10:35. [PMID: 37488578 PMCID: PMC10364347 DOI: 10.1186/s40621-023-00444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/22/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Firearm violence is the leading cause of pediatric mortality in the USA. The presence of a firearm in the home poses an immense risk to children with increased rates of suicide and unintentional injury by firearm. Recent literature has not explored child ACEs and child behavioral health needs with the presence of a firearm in the home. The objective of this study was to explore an association between these factors, parent health, family experience with firearm violence, and demographics, and the presence of a firearm in the home. RESULTS Overall, 382 of 1,436 (weighted to 22.0%) responding parents reported the presence of a firearm in the home. In an adjusted model, the odds ratio of firearm presence increased incrementally with a child's increasing exposure to ACEs. Compared to a child in the household exposed to no ACEs, a child in the household exposed to two or more ACEs was associated with a 5.16 times higher odds of firearm presence in the home (95% confidence interval (CI) 2.92-9.10). Similarly, a child in the household who had used behavioral health services was associated with a 2.10 times higher odds of firearm presence in the home (95% CI 1.35-3.26), compared to a child in the household who had not. Presence of firearm in the home was also associated with higher household income, younger parent age (under 35 years), and male parent gender. CONCLUSIONS Chicago parents have higher odds of reporting the presence of a firearm in the home when living in a household with a child exposed to ACEs and with behavioral health needs. These findings could inform future public health interventions and targeted safe storage messaging to prevent pediatric firearm injury in the home.
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Affiliation(s)
- Megan M. Attridge
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611 USA
| | - Marie E. Heffernan
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Smith Child Health Outcomes, Research, and Evaluation Center and Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 157, Chicago, IL 60611 USA
| | - Anne Bendelow
- Department of Data Analytics and Reporting, Ann & Robert H. Lurie Children’s Hospital of Chicago, 680 North Lake Shore Drive 13-002D;307, Chicago, IL 60611 USA
| | - Carly G. Menker
- Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 157, Chicago, IL 60611 USA
| | - Matthew M. Davis
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 1, Chicago, IL 60611 USA
| | - Karen Sheehan
- Division of Emergency Medicine, Department of Pediatrics, Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611 USA
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Mueller KL, Chapman-Kramer K, Cooper BP, Kaser T, Mancini M, Moran V, Vogel M, Foraker RE, Anwuri V. A Regional Approach to Hospital-Based Violence Intervention Programs Through LOV. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:306-316. [PMID: 36961541 DOI: 10.1097/phh.0000000000001716] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
CONTEXT Community violence is an underaddressed public health threat. Hospital-based violence intervention programs (HVIPs) have been used to address the root causes of violence and prevent reinjury. OBJECTIVE In this article, we describe the methodology of the St Louis Region-wide HVIP, Life Outside Violence (LOV) program, and provide preliminary process outcomes. DESIGN Life Outside Violence mentors intervene following a violent injury to decrease risk of subsequent victimization and achieve goals unique to each participant by providing therapeutic counseling and case management services to patients and their families. PARTICIPANTS AND SETTING Eligible patients are victims of violent injury between the ages of 8 and 24 years, who are residents of St Louis, Missouri, and present for care at a LOV partner adult or pediatric level I trauma hospital. INTERVENTION Enrolled participants receive program services for 6 to 12 months and complete an individual treatment plan. MAIN OUTCOME MEASURES In this article, we report LOV operational methodology, as well as process metrics, including program enrollment, graduation, and qualitative data on program implementation. RESULTS From August 15, 2018, through April 30, 2022, 1750 LOV-eligible violently injured patients presented to a partner hospital, 349 were approached for program enrollment, and 206 consented to enroll in the program. During this pilot phase, 91 participants graduated from the LOV program and have process output data available for analysis. CONCLUSIONS Life Outside Violence has been implemented into clinical practice as the first HVIP to influence across an entire region through partnership with multiple university and hospital systems. It is our hope that methods shared in this article will serve as a primer for organizations hoping to implement and expand HVIPs to interrupt community violence at the regional level.
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Affiliation(s)
- Kristen L Mueller
- Department of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri (Dr Mueller); Institute for Public Health, Washington University in St Louis School of Medicine, St Louis, Missouri (Mss Chapman-Kramer, Kaser, and Anwuri, Mr Cooper, and Dr Foraker); Saint Louis University School of Social Work, St Louis, Missouri (Dr Mancini); Trudy Busch Valentine School of Nursing, Saint Louis University, St Louis, Missouri (Dr Moran); and School of Criminal Justice, University at Albany, Albany, New York (Dr Vogel)
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Understanding factors associated with firearm possession: Examining differences between male and female adolescents and emerging adults seeking emergency department care. Prev Med 2022; 165:107286. [PMID: 36202257 PMCID: PMC10368177 DOI: 10.1016/j.ypmed.2022.107286] [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: 05/06/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
Firearm possession increases the likelihood of hospital visits among adolescents and emerging adults for both males and females. To better inform prevention practices, we examine data among adolescents and emerging adults (A/EAs; ages 16 to 29) presenting to an urban emergency department for any reason to understand the differences in firearm possession between males and females (N = 1312; 29.6% male; 50.5% Black). Regression identified firearm possession correlates, such as male sex (AOR = 2.26), firearm attitudes (AOR = 1.23), peer firearm possession (AOR = 9.84), and community violence exposure (AOR = 1.02). When stratified by sex (e.g., male vs female), regression results yielded differences in correlates for firearm possession: in males, peer firearm possession (AOR = 8.96) were significant, and in females, firearm attitudes (AOR = 1.33) and peer firearm possession (AOR = 11.24) were significant. An interaction between sex and firearm attitudes demonstrated that firearm attitudes were differentially associated with firearm possession between female and male A/EAs (AOR = 1.28). Overall, we found that females are more likely to endorse retaliatory firearm attitudes, and both males and females are highly influenced by their perception of peer firearm possession. These results help inform prevention strategies across multiple settings, especially for hospital-based violence interventions, and suggest that tailored approaches addressing differences between male and female A/EAs are appropriate when addressing firearm violence and injury risk among A/EAs.
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13
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Seewald LA, Myers M, Zimmerman MA, Walton MA, Cunningham RM, Rupp LA, Haasz M, Carter PM. Firearm safety counseling among caregivers of high-school age teens: Results from a National Survey. Prev Med 2022; 165:107285. [PMID: 36183798 PMCID: PMC9900740 DOI: 10.1016/j.ypmed.2022.107285] [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: 07/08/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 02/08/2023]
Abstract
Firearms are the leading cause of death for high-school age teens. To inform prevention efforts, we characterize the prevalence of healthcare provider (HCP) counseling of caregivers of teens around firearm safety, safety conversation elements, and caregiver receptivity towards counseling. A cross-sectional web survey (6/24/2020-7/22/2020) was conducted among caregivers (n = 2924) of teens (age:14-18). Weights were applied to generate nationally representative estimates. Bivariate analyses and multivariate regressions were examined. Among respondents, 56.0% were women, 75.1% were non-Hispanic White, and mean (SD) age was 47.4. Firearm safety was the least discussed topic among caregivers reporting their teen received HCP preventative counseling (14.9%). For caregivers receiving counseling, the most common issues discussed were household firearms screening (75.7%); storing firearms locked (66.8%); and storing firearms unloaded (53.0%). Only 24.6% of caregivers indicated firearm safety was an important issue for teen HCPs to discuss and only 21.9% trusted teen HCPs to counsel about firearm safety. Female caregivers (aOR = 1.86;95%CI = 1.25-2.78), those trusting their teen's HCP to counsel on firearm safety (aOR = 9.63;95%CI = 6.37-14.56), and those who received teen HCP firearm safety counseling (aOR = 5.14;95%CI = 3.02-8.72) were more likely to favor firearm safety counseling. Caregivers of teens with prior firearm safety training (aOR = 0.50;95%CI = 0.31-0.80) were less likely to agree that firearm safety was an important preventative health topic. In conclusion, few caregivers receive preventive counseling on firearm safety from their teen's HCP, with trust a key barrier to effective intervention delivery. Future research, in addition to understanding barriers and establishing effective strategies to increase safety practices, should focus on increasing provider counseling competency.
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Affiliation(s)
- Laura A Seewald
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, United States of America.
| | - Matthew Myers
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Marc A Zimmerman
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ of Michigan School of Public Health, 1415 Washington Heights 3790A, SPH I, Ann Arbor, MI 48109, United States of America
| | - Maureen A Walton
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Addiction Center, Dept of Psychiatry, Univ of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI 48109, United States of America
| | - Rebecca M Cunningham
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Laney A Rupp
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ of Michigan School of Public Health, 1415 Washington Heights 3790A, SPH I, Ann Arbor, MI 48109, United States of America
| | - Maya Haasz
- Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, 13123 East 16th Ave B251, Aurora, CO 80045, United States of America
| | - Patrick M Carter
- Injury Prevention Center, Univ of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Institute for Firearm Injury Prevention, Univ of Michigan, 540 E. Liberty Street, Ann Arbor, MI 48104, United States of America; Firearm Safety among Children and Teens Consortium, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Emergency Medicine, Univ of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
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A trauma-informed approach to understanding firearm decision-making among Black adolescents: Implications for prevention. Prev Med 2022; 165:107305. [PMID: 36252829 DOI: 10.1016/j.ypmed.2022.107305] [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: 05/07/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022]
Abstract
Firearm violence remains a public health crisis in marginalized, urban communities, with Black adolescents bearing the burden of firearm homicides and injuries. As such, the prevention of firearm violence among adolescents has moved to a high priority of the U.S. public health agenda. The current paper reviews recent literature to highlight the heterogeneity in firearm behavior among Black adolescents and underscore the need for additional research on decision-making and firearm behavior to better understand how adolescents make decisions to acquire, carry, and use firearms. Through a discussion of the disproportionate levels of trauma exposure and trauma symptoms experienced by Black adolescents, the current paper also proposes a trauma-informed approach to understanding decision-making for risky firearm behavior. We discuss the broader impacts of this approach, including the development of a more comprehensive and contextually relevant understanding of the variability in risky firearm behavior and improvements in risk screening capabilities and preventive intervention strategies.
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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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16
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Lee LK, Fleegler EW, Goyal MK, Doh KF, Laraque-Arena D, Hoffman BD, Injury Violence And Poison Prevention CO. Firearm-Related Injuries and Deaths in Children and Youth. Pediatrics 2022; 150:189687. [PMID: 36207778 DOI: 10.1542/peds.2022-060071] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. In 2020, firearms resulted in 10,197 deaths (fatality rate 9.91/100,000 youth 0-24 years old). Firearms are the leading mechanism of death in pediatric suicides and homicides. Increased access to firearms is associated with increased rates of firearm deaths. Substantial disparities in firearm injuries and deaths exist by age, gender, race, ethnicity, and sexual orientation and gender identity and for deaths related to legal intervention. Barriers to firearm access can decrease the risk to youth for firearm suicide, homicide, or unintentional shooting injury and death. Given the high lethality of firearms and the impulsivity associated with suicidal ideation, removing firearms from the home or securely storing them-referred to as lethal means restriction of firearms-is critical, especially for youth at risk for suicide. Primary care-, emergency department-, mental health-, hospital-, and community-based intervention programs can effectively screen and intervene for individuals at risk for harming themselves or others. The delivery of anticipatory guidance coupled with safety equipment provision improves firearm safer storage. Strong state-level firearm legislation is associated with decreased rates of firearm injuries and death. This includes legislation focused on comprehensive firearm licensing strategies and extreme risk protection order laws. A firm commitment to confront this public health crisis with a multipronged approach engaging all stakeholders, including individuals, families, clinicians, health systems, communities, public health advocates, firearm owners and nonowners, and policy makers, is essential to address the worsening firearm crisis facing US youth today.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Kiesha Fraser Doh
- Division of Pediatrics and Emergency Medicine, Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | - Danielle Laraque-Arena
- New York Academy of Medicine, Mailman School of Public Health at Columbia University, Departments of Epidemiology and Pediatrics, New York, NY
| | - Benjamin D Hoffman
- Division of General Pediatrics, Oregon Health and Science University, Portland, OR
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17
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Gunshot casualties in Israel: A decade of violence. Injury 2022; 53:3156-3162. [PMID: 35985856 DOI: 10.1016/j.injury.2022.08.016] [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: 02/26/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to identify and characterize casualties hospitalized with assault (non-terror) related gunshot wounds (GSW) in Israel as a basis for determining the incidence, trends and at-risk population groups. METHODS This retrospective cohort study is based on data from the Israel National Trauma Registry. The data includes GSW casualties hospitalized between January 1, 2011 and December 31, 2020. Attempted suicide, unintentional injury, legal intervention, children (ages 0-9) and terror (Israeli-Arab conflict) related GSW were excluded. The remaining population was classified with an ICD-9-CM diagnosis code of 965.0-965.4. RESULTS The study population included 2,763 GSW admissions. A noticeable increase in GSW casualties was reported, from 206 hospitalization in 2011 to 456 in 2020. The proportion of Arab casualties increased from 73.3% of all GSW casualties in 2011 to 90.8% in 2020, far more than their proportion in the population (∼20%). The majority of the GSW casualties were males (95.8%) and between the ages of 20 and 29 (42.2%). Among severe/critical casualties, 19% of Arabs and 9.9% of Jews arrived by private car. Severe thoracic and abdominal injuries were the prominent injuries among fatal casualties (47.6 and 40.8, respectively). While the all-severity mortality rate was 5.6% (n = 147), 24.4% (n = 135) of severe/critical (ISS16+) casualties died, with no significant differences between Jews and Arabs. Forty percent of deaths occurred in the emergency department. CONCLUSIONS This study establishes that during the past decade in Israel, not only has there been a continuous increase in hospitalizations due to GSW, but also Arabs are at great risk of such related hospitalizations. Preventive strategies targeting at-risk groups are crucial for minimizing morbidity and mortality related to GSW in Israel.
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18
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Li BH, Haukoos JS, Gangidine MM, Hopkins E, McDaniel M, Williams JE, Morgan JL, Green E, Mireles AR, Palacios J, Ramirez JH, Bakes KM. Development of a clinical prediction instrument to estimate risk of initial violent injury. Injury 2022; 53:3263-3268. [PMID: 35970636 DOI: 10.1016/j.injury.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/13/2022] [Accepted: 08/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Interpersonal violent injury is a public health crisis, disproportionately affecting young people of color. We aimed to evaluate associations between sociobehavioral predictors and first-time violent injury, and to develop a predictive risk score for violent injury. METHODS We performed a retrospective case-cohort study of adolescents aged 12-18 years. Multivariable logistic regression was used to estimate associations between 35 candidate variables and interpersonal first-time violent injury resulting in an emergency department (ED) visit. Multiple imputation was used to account for missing values and a risk score was developed by multiplying regression coefficients by 10 to generate a composite tool to predict initial violent injury (IVI). Discrimination and calibration were assessed using 10-fold cross validation. RESULTS 19,210 adolescents were included, 276 (1.4%) as victims of IVI. The final model, the Initial Violent Injury Risk Prediction Tool (IVI-RPT), included: age, fight within the prior year, trouble with the law, and alcohol use. IVI-RPT scores were categorized as: 0-7 (low risk), 8-16 (moderate), and 17-26 (high), and IVI prevalence was 0.8% (95% confidence interval [CI]: 0.6%, 0.9%), 2.5% (95% CI: 1.9%, 3.1%), and 5.3% (95% CI: 4.1%, 6.6%), respectively. The area under the receiver operating characteristic curve was 0.70 (95% CI: 0.66, 0.73), while the slope of the calibration curve was 1.1 (95% CI: 0.9, 1.2). CONCLUSIONS We developed a promising clinical prediction instrument, the IVI-RPT, that categorizes individuals into risk groups with increasing probabilities of violent injury. External validation of this tool is required prior to clinical practice implementation.
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Affiliation(s)
- Benjamin H Li
- Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO, 80204, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America; Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America.
| | - Jason S Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO, 80204, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America; Department of Epidemiology, Colorado School of Public Health, 13001 East 17th Place, 3rd Floor, Mail Stop B119, Aurora, CO, 80045, United States of America
| | - Matthew M Gangidine
- Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO, 80204, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America
| | - Emily Hopkins
- Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO, 80204, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America
| | - Michelle McDaniel
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Johnnie E Williams
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Jerry L Morgan
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Erica Green
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Alma R Mireles
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Jose Palacios
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Jesus H Ramirez
- Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America; At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
| | - Katherine M Bakes
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America; Department of Emergency Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, United States Department of Veterans Affairs, 1700 North Wheeling Street, Aurora, CO, 80045, United States of America
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Negriff S, Sidell M, Nau C, Sharp AL, Koebnick C, Contreras R, Grant DSL, Kim JK, Hechter RC. Factors Associated With Firearm Injury Among Pediatric Members of a Large Integrated Healthcare System. Acad Pediatr 2022; 23:604-609. [PMID: 36122825 DOI: 10.1016/j.acap.2022.09.005] [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: 05/03/2022] [Revised: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Few studies have tested multiple socio-ecological risk factors assocated with firearm injury among pediatric populations and distinguished self-inflicted from non-self-inflicted injury. To address this gap, the current study examined demographic, individual psychosocial, and neighborhood variables as risk factors for firearm injury among a large cohort of children and adolescents. METHODS Retrospective cohort study. Data were obtained from the electronic health records of a large integrated healthcare system. The cohort included children <18 years with at least one clinical encounter between January 1, 2010 and December 31, 2018. Poisson regression was used to examine demographic (age, gender, race and ethnicity, Medicaid status), psychosocial (depression, substance use disorder, medical comorbidities), and neighborhood education variables as potential risk factors for non-self-inflicted and self-inflicted firearm injuries. RESULTS For non-self-inflicted injury, the highest relative risk was found for children age 12-17 years old compared to 0-5 year olds (RR = 37.57); other risk factors included male gender, Black and Hispanic race and ethnicity (compared to White race), being a Medicaid recipient, lower neighborhood education, and substance use disorder diagnosis. For self-inflicted injury, only age 12-17 years old and male gender were associated with increased risk. CONCLUSIONS These results reinforce the established higher risk for firearm injury among adolescent males, highlight differences between self-inflicted and non-self-inflicted injuries, and the need to consider demographic, psychosocial, and neighborhood variables as risk factors to inform interventions aimed to reduce firearm injuries among children and adolescents.
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Affiliation(s)
- Sonya Negriff
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter); Kaiser Permanente Bernard J. Tyson School of Medicine Department of Health Systems Science, Pasadena, CA USA (S Negriff, C Nau, AL Sharp, and RC Hechter).
| | - Margo Sidell
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter)
| | - Claudia Nau
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter); Kaiser Permanente Bernard J. Tyson School of Medicine Department of Health Systems Science, Pasadena, CA USA (S Negriff, C Nau, AL Sharp, and RC Hechter)
| | - Adam L Sharp
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter); Kaiser Permanente Bernard J. Tyson School of Medicine Department of Health Systems Science, Pasadena, CA USA (S Negriff, C Nau, AL Sharp, and RC Hechter); Kaiser Permanente Bernard J. Tyson School of Medicine Department of Clinical Science, Pasadena, CA USA (AL Sharp)
| | - Corinna Koebnick
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter)
| | - Richard Contreras
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter)
| | - Deborah S Ling Grant
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter)
| | - Johnathan K Kim
- Kaiser Permanente Southern California Department of Psychiatry, Riverside, CA USA (JK Kim)
| | - Rulin C Hechter
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA USA (S Negriff, M Sidell, C Nau, AL Sharp, C Koebnick, R Contreras, DSL Grant, and RC Hechter); Kaiser Permanente Bernard J. Tyson School of Medicine Department of Health Systems Science, Pasadena, CA USA (S Negriff, C Nau, AL Sharp, and RC Hechter)
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20
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Harfouche MN, Walton EC, Richardson JB, Scalea TM. Implementation of an Outpatient Violence Intervention Program to Increase Service Uptake. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:535-540. [PMID: 36006598 PMCID: PMC9403958 DOI: 10.1007/s11121-022-01428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/27/2022]
Abstract
Challenges in participant recruitment and retention limit the effectiveness of hospital-based violence intervention programs (HVIPs). This study aimed to determine if an outpatient violence intervention program (VIP) could be integrated into a trauma clinic and increase uptake of violence prevention services. Patients previously hospitalized for intent-to-harm being seen for outpatient follow-up were eligible. VIP counselors met with participants during their clinic visit, administered the survey, and offered violence prevention services (April to June 2019). Patients were followed for 6 months to assess involvement. The primary outcome of interest was long-term participation in the VIP, defined as uptake of services at 6 months, in comparison to inpatient recruitment. Out of 76 patients, 34 (44.7%) did not appear for their appointment. The remainder (n = 42) were offered participation in the study, of which 32 (76.2%) completed the survey. From the group offered VIP services, 57.1% expressed interest, and 5 (20.8%) ultimately took part yielding an overall participation rate of 11.9% at 6 months. The inpatient recruitment rate in 2019 was 2.4%. An outpatient VIP program can be integrated into a clinic setting but suffers from the same challenges faced by inpatient programs resulting in low rates of long-term participation in services. Although a high proportion of participants reported interest, actual engagement at 6 months was low. Reasons behind low participation in VIP services must be investigated.
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Affiliation(s)
- Melike N Harfouche
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, 21201, USA.
| | - Erin C Walton
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, 21201, USA
- Center for Injury Prevention and Policy, University of Maryland Medical Center, Baltimore, MD, 21201, USA
| | - Joseph B Richardson
- University of Maryland, College Park, USA
- Department of African American Studies, University of Maryland, College Park, MD, 20742, USA
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, 21201, USA
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21
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Lee DB, Schmidt CJ, Heinze JE, Carter PM, Cunningham RM, Walton MA, Zimmerman MA. Retaliatory attitudes as mediator of exposure to violence and firearm aggression among youth: The protective role of organized activity involvement. Dev Psychol 2022; 58:990-1002. [PMID: 35377700 PMCID: PMC9716642 DOI: 10.1037/dev0001339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Firearm injury is a significant public health concern among youth living in the United States. Youth with exposure to violence (ETV) are more susceptible to carrying and using a firearm. Few researchers, however, have examined psychological mechanisms undergirding the association between ETV and firearm aggression. Retaliatory attitudes have been discussed as a potential mediator linking ETV with firearm aggression. Moreover, organized activity participation may disrupt direct and indirect pathways connecting ETV to firearm aggression. We tested: (a) the mediating role of retaliatory attitudes in the ETV-firearm aggression link, and (b) the moderating role of organized activity participation among 570 youth with past year illicit drug use and seeking emerging department care in an urban emergency department (ages 14-24; 58.8% males). Using multigroup path analysis, ETV indirectly influenced firearm aggression through retaliatory attitudes for youth not involved organized activities. Organized activities also buffered the association between retaliatory attitudes (mediator) and firearm aggression (outcome). Organized activities may, therefore, prevent firearm aggression by reducing retaliatory attitudes among youth contending with ETV. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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22
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Roberts B, Masiakos PT, Vacek J, Sathya C. Firearm Injury and Mortality Prevention in Pediatric Health-care Settings. Pediatr Rev 2022; 43:212-221. [PMID: 35362027 DOI: 10.1542/pir.2020-001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Bailey Roberts
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Peter T Masiakos
- Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA.,Massachusetts General Hospital Center for Gun Violence Prevention, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jonathan Vacek
- Division of Pediatric Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Chethan Sathya
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.,Center for Gun Violence Prevention, Northwell Health, New Hyde Park, NY
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23
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Pino EC, Fontin F, James TL, Dugan E. Mechanism of penetrating injury mediates the risk of long-term adverse outcomes for survivors of violent trauma. J Trauma Acute Care Surg 2022; 92:511-519. [PMID: 34284465 DOI: 10.1097/ta.0000000000003364] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND While hospital-based violence intervention programs are primarily designed to aid youth victims of gun violence at high risk for reinjury, the root causes and complex outcomes of community violence are varied. In this study, we examined the risk factors for violent penetrating injury and how the risk of adverse outcomes for survivors differs by injury type (stabbing vs. gunshot wound). METHODS This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a penetrating injury due to community violence between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the risk of all-cause mortality and violent reinjury within 3 years after surviving a penetrating injury. RESULTS Of the 4,280 survivors of the initial violent penetrating injury, there were 88 deaths (2.1%) and 568 violent reinjuries (13.3%) within 3 years. Compared with gunshot wound victims, stab wound victims were 31% less likely to be reinjured with a gunshot wound (HR, 0.69; 95% CI, 0.51-0.93), 72% more likely to be reinjured with a stab wound (HR, 1.72; 95% CI, 1.21-2.43), and 49% more likely to be reinjured by assault (HR, 1.49; 95% CI, 1.14-1.94). While survivors of stabbing and firearm injuries were equally at risk for 3-year all-cause mortality, stab wound victims were 3.75 times more likely to die by a drug/alcohol overdose (HR, 3.75; 95% CI, 1.11-20.65). CONCLUSION Patients surviving a stab wound have a significantly higher risk of violent reinjury by stabbing or assault, and risk of death by drug/alcohol overdose. Hospital-based violence intervention programs with similar patient populations should explore options to expand partnerships with drug treatment programs. These results illustrate two distinct populations of victims of violence-gunshot victims and stabbing/assault victims-with separate risk factors and outcomes, mediated by substance use disorder. LEVEL OF EVIDENCE Prognostic and Epidemiologic; level III.
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Affiliation(s)
- Elizabeth C Pino
- From the Boston Violence Intervention Advocacy Program, Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
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24
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O'Neill KM, Jean RA, Dodington J, Davis K, Becher RD. Evaluation of Firearm-related Reinjury in Connecticut: An Opportunity for Gun Violence Prevention. J Surg Res 2022; 274:23-30. [PMID: 35121547 DOI: 10.1016/j.jss.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 11/01/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The regional extent of the risk of repeat firearm-related injury (FRI) and homicide mortality for victims of firearm injury in Connecticut is unknown. In this study, we evaluate the risk of repeat firearm injury in survivors of firearm violence in Connecticut. METHODS Using medical record data from the Yale New Haven Health (YNHH) system and data from the Connecticut Office of the Chief Medical Examiner, we conducted a cohort study of patients with an FRI in 2014 to determine their risk of a repeat firearm injury or mortality from homicide in the ensuing 5 years compared with nonviolence-related trauma patient controls. RESULTS We identified 94 patients with an FRI in the YNHH system from 2014 who survived to discharge. Of these patients, 8.5% (8 of 94) had a repeat FRI and 2% (2 of 94) died from homicide within the next 5 years. Compared with nonviolence-related trauma patients from 2014 (n = 2001), those with an FRI had 12 times the odds of a repeat firearm injury (odds ratio: 12.0, P = 0.047) in the next 5 years after adjustment for relevant covariates. CONCLUSIONS Of the patients presenting with an initial FRI in the YNHH system, one in twelve will experience another firearm injury within the next 5 years. These data indicate that firearm-related reinjury is common in Connecticut and suggest the need for further violence prevention efforts.
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Affiliation(s)
- Kathleen M O'Neill
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut; Investigative Medicine Program, Yale School of Medicine, Yale Graduate School of Arts and Sciences, New Haven, Connecticut.
| | - Raymond A Jean
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - James Dodington
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Kimberly Davis
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Robert D Becher
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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25
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Mattson CM, Kaylor R, Koehler TJ, Ydenberg M, Grill J, Stork BR. Gun Violence and Firearm Injuries in West Michigan: Targeting Prevention. West J Emerg Med 2021; 22:488-497. [PMID: 34125018 PMCID: PMC8203015 DOI: 10.5811/westjem.2021.3.49255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/25/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Firearm-related deaths and injuries are ongoing public health issues in the United States. We reviewed a series of gun violence- and firearm-related injuries treated at a multi-campus community healthcare system in West Michigan to better understand the demographic and clinical characteristics of these injuries. We also studied hospital charges, and payers responsible, in an effort to identify stakeholders and opportunities for community- and hospital-based prevention. METHODS We performed a retrospective review of firearm injuries treated at Mercy Health Muskegon (MHM) between May 1, 2015 and June 30, 2019. Demographic data, injury type, Injury Severity Score (ISS), anatomic location and organ systems involved, length of stay (LOS), mortality, time of year, and ZIP code in which the injury occurred were reviewed, as were hospital charges and payers responsible. RESULTS Of those reviewed, 307 firearm-related injuries met inclusion criteria for the study. In 69.4% of cases the injury type was attempted murder or intent to do bodily harm. Accidental and self-inflicted injuries accounted for 25% of cases. There was a statistically significant difference in the mechanism of injury between Black and White patients with a higher proportion of Black men injured due to gun violence (P < 0.001). Median ISS was 8 and the most commonly injured organ system was musculoskeletal. Median LOS was one day. Self-inflicted firearm injuries had the highest rate of mortality (50%) followed by attempted murder (7%) and accidental discharge (3.1%; P < 0.001). Median hospital charge was $8,008. In 68% of cases, Medicaid was the payer. MHM received $4.98 million dollars in reimbursement from Medicaid; however, when direct and indirect costs were taken into account, a loss of $12,648 was observed. CONCLUSION Findings from this study reveal that young, Black men are the primary victims of gun violence-related injuries in our West Michigan service area. Hospital care of firearm-related injuries at MHM was predominantly paid for by Medicaid. Multiple stakeholders stand to benefit from funding and supporting community- and hospital-based prevention programs designed to reduce gun violence and firearm-related injuries in our service area.
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Affiliation(s)
| | - Ryan Kaylor
- Naval Medical Center, Department of Emergency Medicine, San Diego, California
| | - Tracy J Koehler
- Mercy Health, Department of Scholarly Activity Support, Muskegon, Michigan
| | - Marc Ydenberg
- Mercy Health, Department of Emergency Medicine, Muskegon, Michigan
| | - Justin Grill
- Mercy Health, Department of Emergency Medicine, Muskegon, Michigan
| | - Brian R Stork
- University of Michigan, Department of Urology, Ann Arbor, Michigan
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26
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Bottiani JH, Camacho DA, Lindstrom Johnson S, Bradshaw CP. Annual Research Review: Youth firearm violence disparities in the United States and implications for prevention. J Child Psychol Psychiatry 2021; 62:563-579. [PMID: 33797082 PMCID: PMC9993333 DOI: 10.1111/jcpp.13392] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Research has identified the United States (U.S.) as a global outlier in its firearm ownership rates, with a correspondingly higher risk of youth firearm violence compared to other countries. The relative extent of disparities in youth firearm violence within the U.S. has been less clear. Little is known about factors in the social ecology driving these disparities and whether current firearm violence prevention approaches sufficiently address them. METHOD Applying a health disparities framework, we synthesized epidemiological, sociological, and prevention science literatures, emphasizing structural inequalities in youth sociocultural positionality in life course developmental context. We also highlighted findings from national injury data and other studies regarding the magnitude and impacts of youth firearm violence disparities. RESULTS The burden of firearm violence varied markedly at intersections of gender, race, place, developmental stage, and homicidal or suicidal intent. Firearm homicide among Black boys and young men (ages 15-24) was at outlier levels - many times greater than the rates of any other demographic group, developmental stage, or violence intent, particularly in urban settings. Recent research has operationalized structural racism and implicated historically racialized spaces as a root cause of this disparity. In contrast, elevated firearm suicide rates were found among Native and White boys and young men in rural settings; firearm-related cultural attitudes and gender socialization were points of consideration to explain these disparities. We highlighted research-based youth firearm violence preventive interventions, and emphasized gaps in efforts focused on structural and sociocultural factors. CONCLUSIONS More explicit attention to reducing firearm homicide among Black boys and young men and firearm suicide among Native and rural White boys and young men is urgently needed and has potential to substantially lower overall rates of firearm violence in the U.S.
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Affiliation(s)
- Jessika H Bottiani
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Daniel A Camacho
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | | | - Catherine P Bradshaw
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
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27
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Goldstick JE, Kaufman EJ, Delgado MK, Jay J, Carter PM. Commentary: Reducing youth firearm violence and the associated health disparities requires enhanced surveillance and modern behavioral intervention strategies - a commentary on Bottiani et al. (2021). J Child Psychol Psychiatry 2021; 62:580-583. [PMID: 33817792 PMCID: PMC8437141 DOI: 10.1111/jcpp.13421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
Youth firearm injury is a worsening public health crisis, and the risks are not distributed evenly. Bottiani et al. skillfully explicated those health disparities, described sociological factors underlying them, and explored avenues for prevention. We supplement their analysis by detailing problems and solutions related to a critical barrier to firearm violence prevention - the nonexistence both of reliable 'gold standard' nonfatal firearm injury surveillance data, and systems for near real-time surveillance of firearm injuries at granular spatial scales that would enable to optimization of rapid response protocols and neighborhood-based prevention programs. We conclude with a discussion of modern, scalable, behavioral intervention approaches that could be leveraged to fill the largely absent evidence base resulting from the documented underfunding of youth firearm violence prevention research.
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Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan,
Ann Arbor, MI, USA,Injury Prevention Center, University of Michigan, Ann
Arbor, MI, USA,Department of Health Behavior and Health Education,
University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Elinore J. Kaufman
- Division of Traumatology, Surgical Critical Care, and
Emergency Surgery, University of Pennsylvania Perelman School of Medicine,
Philadelphia, PA, USA
| | - M. Kit Delgado
- Department of Biostatistics and Epidemiology, University of
Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Department of Emergency Medicine, University of
Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jonathan Jay
- Department of Community Health Sciences, Boston University
School of Public Health, Boston, MA, USA
| | - Patrick M. Carter
- Department of Emergency Medicine, University of Michigan,
Ann Arbor, MI, USA,Injury Prevention Center, University of Michigan, Ann
Arbor, MI, USA,Department of Health Behavior and Health Education,
University of Michigan School of Public Health, Ann Arbor, MI, USA
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28
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Carter PM, Zimmerman MA, Cunningham RM. Addressing Key Gaps in Existing Longitudinal Research and Establishing a Pathway Forward for Firearm Violence Prevention Research. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:367-384. [PMID: 34086512 PMCID: PMC8186821 DOI: 10.1080/15374416.2021.1913741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The main purpose of this article and this special section is to encourage greater attention to the key gaps that exist in our understanding of the epidemiology of adolescent firearm violence and to provide a pathway forward for future longitudinal research that will inform prevention efforts. This increased attention is especially salient given: (a) firearms are the leading cause of death for adolescents and emerging adults in the United States, with the majority of these deaths due to interpersonal violence; (b) significant health and social disparities with regards to the populations that are most affected by interpersonal firearm violence have been documented; and, (c) limitations in federal research funding during the past 30 years have created a deficit of knowledge about key risk and protective factors necessary to inform evidence-based prevention efforts. We discuss the implications of the articles in this special edition for existing and novel prevention programs. We also identify key considerations for future epidemiological research, including the need for a greater focus on collecting longitudinal data among nationally representative samples enriched with subgroups of at-risk youth, the need to examine the role of protective factors and mediating variables within existing and novel theoretical models of firearm risk behaviors, the need to examine key factors across all levels of the socio-ecological model, and the need to incorporate novel and innovative research designs, methods and analyses.
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Affiliation(s)
- Patrick M Carter
- Firearm Safety among Children and Teens Consortium, University of Michigan School of Medicine
- Department of Emergency Medicine, University of Michigan School of Medicine
- Department of Health Behavior/Health Education, University of Michigan School Public Health
- Youth Violence Prevention Center, University of Michigan School of Public Health
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine
| | - Marc A Zimmerman
- Firearm Safety among Children and Teens Consortium, University of Michigan School of Medicine
- Department of Health Behavior/Health Education, University of Michigan School Public Health
- Youth Violence Prevention Center, University of Michigan School of Public Health
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine
| | - Rebecca M Cunningham
- Firearm Safety among Children and Teens Consortium, University of Michigan School of Medicine
- Department of Emergency Medicine, University of Michigan School of Medicine
- Department of Health Behavior/Health Education, University of Michigan School Public Health
- Youth Violence Prevention Center, University of Michigan School of Public Health
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine
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29
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Bernardin ME, Moen J, Schnadower D. Factors associated with pediatric firearm injury and enrollment in a violence intervention program. J Pediatr Surg 2021; 56:754-759. [PMID: 32690290 DOI: 10.1016/j.jpedsurg.2020.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/21/2020] [Accepted: 06/14/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To identify factors associated with firearm injury (FI) and willingness to enroll in a violence intervention program amongst pediatric victims of violence. METHODS Cross-sectional study of victims of violence age 6-19 years presenting to a children's hospital emergency department from 2014 to 2017. Participants were interviewed by social workers prior to being offered enrollment in a violence intervention program. We used multivariate logistic regression analyses to identify factors associated with FI and enrollment in the violence intervention program. RESULTS Four hundred seven patients were analyzed, 156 (38%) of which were victims of FI and 251 (62%) were victims of non-firearm-related physical assaults (PA). Multiple factors were associated with FI including older adolescent age, male sex, separated/divorced parents, losses in family/social network due to violence, being on probation, illicit substance use, gang affiliation, and lack of school enrollment. One hundred four patients (26%) enrolled in the violence intervention program. There was no difference in enrollment between FI and PA. However, older adolescent age, illicit substance use and probation were associated with significantly decreased odds of enrolling in the program. CONCLUSIONS Multiple identifiable and potentially actionable risk factors exist amongst pediatric victims of acute FI. More specific targeting of at-risk groups may improve enrollment in violence interventions programs. LEVEL OF EVIDENCE This is a prognostic study, investigating the natural history of pediatric firearm injuries, factors associated with firearm injuries as well as those associated with patient propensity to enroll in a violence intervention program. This study is observational in nature and utilizes patients with non-firearm-related physical assaults as a control group, making this study Level III evidence.
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Affiliation(s)
- Mary Elizabeth Bernardin
- Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, Columbia, MO.
| | - Joseph Moen
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
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30
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Goldstick JE, Roche JS, Carter PM, Arterberry BJ, Bonar EE, Walton MA, Zimmerman M, Cunningham RM. Sex Differences in the Association Between Gaming and Serious Violence Among Predominantly African American Youth. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP2410-NP2422. [PMID: 29580195 PMCID: PMC6119504 DOI: 10.1177/0886260518764104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Video gaming, a remarkably popular hobby in the United States, has been consistently identified as a correlate of aggressive behavior, and this association is not limited to violent video gaming. Prior studies of sex differences in the association between video gaming and aggression have not controlled for other well-known violence correlates (e.g., substance use, community violence exposure, violence attitudes) or focused primarily on high-risk youth. In this study, we used data from an emergency department in Flint, Michigan (N = 409, 59.9% female, 93.4% African American) to identify sex differences in the association between video gaming and serious peer violence. Youth aged 14 to 20 years were recruited from October 2011 to March 2015, and self-administered computerized surveys including measures of demographics, violence perpetration, gaming frequency, substance use, community violence exposure, and violence attitudes. The primary outcome was an indicator of any serious violence perpetration (e.g., choking, burning, weapon violence) in the past 2 months. Using logistic regression, we estimated the association between gaming and serious violence perpetration, and how it varied by sex, while controlling for demographics, substance use, community violence exposure, and violence attitudes. Approximately 36.6% of males and 27.3% of females reported past 2-month serious violence. On adjusted analysis, hours spent gaming was associated with violence among females (odds ratio [OR] = 1.40, 95% confidence interval [CI] = [1.16, 1.78]), but not males (OR = 1.03, 95% CI = [0.89, 1.19]); in the model including both males and females, the interaction between hours gaming and sex was significant (p < .01). Our findings suggest video gaming is a stronger marker of severe violence perpetration in females than males among at-risk youth. Violence interventions among females may be improved by including content related to video gaming and identifying other prosocial activities for youth as an alternative to video gaming. Additional research is required to clarify the causal process underlying the identified associations, and to determine what aspects of video gaming are risk-enhancing.
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Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, E Medical Center Dr, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Jessica S. Roche
- Department of Emergency Medicine, University of Michigan, E Medical Center Dr, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA
| | - Patrick M. Carter
- Department of Emergency Medicine, University of Michigan, E Medical Center Dr, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA
| | - Brooke J. Arterberry
- University of Michigan Addiction Center and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Erin E. Bonar
- University of Michigan Addiction Center and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Maureen A. Walton
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Addiction Center and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Marc Zimmerman
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, E Medical Center Dr, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, Hurley Medical Center, MI, USA
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31
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Goldstick JE, Carter PM, Cunningham RM. Current Epidemiological Trends in Firearm Mortality in the United States. JAMA Psychiatry 2021; 78:241-242. [PMID: 32965479 PMCID: PMC7933080 DOI: 10.1001/jamapsychiatry.2020.2986] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Injury Prevention Center, University of Michigan, Ann Arbor
| | - Patrick M. Carter
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Injury Prevention Center, University of Michigan, Ann Arbor
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Injury Prevention Center, University of Michigan, Ann Arbor
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32
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Teplin LA, Meyerson NS, Jakubowski JA, Aaby DA, Zheng N, Abram KM, Welty LJ. Association of Firearm Access, Use, and Victimization During Adolescence With Firearm Perpetration During Adulthood in a 16-Year Longitudinal Study of Youth Involved in the Juvenile Justice System. JAMA Netw Open 2021; 4:e2034208. [PMID: 33538822 PMCID: PMC7862991 DOI: 10.1001/jamanetworkopen.2020.34208] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Preventing firearm violence requires understanding its antecedents. Yet no comprehensive longitudinal study has examined how involvement with firearms during adolescence-use, access, and victimization (defined as threatened with a weapon or gunshot injury)-is associated with the perpetration of firearm violence in adulthood. OBJECTIVE To examine the association between firearm involvement during adolescence and subsequent firearm perpetration and ownership in adulthood among youth involved in the juvenile justice system. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed interview responses of 1829 randomly selected participants as part of the Northwestern Juvenile Project, a longitudinal study of health needs and outcomes of youth sampled from a temporary juvenile detention center in a large US city. Youth aged 10 to 18 years were interviewed in detention from November 1995 through June 1998. Participants were reinterviewed up to 13 times over 16 years through February 2015, for a total of 17 776 interviews. The sample was stratified by sex, race/ethnicity, age, and legal status (juvenile or adult court). Data were analyzed from April 2017, when data preparation began, through November 2020. EXPOSURES Firearm involvement during adolescence: use (ie, threaten, shoot), access (ownership, ease of access, firearm in household, membership in gang that carries firearms), and victimization (gunshot injury, threatened with a weapon). MAIN OUTCOMES AND MEASURES Firearm involvement during adulthood: perpetration of firearm violence (ie, threatening with or using a firearm) and firearm ownership. RESULTS Among the 1829 participants, 1388 had a 16-year follow-up interview: 860 males, 528 females; 809 were African American, 203 were non-Hispanic White; 374 were Hispanic; and 2 were other race/ethnicity; median (interquartile range) age of 32 (30-32) years. Eighty-five percent of males and 63.2% of females were involved with firearms as adolescents. Compared with females, males had significantly higher odds of every type of involvement except having a firearm in the home. In adulthood, 41.3% of males and 10.5% of females perpetrated firearm violence. Adolescents who had been threatened with a weapon or injured by firearms had 3.1 (95% CI, 2.0-4.9) and 2.4 (95% CI, 1.2-4.9) times the odds of perpetrating violence during adulthood. Similar associations were found for firearm ownership. CONCLUSIONS AND RELEVANCE Involvement with firearms during adolescence-including victimization-is a significant risk factor for firearm perpetration and ownership during adulthood.
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Affiliation(s)
- Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Medicine, Infectious Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Institute for Policy Research, Northwestern University, Evanston, Illinois
- Department of Sociology, Weinberg College of Arts & Sciences, Northwestern University, Evanston, Illinois
- School of Education and Public Policy, Northwestern University, Evanston, Illinois
| | - Nicholas S. Meyerson
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jessica A. Jakubowski
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David A. Aaby
- Department of Medicine, Infectious Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nanzi Zheng
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen M. Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leah J. Welty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Abstract
OBJECTIVES To review the public health approach to preventing and treating firearm violence. DATA SOURCES Peer-reviewed, published scholarship and federal data systems. STUDY SELECTION English-language, indexed research articles on the epidemiology, risk, prevention, and consequences of firearm violence. DATA EXTRACTION This narrative review includes findings related to the epidemiology and impact of firearm violence, focusing on short- and long-term outcomes. Evidence supporting interventions at the individual, agent, and environmental level to reduce firearm-related harm was examined. DATA SYNTHESIS Firearm violence is a major public health challenge in the Unites States. The consequences of firearm violence reach beyond the nearly 40,000 firearm-related deaths and 90,000 firearm-related injuries each year. Firearm violence, including self-harm, assault, and unintentional injury, affects the health of individuals, families, communities, and health systems. Data sources remain inadequate, however, to fully capture these impacts. Treating firearm violence as a disease and taking a public health approach to prevention and treatment is key to reducing the harms of firearm violence. Using a public health framework not only recognizes the physical and mental consequences of firearm violence but also focuses our attention on underlying causes and on innovative, multi-level interventions to reduce the harms of firearm violence. CONCLUSIONS The public health approach positions clinicians to change the conversation from political diatribe of pro-gun and anti-gun to systematically reducing injury and death. To achieve comparable success, we must design, test, and implement effective interventions at the environmental, policy, technological, and individual levels to prevent firearm violence. We must collect robust data on firearm violence and its consequences. And we must reckon with the conditions of inequality and disadvantage that feed violence through all means.
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Walker GN, Dekker AM, Hampton DA, Akhetuamhen A, Moore PQ. A Case for Risk Stratification in Survivors of Firearm and Interpersonal Violence in the Urban Environment. West J Emerg Med 2020; 21:132-140. [PMID: 33207158 PMCID: PMC7673864 DOI: 10.5811/westjem.2020.8.45041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 08/06/2020] [Indexed: 11/11/2022] Open
Abstract
The emergency department (ED) serves as the main source of care for patients who are victims of interpersonal violence. As a result, emergency physicians across the nation are at the forefront of delivering care and determining dispositions for many at-risk patients in a dynamic healthcare environment. In the majority of cases, survivors of interpersonal violence are treated and discharged based on the physical implications of the injury without consideration for risk of reinjury and the structural drivers that may be at play. Some exceptions may exist at institutions with hospital-based violence intervention programs (HVIPs). At these institutions, disposition decisions often include consideration of a patient’s risk for repeat exposure to violence. Ideally, HVIP services would be available to all survivors of interpersonal violence, but a variety of current constraints limit availability. Here we offer a scoping review of HVIPs and our perspective on how risk-stratification could help emergency physicians determine which patients will benefit most from HVIP services and potentially reduce re-injury secondary to interpersonal violence.
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Affiliation(s)
- Garth N Walker
- Northwestern Buehler Center Health Economics and Policy and Northwestern Department of Emergency Medicine, Chicago, Illinois
| | - Annette M Dekker
- University of California, Los Angeles, Department of Emergency Medicine, Los Angeles, California
| | - David A Hampton
- University of Chicago, Department of Surgery, Section of Trauma and Acute Care Surgery, Chicago, Illinois
| | - Adesuwa Akhetuamhen
- Northwestern Buehler Center Health Economics and Policy and Northwestern Department of Emergency Medicine, Chicago, Illinois
| | - P Quincy Moore
- University of Chicago, Department of Medicine, Section of Emergency Medicine, Chicago, Illinois
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Sokol RL, Carter PM, Goldstick J, Miller AL, Walton MA, Zimmerman MA, Cunningham RM. Within-Person Variability in Firearm Carriage Among High-Risk Youth. Am J Prev Med 2020; 59:386-393. [PMID: 32430221 PMCID: PMC7483893 DOI: 10.1016/j.amepre.2020.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Youth who carry firearms-and peers that surround them-are at increased risk for violent injuries. Because firearm carriage behaviors can change over time within an individual, it is important to identify individual and social-contextual determinants that explain this within-person variability in carriage. METHODS The authors identified individual and social-contextual determinants of firearm carriage in the past 6 months using multilevel logistic models on 5 waves of panel data from the Flint Youth Injury Study (n=597; ages 14-24 years), collected in 2009-2011 and analyzed in 2019. RESULTS Regarding within-person effects, when an individual had more positive peer affiliations than their average, their odds of carrying a firearm decreased (OR=0.88; 95% CI=0.81, 0.96). Conversely, an individual's odds of carrying a firearm increased when they had more negative peer affiliations (OR=1.08, 95% CI=1.02, 1.14), experienced more victimization (OR=1.03, 95% CI=1.01, 1.05), perceived greater community violence (OR=1.12, 95% CI=1.05, 1.21), or exhibited greater retaliatory attitudes (OR=1.10, 95% CI=1.01, 1.19) than their average. CONCLUSIONS Peer affiliations, victimization, community violence perceptions, and retaliatory attitudes explain within-person variability in firearm carriage. Strategies for reducing carriage among youth should consider individual- and environmental-level interventions to address these individual and social-contextual determinants.
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Affiliation(s)
- Rebeccah L Sokol
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Patrick M Carter
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jason Goldstick
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Alison L Miller
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Marc A Zimmerman
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, School of Public Health, University of Michigan, Ann Arbor, Michigan; Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan
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Abstract
BACKGROUND Gun injury accounts for substantial acute mortality worldwide and many others survive with lingering disabilities. We investigated whether additional health losses beyond mortality can also arise for patients who survive with long-term disability. METHODS We conducted a population-based individual patient analysis of adults injured by firearms who had received emergency medical care in Ontario, Canada, from Apr. 1, 2002, to Apr. 1, 2019. Longitudinal cohort analyses were evaluated through deterministic linkages of individual electronic patient files. The primary outcome was death or subsequent application for long-term disability in the years after hospital discharge. RESULTS In total, 8313 patients were injured from firearms, of which 3020 were injured from intentional incidents and 5293 were injured from unintentional incidents. A total of 2657 (88.0%) patients with intentional gun injury and 5089 (96.1%) patients with unintentional gun injury survived initial injuries. After a mean 7.75 years of follow-up, patients surviving intentional injuries had a disability rate twice as high as patients surviving unintentional injuries (19.7% v. 10.1%, p < 0.001), equivalent to a hazard ratio of 2.01 (95% confidence interval 1.80-2.25). The higher risk of long-term disability for survivors after intentional gun injury was not explained by demographic characteristics, extended to survivors treated and released from the emergency department, and was observed regardless of whether the incident was self-inflicted or from interpersonal assault. Half of the disability cases were identified after the first year. Additional predictors of long-term disability included a lower socioeconomic status, an urban home location, arrival by ambulance transport, a history of mental illness and a diagnosis of substance use disorder. INTERPRETATION Our study shows that gun death statistics underestimate the extent of health losses from long-term disability, particularly for those with intentional injuries. Additional and sustainable follow-up medical care might improve patient outcomes.
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Affiliation(s)
- Sheharyar Raza
- Department of Medicine (Raza, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Raza, Thiruchelvam, Redelmeier), Sunnybrook Research Institute; ICES in Ontario (Thiruchelvam); Institute of Health Policy, Management and Evaluation (Redelmeier), Toronto, Ont
| | - Deva Thiruchelvam
- Department of Medicine (Raza, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Raza, Thiruchelvam, Redelmeier), Sunnybrook Research Institute; ICES in Ontario (Thiruchelvam); Institute of Health Policy, Management and Evaluation (Redelmeier), Toronto, Ont
| | - Donald A Redelmeier
- Department of Medicine (Raza, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Raza, Thiruchelvam, Redelmeier), Sunnybrook Research Institute; ICES in Ontario (Thiruchelvam); Institute of Health Policy, Management and Evaluation (Redelmeier), Toronto, Ont.
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Attridge MM, Holmstrom SE, Sheehan KM. Injury Prevention Opportunities in the Pediatric Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lécuyer L, Dalle C, Lefevre-Arbogast S, Micheau P, Lyan B, Rossary A, Demidem A, Petera M, Lagree M, Centeno D, Galan P, Hercberg S, Samieri C, Assi N, Ferrari P, Viallon V, Deschasaux M, Partula V, Srour B, Latino-Martel P, Kesse-Guyot E, Druesne-Pecollo N, Vasson MP, Durand S, Pujos-Guillot E, Manach C, Touvier M. Diet-Related Metabolomic Signature of Long-Term Breast Cancer Risk Using Penalized Regression: An Exploratory Study in the SU.VI.MAX Cohort. Cancer Epidemiol Biomarkers Prev 2020; 29:396-405. [PMID: 31767565 DOI: 10.1158/1055-9965.epi-19-0900] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/03/2019] [Accepted: 11/18/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diet has been recognized as a modifiable risk factor for breast cancer. Highlighting predictive diet-related biomarkers would be of great public health relevance to identify at-risk subjects. The aim of this exploratory study was to select diet-related metabolites discriminating women at higher risk of breast cancer using untargeted metabolomics. METHODS Baseline plasma samples of 200 incident breast cancer cases and matched controls, from a nested case-control study within the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) cohort, were analyzed by untargeted LC-MS. Diet-related metabolites were identified by partial correlation with dietary exposures, and best predictors of breast cancer risk were then selected by Elastic Net penalized regression. The selection stability was assessed using bootstrap resampling. RESULTS 595 ions were selected as candidate diet-related metabolites. Fourteen of them were selected by Elastic Net regression as breast cancer risk discriminant ions. A lower level of piperine (a compound from pepper) and higher levels of acetyltributylcitrate (an alternative plasticizer to phthalates), pregnene-triol sulfate (a steroid sulfate), and 2-amino-4-cyano butanoic acid (a metabolite linked to microbiota metabolism) were observed in plasma from women who subsequently developed breast cancer. This metabolomic signature was related to several dietary exposures such as a "Western" dietary pattern and higher alcohol and coffee intakes. CONCLUSIONS Our study suggested a diet-related plasma metabolic signature involving exogenous, steroid metabolites, and microbiota-related compounds associated with long-term breast cancer risk that should be confirmed in large-scale independent studies. IMPACT These results could help to identify healthy women at higher risk of breast cancer and improve the understanding of nutrition and health relationship.
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Affiliation(s)
- Lucie Lécuyer
- Center of Research of Epidemiology and StatisticS (CRESS), French National Institute of Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (CNAM), Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny, France.
| | - Céline Dalle
- Clermont Auvergne University, INRA, UMR 1019, Human Nutrition Unit (UNH), CRNH Auvergne, Micronutriments et Santé cardiovasculaire (MicroCard), Clermont-Ferrand, France
- Clermont Auvergne University, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Sophie Lefevre-Arbogast
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Pierre Micheau
- Clermont Auvergne University, INRA, UMR 1019, Human Nutrition Unit (UNH), CRNH Auvergne, Micronutriments et Santé cardiovasculaire (MicroCard), Clermont-Ferrand, France
| | - Bernard Lyan
- Clermont Auvergne University, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Adrien Rossary
- Clermont Auvergne University, INRA, UMR 1019, Human Nutrition Unit (UNH), CRNH Auvergne, Cellular Micro-Environment, Immunomodulation and Nutrition (ECREIN), Clermont-Ferrand, France
| | - Aicha Demidem
- Clermont Auvergne University, INRA, UMR 1019, Human Nutrition Unit (UNH), CRNH Auvergne, Cellular Micro-Environment, Immunomodulation and Nutrition (ECREIN), Clermont-Ferrand, France
| | - Mélanie Petera
- Clermont Auvergne University, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Marie Lagree
- Clermont Auvergne University, Institut de Chimie de Clermont-Ferrand, Plateforme d'Exploration du Métabolisme, MetaboHUB-Clermont, Aubière, France
| | - Delphine Centeno
- Clermont Auvergne University, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Pilar Galan
- Center of Research of Epidemiology and StatisticS (CRESS), French National Institute of Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (CNAM), Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Serge Hercberg
- Center of Research of Epidemiology and StatisticS (CRESS), French National Institute of Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (CNAM), Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny, France
- Public Health Department, Avicenne Hospital, Bobigny, France
| | - Cecilia Samieri
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Nada Assi
- International Agency for Research on Cancer, Section of Nutrition and Metabolism, Nutritional Methodology and Biostatistics Group, Lyon, France
| | - Pietro Ferrari
- International Agency for Research on Cancer, Section of Nutrition and Metabolism, Nutritional Methodology and Biostatistics Group, Lyon, France
| | - Vivian Viallon
- International Agency for Research on Cancer, Section of Nutrition and Metabolism, Nutritional Methodology and Biostatistics Group, Lyon, France
| | - Mélanie Deschasaux
- Center of Research of Epidemiology and StatisticS (CRESS), French National Institute of Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (CNAM), Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Valentin Partula
- Center of Research of Epidemiology and StatisticS (CRESS), French National Institute of Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (CNAM), Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Bernard Srour
- Center of Research of Epidemiology and StatisticS (CRESS), French National Institute of Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (CNAM), Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Paule Latino-Martel
- Center of Research of Epidemiology and StatisticS (CRESS), French National Institute of Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (CNAM), Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Center of Research of Epidemiology and StatisticS (CRESS), French National Institute of Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (CNAM), Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Nathalie Druesne-Pecollo
- Center of Research of Epidemiology and StatisticS (CRESS), French National Institute of Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (CNAM), Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny, France
| | - Marie-Paule Vasson
- Clermont Auvergne University, INRA, UMR 1019, Human Nutrition Unit (UNH), CRNH Auvergne, Cellular Micro-Environment, Immunomodulation and Nutrition (ECREIN), Clermont-Ferrand, France
- Anticancer Center Jean-Perrin, CHU Clermont-Ferrand, France
| | - Stéphanie Durand
- Clermont Auvergne University, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Estelle Pujos-Guillot
- Clermont Auvergne University, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Clermont-Ferrand, France
| | - Claudine Manach
- Clermont Auvergne University, INRA, UMR 1019, Human Nutrition Unit (UNH), CRNH Auvergne, Micronutriments et Santé cardiovasculaire (MicroCard), Clermont-Ferrand, France
| | - Mathilde Touvier
- Center of Research of Epidemiology and StatisticS (CRESS), French National Institute of Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (CNAM), Paris 13 University, Nutritional Epidemiology Research Team (EREN), Bobigny, France
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Carter PM, Mouch CA, Goldstick JE, Walton MA, Zimmerman MA, Resnicow K, Cunningham RM. Rates and correlates of risky firearm behaviors among adolescents and young adults treated in an urban emergency department. Prev Med 2020; 130:105891. [PMID: 31726077 PMCID: PMC7182087 DOI: 10.1016/j.ypmed.2019.105891] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/12/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
Firearm violence is a leading cause of death for urban adolescents and young adults (A/YAs). Little is known about patterns of risky firearm behaviors (RFBs) that may increase firearm-related fatality and non-fatal injury risk. To inform prevention efforts, we examined the rates and correlates of RFBs, including firearm carriage in risky situations (e.g., while drunk/high), discharge in risky situations (e.g., fleeing police), and firearm aggression (e.g., firearm threats/use against a partner/non-partner), among a sample of A/YAs (age-16-29) seeking medical or injury related care (7/2017-6/2018) at a Level-1 urban Emergency Department (ED). In total, 1312 A/YAs completed the survey (mean-age 23.2; 29.6%-male; 50.5%-Black; 56.3%-public assistance), with 102 (7.8%) engaging in RFBs. Among those engaging in RFBs, 42% reported firearm ownership, 68.6% firearm carriage in high-risk situations, 39.2% firearm discharge in risky situations, and 41.2% reported partner/non-partner firearm aggression. Regression identified RFBs correlates, including older age (AOR = 1.09), male sex (AOR = 1.63), Black race/ethnicity (AOR = 2.01), substance misuse (AOR = 2.75), attitudes favoring firearm use/retaliation (AOR = 1.38), peer firearm ownership/carriage (AOR = 3.26), higher levels of community violence exposure (AOR = 1.05), and active parole/probation (AOR 2.38). Higher coping skills were protective for RFBs (AOR = 0.83). Overall, we found that A/YAs seeking urban ED treatment reported elevated RFB rates, emphasizing the need for novel prevention initiatives, especially those incorporating tailored content addressing substance use, retaliatory violence, and peer delinquency/norms, while enhancing self-efficacy for avoiding RFBs and providing access to external resources within a resiliency-based framework. Such prevention approaches may be a critical step towards addressing the public health problem of firearm violence. Primary Funding Sources: NIH/NIDA K23DA039341; NIH/NCATS UL1TR000433.
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Affiliation(s)
- Patrick M Carter
- Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Youth Violence Prevention Center, University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America.
| | - Charles A Mouch
- Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Surgery, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America.
| | - Jason E Goldstick
- Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America.
| | - Maureen A Walton
- Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; University of Michigan, Addiction Center, Department of Psychiatry, School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, United States of America.
| | - Marc A Zimmerman
- Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Youth Violence Prevention Center, University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America; University of Michigan, Addiction Center, Department of Psychiatry, School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, United States of America.
| | - Ken Resnicow
- Department of Health Behavior & Health, Education, University of Michigan, School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America.
| | - Rebecca M Cunningham
- Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Youth Violence Prevention Center, University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America; Department of Health Behavior & Health, Education, University of Michigan, School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America; Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, MI 48503, United States of America.
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Goldstick JE, Walton MA, Bohnert ASB, Heinze JE, Cunningham RM. Predictors of alcohol use transitions among drug-using youth presenting to an urban emergency department. PLoS One 2019; 14:e0227140. [PMID: 31891632 PMCID: PMC6938309 DOI: 10.1371/journal.pone.0227140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background Precipitants of alcohol use transitions can differ from generalized risk factors. We extend prior research by predicting transitions in alcohol use disorder (AUD) during adolescence and emerging adulthood. Methods From 12/2009-9/2011, research assistants recruited 599 drug-using youth age 14–24 from Level-1 Emergency Department in Flint, Michigan. Youth were assessed at baseline and four biannual follow-ups, including a MINI Neuropsychiatric interview to diagnose AUD (abuse/dependence). We modeled AUD transitions using continuous time Markov Chains with transition probabilities modulated by validated measures of demographics, anxiety/depression symptoms, cannabis use, peer drinking, parental drinking, and violence exposure. Separate models were fit for underage (<21) and those of legal drinking age. Results We observed 2,024 pairs of consecutive AUD states, including 264 transitions (119 No-AUD→AUD; 145 AUD→No-AUD); 194 (32.4%) individuals were diagnosed with AUD at ≥1 assessment. Among age 14–20, peer drinking increased AUD onset (No-AUD→AUD transition) rates (Hazard ratio—HR = 1.70; 95%CI: [1.13,2.54]), parental drinking lowered AUD remission (AUD→No-AUD transition) rates (HR = 0.53; 95%CI: [0.29,0.97]), and cannabis use severity both hastened AUD onset (HR = 1.18; 95%CI: [1.06,1.32]) and slowed AUD remission (HR = 0.85; 95%CI: [0.76,0.95]). Among age 21–24, anxiety/depression symptoms both increased AUD onset rates (HR = 1.35; 95%CI: [1.13,1.60]) and decreased AUD remission rates (HR = 0.74; 95%CI: [0.63,0.88]). Friend drinking hastened AUD onset (HR = 1.18, 95%CI: [1.05,1.33]), and slowed AUD remission (HR = 0.84; 95%CI: [0.75,0.95]). Community violence exposure slowed AUD remission (HR = 0.69, 95%CI: [0.48,0.99]). In both age groups, males had >2x the AUD onset rate of females, but there were no sex differences in AUD remission rates. Limitations, most notably that this study occurred at a single site, are discussed. Conclusions Social influences broadly predicted AUD transitions in both age groups. Transitions among younger youth were predicted by cannabis use, while those among older youth were predicted more by internalizing symptoms and stress exposure (e.g., community violence). Our results suggest age-specific AUD etiology, and contrasts between prevention and treatment strategies.
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Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
| | - Maureen A. Walton
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, United States of America
| | - Amy S. B. Bohnert
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, United States of America
| | - Justin E. Heinze
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Hurley Medical Center, Department of Emergency Medicine, Flint, MI, United States of America
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Dora-Laskey AD, Goldstick JE, Buckley L, Bonar EE, Zimmerman MA, Walton MA, Cunningham RM, Carter PM. Trajectories of Driving after Drinking among Marijuana-Using Youth in the Emergency Department: Substance Use, Mental Health, and Peer and Parental Influences. Subst Use Misuse 2019; 55:175-187. [PMID: 31502499 PMCID: PMC6980673 DOI: 10.1080/10826084.2019.1660675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The psychosocial correlates and longitudinal trajectories of driving after drinking (DAD) among youth remain understudied in at-risk populations. Objectives: We investigated the relationships of DAD trajectories and negative peer and parental influences, substance use, and mental health among predominantly marijuana-using youth seeking emergency department (ED) treatment. Methods: Data were from a 2-year prospective cohort study of drug-using patients (97.4% used marijuana) ages 14-24 seeking ED care for assault injury, or as part of a non-assaulted comparison group. Validated surveys measured DAD behaviors and correlates at baseline, 6, 12, 18, and 24 months. Latent class growth analysis identified characteristic DAD trajectory groups; baseline predictors were analyzed descriptively and using multinomial logistic regression. Results: Three DAD trajectory groups were identified among driving-age youth (n = 580): no DAD (NDAD; 55.2%), low-steady (LDAD; 29.0%), and high-declining (HDAD; 15.9%). In unadjusted analyses, HDAD youth were older, but otherwise similar to other groups demographically. Compared to NDAD, LDAD and HDAD group members had higher rates of drug and alcohol use disorders (p < .001). Further, HDAD group members had higher rates of anxiety symptoms and were more likely to be diagnosed with PTSD or depression than NDAD or LDAD youth (p < .05). Negative peer and parent influences were significantly higher in progressively more severe trajectory groups (p < .01). Adjusted effects from the multinomial model were analogous for peer and parental influences and substance use disorders, but not mental health. Conclusion: DAD is strongly associated with negative social influences and substance use disorders among marijuana-using youth, reinforcing their importance when developing interventions.
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Affiliation(s)
- Aaron D Dora-Laskey
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Hurley Medical Center, Flint, Michigan, USA
| | - Jason E Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
| | - Lisa Buckley
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- The University of Queensland, St. Lucia, Queensland, Australia
| | - Erin E Bonar
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc A Zimmerman
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- Hurley Medical Center, Flint, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
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42
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Holt SR, Rosenbaum J, Ellman M, Doolittle B, Tobin DG. Physicians Should Play a Role in Ensuring Safe Firearm Ownership. J Gen Intern Med 2019; 34:1637-1640. [PMID: 31062224 PMCID: PMC6667526 DOI: 10.1007/s11606-019-05034-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 02/05/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
The USA is unique among industrialized nations in its dramatic rate of firearm violence. Unfortunately, firearm-related issues in America are politically divisive and fraught with controversy, thus impeding the study and implementation of safety strategies. Despite the lack of consensus, there is agreement that firearms should be kept away from individuals with criminal intent and those who are dangerous due to medical impairment. While predicting criminal intent remains challenging, assessment of medical impairment remains a viable target. One approach in which physicians could contribute their expertise includes training a subset of doctors to perform specialized medical evaluations as a prerequisite for gun ownership. Such a process is not unprecedented, as physicians currently have a role in protecting the public's safety through assessments for commercial drivers, pilots, and train operators. Certified physician examiners could conduct these evaluations with a focus on evaluating objective, skill-based metrics to limit potential evaluator bias. The results of the medical evaluation would then be considered by an existing regulatory body to determine if disqualifying criteria are present. This proposal provides a mechanism for trained physicians to meaningfully participate in addressing an alarming public health issue, while still working within existing legal frameworks.
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Affiliation(s)
- Stephen R Holt
- Yale University School of Medicine, 1450 Chapel Street, Rm P-312, New Haven, CT, USA.
| | - Julie Rosenbaum
- Yale University School of Medicine, 1450 Chapel Street, Rm P-312, New Haven, CT, USA
| | - Matthew Ellman
- Yale University School of Medicine, 1450 Chapel Street, Rm P-312, New Haven, CT, USA
| | - Benjamin Doolittle
- Yale University School of Medicine, 1450 Chapel Street, Rm P-312, New Haven, CT, USA
| | - Daniel G Tobin
- Yale University School of Medicine, 1450 Chapel Street, Rm P-312, New Haven, CT, USA
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43
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Oliphant SN, Mouch CA, Rowhani-Rahbar A, Hargarten S, Jay J, Hemenway D, Zimmerman M, Carter PM. A scoping review of patterns, motives, and risk and protective factors for adolescent firearm carriage. J Behav Med 2019; 42:763-810. [PMID: 31367939 PMCID: PMC7182091 DOI: 10.1007/s10865-019-00048-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/23/2019] [Indexed: 12/14/2022]
Abstract
Firearm carriage is a key risk factor for interpersonal firearm violence, a leading cause of adolescent (age < 18) mortality. However, the epidemiology of adolescent firearm carriage has not been well characterized. This scoping review examined four databases (PubMed; Scopus; EMBASE; Criminal Justice Abstracts) to summarize research on patterns, motives, and underlying risk/protective factors for adolescent firearm carriage. Of 6156 unique titles, 53 peer-reviewed articles met inclusion criteria and were reviewed. These studies mostly examined urban Black youth, finding that adolescents typically carry firearms intermittently throughout adolescence and primarily for self-defense/protection. Seven future research priorities were identified, including: (1) examining adolescent carriage across age, gender, and racial/ethnic subgroups; (2) improving on methodological limitations of prior research, including disaggregating firearm from other weapon carriage and using more rigorous methodology (e.g., random/systematic sampling; broader population samples); (3) conducting longitudinal analyses that establish temporal causality for patterns, motives, and risk/protective factors; (4) capitalizing on m-health to develop more nuanced characterizations of underlying motives; (5) increasing the study of precursors for first-time carriage; (6) examining risk and protective factors beyond the individual-level; and, (7) enhancing the theoretical foundation for firearm carriage within future investigations.
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Affiliation(s)
- Stephen N. Oliphant
- Firearm Safety Among Children and Teens Consortium, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA,Gerald R. Ford School of Public Policy, University of Michigan, 735 S State St, Ann Arbor, MI 48109, USA
| | - Charles A. Mouch
- Firearm Safety Among Children and Teens Consortium, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA,Department of Surgery, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Ali Rowhani-Rahbar
- Firearm Safety Among Children and Teens Consortium, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA,Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, F-262, Seattle, WA 98195, USA,Harborview Injury Prevention and Research, Center University of Washington, 401 Broadway, 4th Floor, Seattle, WA 98122, USA
| | - Stephen Hargarten
- Firearm Safety Among Children and Teens Consortium, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA,Department of Emergency Medicine and Comprehensive Injury Center, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Jonathan Jay
- Firearm Safety Among Children and Teens Consortium, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, 3rd & 4th Floors, 677 Huntington Avenue, Boston, MA 02115, USA
| | - David Hemenway
- Firearm Safety Among Children and Teens Consortium, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, 3rd & 4th Floors, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Marc Zimmerman
- Firearm Safety Among Children and Teens Consortium, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA,Department of Health Behavior and Health Education, University of Michigan School Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, USA,Youth Violence Prevention Center, Univ. of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA,Department of Emergency Medicine, Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, USA
| | - Patrick M. Carter
- Firearm Safety Among Children and Teens Consortium, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA,Department of Health Behavior and Health Education, University of Michigan School Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, USA,Youth Violence Prevention Center, Univ. of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA,Department of Emergency Medicine, Univ. of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, USA
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44
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Goldstick JE, Carter PM, Heinze JE, Walton MA, Zimmerman M, Cunningham RM. Predictors of transitions in firearm assault behavior among drug-using youth presenting to an urban emergency department. J Behav Med 2019; 42:635-645. [PMID: 31367929 PMCID: PMC6999855 DOI: 10.1007/s10865-019-00021-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/14/2019] [Indexed: 12/14/2022]
Abstract
Risk and protective factors for firearm assault (FA) have been established, but little is known about factor preceding transitions in FA behavior. We modeled covariate effects on individuals' transitions in FA behavior (Yes/No) using inhomogeneous, continuous-time, Markov Chains. 3287 assessments were made across five initial biannual follow-ups, and two additional biannual follow-ups (an average of 2.2 years later) from a follow-on study; 2687 pairs of transitions were observed (2414 No-FA → No-FA; 89 No-FA → FA; 121 FA → No-FA; 63 FA → FA). Non-firearm peer violence (HR = 2.31, 95% CI [1.28,4.21]), firearm victimization (HR = 2.57, 95% CI [1.31,5.04]), and marijuana ASSIST sum (HR = 1.27, 95% CI [1.05,1.54]) all preceded transitions into FA, but not transitions out of FA. Delinquent peer associations both hastened transitions into FA (HR = 1.19, 95% CI [1.00,1.40]) and slowed transitions out of FA (HR = 0.84, 95% CI:[0.72,1.00]), with analogous findings regarding attitudes favoring retaliation. Efforts to prevent FA initiation should focus on those currently reporting firearm violence victimization, and on factors indicating an escalating delinquency trajectory (e.g. non-firearm violence, substance use), while programs focusing on peer influences and social norms may be effective at preventing FA regardless of current FA status.
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Affiliation(s)
- Jason E Goldstick
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA.
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Justin E Heinze
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
| | - Maureen A Walton
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
- University of Michigan Addiction Center, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Marc Zimmerman
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
- Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, USA
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45
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Ngo QM, Sigel E, Moon A, Stein SF, Massey LS, Rivara F, King C, Ilgen M, Cunningham R, Walton MA. State of the science: a scoping review of primary prevention of firearm injuries among children and adolescents. J Behav Med 2019; 42:811-829. [DOI: 10.1007/s10865-019-00043-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/06/2019] [Indexed: 12/21/2022]
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46
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Youth exposure to violence involving a gun: evidence for adverse childhood experience classification. J Behav Med 2019; 42:646-657. [PMID: 31367930 DOI: 10.1007/s10865-019-00053-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/30/2019] [Indexed: 01/13/2023]
Abstract
Adverse childhood experiences (ACEs) have historically included child maltreatment, household dysfunction, and other critical issues known to impact children negatively. Although youth experiences with violence are broadly captured in some ACE measures, youth exposure to violence involving a gun has not been included specifically in the operationalizing, and therefore scientific study, of ACEs. There are numerous implications of this omission, including limiting access to ACE interventions that are currently available and resources for individuals who have been exposed to gun violence. Thus, and given the persistent prevalence of gun violence in the US, we conducted a systematic review of the literature over the past two decades on the assessment of and response to ACEs and gun violence. Eighty-one journal articles across four search engines met our inclusion criteria. Our findings provide evidence that youth gun violence exposure should be classified as an ACE. In addition to increasing access to resources for youth affected by gun violence, these findings may improve the likelihood of funding and research into gun violence, with direct implications for prevention and intervention efforts.
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47
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Schmidt CJ, Rupp L, Pizarro JM, Lee DB, Branas CC, Zimmerman MA. Risk and protective factors related to youth firearm violence: a scoping review and directions for future research. J Behav Med 2019; 42:706-723. [PMID: 31367936 PMCID: PMC8682918 DOI: 10.1007/s10865-019-00076-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 06/26/2019] [Indexed: 12/14/2022]
Abstract
To conduct our scoping review of risk and protective factors for firearm violence among youth, we searched PubMed, Scopus, EMBASE, and Criminal Justice Abstracts for English-language research articles published between January 1985 and May 2018. We included studies of modifiable risk or protective factors associated with intentional (including suicide) or unintentional firearm victimization or perpetration with samples that included youth ≤ 17. Among the 28 included studies, 15 explored risk/protective factors for victimization, five focused on perpetration, five did not differentiate between victimization and perpetration, and five focused on suicide. Most studies examined individual-level risk factors. The few that explored factors beyond the individual were limited by methodological weaknesses and inconsistent findings. Protective factors for youth firearm outcomes were understudied. We need more research on youth firearm violence using longitudinal data and robust statistical methods. Future research is needed to understand the underlying mechanisms by which risk/protective factors influence firearm violence.
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Affiliation(s)
- Carissa J. Schmidt
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Laney Rupp
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Jesenia M. Pizarro
- Arizona State University, School of Criminology and Criminal Justice, 411 N. Central Ave. Ste. 600, Phoenix, AZ 85004
| | - Daniel B. Lee
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Charles C. Branas
- Columbia Mailman School of Public Health, Department of Epidemiology, 722 W. 168th St., New York, NY 10032
| | - Marc A. Zimmerman
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109
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48
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Goldstick JE, Heinze JE, Stoddard SA, Cunningham RM, Zimmerman MA. Age-Specific Associations Between Violence Exposure and Past 30-Day Marijuana and Alcohol Use. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2019; 29:480-492. [PMID: 29683238 PMCID: PMC6201281 DOI: 10.1111/jora.12399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Using data from a cohort study of students at risk for high school dropout, we examined associations between violence exposure and past 30-day alcohol and marijuana use. We used varying-coefficient regression with person-level fixed effects to estimate how those associations changed within-person across ages approximately 14-23. Generally, violence perpetration was most strongly associated with substance use, within-person. Substance use became increasingly associated with both observed violence and violence perpetration during early/middle adolescence; this increase continued longer into development (age 18+) for alcohol use. Across most of the age range studied here, violence victimization was minimally associated with within-person changes in substance use. Results indicate age-specific associations between violence exposure and alcohol and other drug use, which may be useful for informing prevention strategies.
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49
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Bulger EM, Kuhls DA, Campbell BT, Bonne S, Cunningham RM, Betz M, Dicker R, Ranney ML, Barsotti C, Hargarten S, Sakran JV, Rivara FP, James T, Lamis D, Timmerman G, Rogers SO, Choucair B, Stewart RM. Proceedings from the Medical Summit on Firearm Injury Prevention: A Public Health Approach to Reduce Death and Disability in the US. J Am Coll Surg 2019; 229:415-430.e12. [PMID: 31108194 DOI: 10.1016/j.jamcollsurg.2019.05.018] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Eileen M Bulger
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Washington, Seattle, WA.
| | - Deborah A Kuhls
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Nevada, Las Vegas, NV
| | - Brendan T Campbell
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Connecticut, Hartford, CT
| | - Stephanie Bonne
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | | | - Marian Betz
- Department of Emergency Medicine, University of Colorado, Denver, CO
| | - Rochelle Dicker
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of California-Los Angeles, Los Angeles, CA
| | - Megan L Ranney
- Department of Emergency Medicine, Brown University, Alpert Medical School, Providence, RI
| | - Chris Barsotti
- Department of Emergency Medicine, Berkshire Medical Center, Pittsfield, MA
| | - Stephen Hargarten
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Joseph V Sakran
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, Johns Hopkins University, Baltimore, MD
| | | | - Thea James
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA
| | - Dorian Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Gary Timmerman
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of South Dakota Sanford School of Medicine, Sioux Falls, SD
| | - Selwyn O Rogers
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Chicago, Chicago, IL
| | | | - Ronald M Stewart
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Texas San Antonio, San Antonio, TX
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50
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Abaya R. Firearm Violence and the Path to Prevention: What We Know, What We Need. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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