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Adams M, Gong C, Heinze JE. Firearm ownership and storage among US college students: results from the healthy minds study, 2021-2022. J Behav Med 2024; 47:662-671. [PMID: 38460062 DOI: 10.1007/s10865-024-00467-5] [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: 04/18/2023] [Accepted: 01/15/2024] [Indexed: 03/11/2024]
Abstract
The purpose of this study is to address a significant gap in knowledge on firearm ownership rates and storage characteristics in a national sample of college students. We used 2021-2022 survey data from the Healthy Minds Study, which included approximately 88,500 students at over 100 US colleges and universities. We conducted analyses using descriptive statistics and two-sample proportion tests. About 4% of respondents reported having a firearm on or around campus. Among firearm owners, 68.8% reported storing firearms at their permanent address within an hour's drive from campus, and 43.1% reported storing their firearms unloaded and locked. Firearm ownership rates were significantly higher for respondents who were positive for specific risk factors (i.e., in a relationship, suicide ideation, recent binge drinking, and having been physically assaulted) versus those who were negative. These findings support the need for targeted messaging and firearm safety training for college students to reduce firearm-related risks.
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Affiliation(s)
- Mackenzie Adams
- University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Catherine Gong
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Justin E Heinze
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Bornstein SS, Laine C. Reducing Firearm Injury: Make America Safe Again. Ann Intern Med 2024. [PMID: 39074370 DOI: 10.7326/m24-0891] [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: 07/31/2024] Open
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Lee YH, DeJong W. Depictions of Firearms and Other Projectile Weapons in Top-Selling Japanese Manga. Psychol Rep 2024:332941241246204. [PMID: 38591268 DOI: 10.1177/00332941241246204] [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: 04/10/2024]
Abstract
Firearm violence is a pressing public health issue in the United States and becoming increasingly so worldwide. This concern has prompted researchers to examine the prevalence of such violence in media entertainment. Japanese manga have a large youth readership in the U.S., yet research on their depictions of firearms is presently lacking. We randomly selected 50 chapters from each of ten top-selling manga series worldwide (N = 500) to identify dialogue, action, and other illustrations involving handguns, rifles, machine guns, other projectile weapons, and bombs. Of the 500 chapters, 129 (25.8%) had at least one depiction of a firearm or other projectile weapon, with 684 instances of characters handling (e.g., carrying, holding, firing, reloading) such a weapon. Of the 384 unique characters so depicted, the vast majority were males (88.3%), adults (92.2%), and "good" characters (73.4%). Manga readers, especially male adolescents and preteens, are frequently exposed to storylines in which one or more characters are using a firearm or other projectile weapon. Working collaboratively, manga publishers and distributors should act to develop and implement a comprehensive rating system to flag content that may be harmful to youth so that parents can more easily monitor what their children are reading.
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Affiliation(s)
- Yen-Han Lee
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - William DeJong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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Trinidad S, Goldshore M, Kotagal M. Addressing health equity in pediatric surgical care in the United States- Progress and challenges. Semin Pediatr Surg 2023; 32:151354. [PMID: 37967486 DOI: 10.1016/j.sempedsurg.2023.151354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
There are notable inequities in health outcomes for children based on their social determinants of health (SDOH), including where they are born and live, their primary language, their race and ethnicity, socioeconomic status, and more. These health inequities are not restricted to resource limited settings; here we highlight three broad topics that are relevant to pediatric surgeons in the United States (US): access to care and disparities, and examples of inequities in firearm-related injuries and appendicitis. Most of our patients will at some point require operative interventions, yet there can be significant challenges in accessing this care and navigating our health systems, particularly around complex perioperative care. There are significant opportunities to improve equitable care by helping patients navigate our health systems and connecting them with additional resources, including screening for primary care services. Firearm-related injuries are now the leading cause of death in children in the US, with significant associated morbidity for non-fatal injuries. There are notable inequities in the risk of injury and types of injuries experienced by children based on their SDOH. Appendicitis is one of the most common pathologies managed by pediatric surgeons, with similar inequities in the rates of perforated appendicitis based on a child's SDOH. For both issues, addressing the inequities our patients experience requires moving upstream and working towards prevention. Key opportunities include better research and data to understand the drivers for observed inequities, multidisciplinary collaboration, community engagement, and public health advocacy among others. As a profession, we have a responsibility to work to address the health inequities our patients experience.
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Affiliation(s)
- Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Matthew Goldshore
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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Hynes AM, Weaver JL, Hatchimonji JS, Sperry JL, Sanchez SE, Seamon MJ, Kheirbek T, Scantling DR. Funding the war in America: A look in the mirror. J Trauma Acute Care Surg 2023; 95:621-627. [PMID: 37012619 DOI: 10.1097/ta.0000000000003982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Health care political action committees (HPACs) historically contribute more to candidates opposing firearm restrictions (FRs), clashing with their affiliated medical societies. These societies have increasingly emphasized the prevention of firearm violence and it is not known if recent contributions by their HPACs have aligned with their stated goals. We hypothesized that such HPACs still contribute similar amounts toward legislators up for reelection opposing FR. METHODS We identified HPACs of medical societies endorsing one or both calls-to-action against firearm violence published in the Annals of Internal Medicine (2015, 2019). House of Representatives (HOR) votes on H.R.8, a background checks bill, were characterized from GovTrack. We compiled HPAC contributions between the H.R.8 vote and election to HOR members up for re-election from the National Institute on Money in Politics. Our primary outcome was total campaign contributions by H.R.8 stance. Secondary outcomes included percentage of politicians funded and total contributions. RESULTS Nineteen societies endorsed one or both call-to-action articles. Three hundred eighty-five of 430 HOR members ran for reelection in 2020. Those endorsing H.R.8 (n = 226, 59%) received $2.8 M for $4,750 (interquartile range [IQR], $1000-$15,500) per candidate. Those opposing (n = 159, 41%) received $1.5 M for $2,500 (IQR, $0-$11,000) per candidate ( p = 0.0057). Health care political action committees donated toward a median of 20% (IQR, 7-28) of candidates endorsing H.R.8 and 9% (IQR, 4-22) of candidates opposing H.R.8 ( p = 0.0014). Those endorsing H.R.8 received 1,585 total contributions for a median of 3 (IQR, 1-10) contributions per candidate, while those opposing received 834 total contributions for a median of 2 (IQR, 0-7) contributions per candidate ( p = 0.0029). CONCLUSION Politicians voting against background checks received substantial contributions toward reelection from the HPACs of societies advocating for firearm restrictions. However, this is the first study to suggest that HPAC's contributions have become more congruent with their respective societies. Further alignment of medical society goals and their HPAC political contributions could have a profound impact on firearm violence. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Allyson M Hynes
- From the Department of Emergency Medicine (A.M.H.), Department of Surgery (A.M.H.), University of New Mexico School of Medicine, Albuquerque, New Mexico; Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery (J.L.W.), UC San Diego, San Diego, California; Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery (J.S.H., M.J.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Division of Trauma and Surgery, Department of Surgery (J.L.S.), University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Trauma and Acute Care Surgery (S.E.S., D.R.S.), The Boston University School of Medicine, Boston, Massachusetts; and Department of Surgery (T.K.), Brown University Warren Alpert Medical School, Providence, Rhode Island
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Buck-Atkinson J, McCarthy M, Stanley IH, Harnke B, Anestis MD, Bryan CJ, Baker JC, Betz ME. Firearm locking device preferences among firearm owners in the USA: a systematic review. Inj Epidemiol 2023; 10:33. [PMID: 37415242 DOI: 10.1186/s40621-023-00436-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Preventing firearm-involved injuries is a critical public health priority. Firearm locking devices can prevent firearm injuries, such as suicide and unintentional shootings, as well as theft. Various firearm locking devices exist; however, little is known about firearm owners' preferred locking devices for secure firearm storage. In this systematic review, we examined existing literature on preferred locking devices for secure storage of personal firearms among United States (US) firearm owners with the purpose of understanding practical implications and needs for future research. METHODS We searched 8 major databases, as well as the grey literature, for English-language sources published on or before January 24, 2023, that empirically examined firearm locking device preferences. Following PRISMA guidelines, coders independently screened and reviewed 797 sources using pre-determined criteria. Overall, 38 records met inclusion criteria and were included in this review. RESULTS The majority of studies measure and report on participant use of various types of locking devices, but few go on to measure preference between device options and the attributes and features that may contribute to an individual's preference. Included studies suggest that a preference for larger devices, such as lockboxes and gun safes, may exist among US firearm owners. CONCLUSIONS Review of included studies suggests that current prevention efforts may not be aligned with firearm owners' preferences. Additionally, findings from this systematic review emphasize the need for additional methodological rigorous research to understand firearm locking device preferences. Expanded knowledge in this area will result in actionable data and foundational best practices for programming that encourages behavior change concerning secure storage of personal firearms to prevent injury and death.
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Affiliation(s)
- Jessica Buck-Atkinson
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA.
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA.
| | - Megan McCarthy
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA
| | - Ian H Stanley
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Center for COMBAT Research, Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, 12950 E Montview Blvd, Aurora, CO, 80045, USA
| | - Michael D Anestis
- Rutgers School of Public Health, New Jersey Gun Violence Research Center, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
- School of Public Health, The State University of New Jersey, 683 Hoes Lane West, Rutgers, Piscataway, NJ, 08854, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH, 43214, USA
| | - Justin C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH, 43214, USA
| | - Marian E Betz
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
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Bond AE, Moceri-Brooks J, Rodriguez TR, Semenza D, Anestis MD. Determining who healthcare providers screen for firearm access in the United States. Prev Med 2023; 169:107476. [PMID: 36870571 DOI: 10.1016/j.ypmed.2023.107476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Healthcare providers are well positioned to screen for firearm access to reduce risk of suicides, yet there is a limited understanding of how often and for whom firearm access screening occurs. The present study examined the extent to which providers screen for firearm access and sought to identify who has been screened in the past. The representative sample included 3510 residents from five US states who reported whether they have been asked about their access to firearms by a healthcare provider. The findings demonstrate that most participants have never been asked by a provider about firearm access. People who have been asked were more likely to be White, male, and firearm owners. Those with children under 17 years old in the home, that have been in mental health treatment, and report a history of suicidal ideation were more likely to be screened for firearm access. Although there are interventions for mitigating firearm related risks in healthcare settings, many providers may be missing the opportunity to implement these because they do not ask about firearm access.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; Department of Psychology, Rutgers University, United States of America; Department of Sociology, Anthropology, and Criminal Justice, Rutgers University - Camden, United States of America.
| | - Jayna Moceri-Brooks
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; School of Public Health, Rutgers University, United States of America
| | - Taylor R Rodriguez
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; Department of Psychology, Rutgers University, United States of America
| | - Daniel Semenza
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; Department of Sociology, Anthropology, and Criminal Justice, Rutgers University - Camden, United States of America
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; School of Public Health, Rutgers University, United States of America
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Lal A, John KJ, Mishra AK, Sherif AA. Burden of firearm-related injuries as associated secondary diagnosis in the United States from National Inpatient Sample Dataset. Intern Emerg Med 2023; 18:457-465. [PMID: 36592271 PMCID: PMC9806811 DOI: 10.1007/s11739-022-03190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/24/2022] [Indexed: 01/03/2023]
Abstract
There is little known about the differences, from the point of view of healthcare resource utilization, between non-fatal versus fatal firearm-related injuries. We undertook this research project utilizing the National Inpatient Sample (NIS) database to address this critical knowledge gap. Our aims for this study were to describe the patterns of FRI in the United States during the period of 2016-2019 and to evaluate the patient-centered outcomes in the survivor (non-fatal injuries) versus the non-survivor (fatal injuries) groups. We used the National Inpatient Sample (NIS) Database, 2016-2019 (5) (~ 20% of United States hospitalizations) to identify patients with an associated diagnosis of firearm-related injuries (FRI) [Gibson T et al (2016) in Agency for Healthcare Research and Quality 2016-02]. We found that the individuals from the lowest quartile of annual household income, males, young Americans, and racial minorities were disproportionally affected The non-survivor (fatal injuries) group had a shorter length of stay in the hospital by 5.1 days (95% CI - 5.64 to - 4.58, p value = < 0.01), the higher median cost of hospitalization by $8903 (95% confidence interval $311.9 to $17,494.2, p value = 0.04), and a higher median cost of hospitalization per day by $41,576.74 (95% confidence interval $ 40,333.1 to $42,820.3, p value = < 0.01). In conclusion, the individuals from the lowest quartile of annual household income, males, young Americans and racial minorities were disproportionally affected. Firearm-related injuries pose a persistent healthcare cost burden with the cumulative and per day cost of hospitalization for fatal injuries being significantly higher than the non-fatal injuries despite a shorter hospital LOS.
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Affiliation(s)
- Amos Lal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Kevin John John
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Ajay Kumar Mishra
- Department of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Akil Adrian Sherif
- Department of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
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Hamill ME, Hernandez MC, Bailey KR, Cutherell CL, Zielinski MD, Jenkins DH, Naylor DF, Matos MA, Collier BR, Schiller HJ. Legal Firearm Sales at State Level and Rates of Violent Crime, Property Crime, and Homicides. J Surg Res 2023; 281:143-154. [PMID: 36155271 DOI: 10.1016/j.jss.2022.08.004] [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: 01/19/2022] [Revised: 06/23/2022] [Accepted: 08/15/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The effects of firearm sales and legislation on crime and violence are intensely debated, with multiple studies yielding differing results. We hypothesized that increased lawful firearm sales would not be associated with the rates of crime and homicide when studied using a robust statistical method. METHODS National and state rates of crime and homicide during 1999-2015 were obtained from the United States Department of Justice and the Centers for Disease Control and Prevention. National Instant Criminal Background Check System background checks were used as a surrogate for lawful firearm sales. A general multiple linear regression model using log event rates was used to assess the effect of firearm sales on crime and homicide rates. Additional modeling was then performed on a state basis using an autoregressive correlation structure with generalized estimating equation estimates for standard errors to adjust for the interdependence of variables year to year within a particular state. RESULTS Nationally, all crime rates except the Centers for Disease Control and Prevention-designated firearm homicides decreased as firearm sales increased over the study period. Using a naive national model, increases in firearm sales were associated with significant decreases in multiple crime categories. However, a more robust analysis using generalized estimating equation estimates on state-level data demonstrated increases in firearms sales were not associated with changes in any crime variables examined. CONCLUSIONS Robust analysis does not identify an association between increased lawful firearm sales and rates of crime or homicide. Based on this, it is unclear if efforts to limit lawful firearm sales would have any effect on rates of crime, homicide, or injuries from violence committed with firearms.
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Affiliation(s)
- Mark E Hamill
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Matthew C Hernandez
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Caleb L Cutherell
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Martin D Zielinski
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Donald H Jenkins
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
| | | | - Miguel A Matos
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Bryan R Collier
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Henry J Schiller
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota
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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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Hink AB, Killings X, Bhatt A, Ridings LE, Andrews AL. Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death. CURRENT TRAUMA REPORTS 2022; 8:41-53. [PMID: 35399601 PMCID: PMC8976221 DOI: 10.1007/s40719-022-00223-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/21/2022]
Abstract
Purpose of Review This provides up-to-date epidemiology of adolescent suicide and risk factors for suicide and highlights the overlap of risks for suicide and injury. It reviews signs and symptoms, and the up-to-date evidence on screening for depression, post-traumatic stress disorder (PTSD), suicide, substance abuse, and lethal means, and offers strategies of implementation in trauma centers. Recent Findings The incidence of adolescent suicide has continued to rise in the USA to 6.5 per 100,000, with notable racial disparities. The risk factors are complex, but many pre-existing risk factors and sequela after injury such as exposures to violence, suicidal behaviors, substance abuse, depression and post-traumatic stress disorder, and specific injuries including traumatic brain injury and spinal cord injury have further emerged as risks. Studies show rates of suicidality as high as 30% in the acute care setting. There are short screening instruments that can be used to universally screen for depression and suicidality in adolescent trauma patients. Step-up models of care for PTSD are promising to increase screening and services after injury. Lethal means counseling, secure firearm storage practices, and firearm safety policies can reduce the risk of suicide. Summary Suicide is the second leading cause of death in US adolescents, and trauma patients have significant risk factors for mental illness and suicidality before and after injury. Trauma centers should strongly consider screening adolescents, establish strategies for mental health support and referrals, and provide lethal means counseling to help prevent suicide.
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Oddo ER, Gastineau KAB, Andrews AL. Our power to reduce gun violence. J Hosp Med 2022; 17:225-228. [PMID: 35504582 DOI: 10.1002/jhm.12794] [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] [Received: 01/13/2022] [Revised: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Elizabeth R Oddo
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kelsey A B Gastineau
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annie L Andrews
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
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13
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Lillvis D, White J, Cooper M, DiCecca J, Bass K. An analysis of American physician professional statements about gun violence against children. J Pediatr Surg 2022; 57:130-134. [PMID: 34686378 DOI: 10.1016/j.jpedsurg.2021.09.011] [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: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We examine the content of physician professional association statements and assess the extent to which these statements kept gun violence-especially against children-on policymakers' agendas. METHODS After constructing a list of U.S. physician professional associations, we located position statements by consulting association websites, conducting a PubMed search, and reviewing the citations of identified statements. Once unique statements were identified (N = 32), two reviewers independently coded content such as major events, pediatric focus, firearm type, and policy recommendations. RESULTS Recent statements appear to be timed following mass casualty events such as the Sandy Hook and Parkland school shootings. Associations have increasingly adopted public health framing over time. Nine statements focused on the pediatric population, while an additional 13 made reference to the pediatric population. The most common recommendations include increased gun violence research or research funding (84%), freedom of physician counseling (75%), mandatory background checks (72%), and safe storage (72%). CONCLUSION Based on this analysis, recent statement volume appears to be tied to current events rather than keeping daily gun violence against children continuously on the agenda. Mentions of "gun control" have receded over time and have been replaced by public health framing that places advocacy for firearm injury prevention in the physician's domain. LEVEL OF EVIDENCE III/IV.
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Affiliation(s)
- Denise Lillvis
- Pediatric Trauma Department, John R. Oishei Children's Hospital, Buffalo, NY, United States; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1001 Main Street, 5th Floor, Buffalo, NY 14203, United States; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States.
| | - Jarrett White
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Madison Cooper
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Juliana DiCecca
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Kathryn Bass
- Pediatric Trauma Department, John R. Oishei Children's Hospital, Buffalo, NY, United States; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1001 Main Street, 5th Floor, Buffalo, NY 14203, United States
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14
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Roy Paladhi U, Dalve KN, Gurrey SO, Hawes SE, Mills B. Firearm ownership and access to healthcare in the U.S.: A cross-sectional analysis of six states. Prev Med 2021; 153:106830. [PMID: 34624385 DOI: 10.1016/j.ypmed.2021.106830] [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: 04/03/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/20/2022]
Abstract
Provider-led firearm storage counseling is a form of firearm suicide prevention intervention. Little research examines whether barriers to healthcare access for at-risk individuals limit this intervention's impact. This study explores the relationship between household firearm presence/storage practices and healthcare access/utilization using a cross-sectional analysis of the 2017 Behavioral Risk Factor Surveillance System (BRFSS), which included state-representative data from six states that completed the Firearm Safety and Healthcare Access Modules: California, Idaho, Kansas, Oregon, Texas, and Utah. Exposures were household firearm presence and firearm storage practices. Outcomes were lacking health insurance, not having a healthcare provider, inability to afford care, and no recent routine checkup. Logistic regression models adjusted for age, sex, education, employment, children in the household, and state of residency. Our analysis included 31,888 individuals; 31.1% reported a household firearm. Compared to those in firearm-owning households, those in non-firearm-owning households had higher odds of being uninsured (aOR 1.99, 95%CI 1.60-2.48), not having a provider (aOR 1.40, 95%CI 1.18-1.67), and reporting cost as a barrier to care (aOR 1.37, 95%CI 1.13-1.67). Among firearm-owning households, those with firearms stored loaded and unlocked had higher odds of lacking a personal healthcare provider (aOR 1.52, 95%CI 1.07-2.15) compared to individuals in homes where firearms were stored unloaded. Results indicate that while individuals in firearm-owning households are more likely than non-firearm owning households to have healthcare access, those in homes with the riskiest firearm storage practices had less access. Provider-led counseling may have limited reach for individuals in homes with risky firearm storage practices.
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Affiliation(s)
- Unmesha Roy Paladhi
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Kimberly N Dalve
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - Sixtine O Gurrey
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Brianna Mills
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
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15
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Castillo CM, Chang RG, Glassman SJ, Jones G, Venkatachalam AM, Williams T, Ifejika NL. Advocacy for the prevention and reduction of firearm-related injuries. PM R 2021; 13:1291-1295. [PMID: 34415109 DOI: 10.1002/pmrj.12696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/27/2021] [Accepted: 08/06/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Camilo M Castillo
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Richard G Chang
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stuart J Glassman
- Granite Physiatry, Concord, New Hampshire, USA.,Department of Orthopedics/Division of Physical Medicine and Rehabilitation, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Gaberiel Jones
- Department of Health Promotion and Behavioral Sciences, University of Louisville School of Public Health & Information Sciences, Louisville, Kentucky, USA
| | | | - Terrell Williams
- Youth Violence Prevention Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Nneka L Ifejika
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurology, UT Southwestern Medical Center, Dallas, Texas, USA.,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
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16
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Pallin R, Wintemute GJ, Kravitz-Wirtz N. Firearm Practices, Perceptions of Safety, and Opinions on Injury Prevention Strategies Among California Adults. JAMA Netw Open 2021; 4:e2119146. [PMID: 34342649 PMCID: PMC8335574 DOI: 10.1001/jamanetworkopen.2021.19146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Safe firearm storage and other interventions may reduce pediatric firearm deaths and injuries. OBJECTIVE To compare firearm ownership and storage practices, opinions on firearm injury prevention strategies, and perceptions of safety among adults in California households with and without children and/or adolescents. DESIGN, SETTING, AND PARTICIPANTS This survey study used data from the 2018 California Safety and Well-being Survey, a California-representative, probability-based internet survey. Respondents were part of the Ipsos KnowledgePanel, an online research panel that uses address-based sampling and provides survey weights to produce estimates representative of the adult population of California. MAIN OUTCOMES AND MEASURES Topics included firearm storage practices, opinions on interventions to reduce pediatric firearm injury, and perceptions of household safety related to firearm ownership. Respondents were stratified by firearm ownership and household presence or absence of children and/or adolescents. Weighted percentages and 95% CIs are presented. RESULTS Of 5232 invited panel members, 2558 (48.9%) completed the survey. Among respondents, 52.5% (95% CI, 49.3%-55.7%) were women, 42.9% (95% CI, 39.9%-45.9%) were White, 30.0% (95% CI, 26.8%-32.9%) lived in homes with children, and the mean (SD) age was 48.0 (17.1) years. Among those in homes with children, more than two-thirds of individuals who owned firearms (70.6% [95% CI, 50.1%-85.2%]) and more than half of individuals who did not own firearms but lived in homes with guns (54.9% [95% CI, 37.9%-70.8%]) reported that they believed a firearm in the home made it safer. Half of those who owned firearms (52.3% [95% CI, 34.9%-69.2%]) and more than three-quarters of individuals who did not own firearms but lived in homes with guns (78.4% [95% CI, 57.5%-90.7%]) reported it was always appropriate for parents to inquire about unlocked guns in homes where their children play. Among those who had previously owned at least 1 gun but no longer did, 13.3% (95% CI, 7.1%-23.8%) reported getting rid of guns at least in part due to concern for the safety of a child in the home. Nearly two-thirds of those who owned firearms living with children and/or adolescents (64.5% [95% CI, 46.5%-79.2%]) did not store all firearms in the most secure manner (ie, unloaded and locked up), compared with 36.4% (95% CI, 29.4%-44.1%) of individuals who owned firearms but did not live with children. CONCLUSIONS AND RELEVANCE In this study, although a substantial percentage of individuals who owned guns and lived with children did not store all firearms as recommended, parents and caregivers who owned firearms reported being amenable to interventions that reduce young people's risk of firearm-related harm. Future work should investigate acceptable risk reduction and safe storage interventions.
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Affiliation(s)
- Rocco Pallin
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento
- University of California Firearm Violence Research Center, Sacramento
| | - Garen J. Wintemute
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento
- University of California Firearm Violence Research Center, Sacramento
| | - Nicole Kravitz-Wirtz
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento
- University of California Firearm Violence Research Center, Sacramento
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17
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Kafka JM, Moracco KE, Williams DS, Hoffman CG. What is the role of firearms in nonfatal intimate partner violence? Findings from civil protective order case data. Soc Sci Med 2021; 283:114212. [PMID: 34271368 DOI: 10.1016/j.socscimed.2021.114212] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Perpetrators of intimate partner violence (IPV) use firearms to injure, scare, and manipulate their partners. Abusers who have a firearm in their homes are more likely to threaten and/or kill their partner. To date, however, limited research documents the nature of IPV perpetrator firearm access or the prevalence of nonfatal firearm abuse behaviors. METHODS Federal law restricts firearm access for IPV perpetrators in qualifying domestic violence protective order (DVPO) cases and information about firearms should be disclosed during the DVPO process. We used secondary data from civil DVPO cases (n = 406) in North Carolina that were collected using a representative sampling strategy. Data were from DVPO case files and structured DVPO hearing observations. We conducted a content analysis to record IPV perpetrator access to guns and reported firearm abuse behaviors. We used a linear regression analysis to determine whether IPV perpetrator gun access was associated with higher levels of reported abuse. We also examined factors associated with perpetration of nonfatal firearm abuse. RESULTS We found evidence of perpetrator firearm access in nearly half of all cases (46%, n = 108). Controlling for covariates, gun access was significantly associated with higher levels of reported IPV (b = 0.5, p < .001). Firearm abuse was reported in nearly one out of four cases (23.1%, n = 101), and often entailed spoken threats, displaying a gun, or holding a partner at gun point. The only factors associated with firearm abuse in the multivariate models were related to English language speaking/fluency. CONCLUSIONS Gun access should be considered an indicator for severe IPV. We must ensure that existing legal mechanisms to identify and restrict abuser access to firearms are fully implemented and enforced. Firearm abuse often manifests as non-physical coercive control which is traumatic and has the potential to escalate to homicide, even in the absence of past physical violence.
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Affiliation(s)
- Julie M Kafka
- Department of Health Behavior, Gillings School for Global Public Health, University of North Carolina at Chapel Hill, 359 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA; University of North Carolina Injury Prevention Research Center, 359 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA.
| | - Kathryn E Moracco
- Department of Health Behavior, Gillings School for Global Public Health, University of North Carolina at Chapel Hill, 359 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA; University of North Carolina Injury Prevention Research Center, 359 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA
| | - Deanna S Williams
- Department of Health Behavior, Gillings School for Global Public Health, University of North Carolina at Chapel Hill, 359 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA; University of North Carolina Injury Prevention Research Center, 359 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA
| | - Claire G Hoffman
- Department of Health Behavior, Gillings School for Global Public Health, University of North Carolina at Chapel Hill, 359 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA; University of North Carolina Injury Prevention Research Center, 359 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA
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18
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Paes FM, Munera F. Invited Commentary: Key Concepts of CT for Penetrating Abdominopelvic Injuries. Radiographics 2021; 41:E119-E120. [PMID: 34019438 DOI: 10.1148/rg.2021210041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fabio M Paes
- From the Department of Radiology, University of Miami-Miller School of Medicine, Jackson Memorial Hospital/Ryder Trauma Center, University of Miami Health System (UHealth), 1611 NW 12th Ave, West Wing 279, Miami, FL 33136
| | - Felipe Munera
- From the Department of Radiology, University of Miami-Miller School of Medicine, Jackson Memorial Hospital/Ryder Trauma Center, University of Miami Health System (UHealth), 1611 NW 12th Ave, West Wing 279, Miami, FL 33136
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19
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Abstract
Objective Injuries associated with firearms are a significant health burden. However, there is no comprehensive study of firearm spinal injuries over a large population. It was the purpose of this study to analyze the demographics of spinal firearm injuries across the entire United States for all ages using a national database. Methods A retrospective review of prospectively collected data using the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993-2015 (ICPSR 37276) was performed. The demographic variables of patients with spinal injuries due to firearms were analyzed with statistical analyses accounting for the weighted, stratified nature of the data, using SUDAAN 11.0.01™ software (RTI International, Research Triangle Park, North Carolina, 2013). A p-value of < 0.05 was considered statistically significant. Results For the years 1993 through 2015, there were an estimated 2,667,896 emergency department (ED) visits for injuries due to firearms; 10,296 of these injuries (0.4%) involved the spine. The vast majority (98.2%) were due to powder firearm gunshot wounds. Those with a spine injury were more likely to have been injured in an assault (83.7% vs. 60.2%), involved a handgun (83.5% vs. 60.2%), were male (90.8% vs. 86.4%), were admitted to the hospital (86.8% vs. 30.9%), and were seen in urban hospitals (86.7 vs. 64.6%). The average age was 28 years with very few on those < 14 years of age. Illicit drug involvement was over four times as frequent in those with a spine injury (34.7% vs. 8.0%). The cervical spine was involved in 30%, thoracic in 32%, lumbar in 32%, and sacrum in 6%. A fracture occurred in 91.8% and neurologic injury in 33%. Injuries to the thoracic spine had the highest percentage of neurologic involvement (50.4%). There was an annual percentage decrease for patients with and without spine involvement in the 1990s, followed by increases through 2015. The average percentage increase for patients with a spine injury was 10.3% per year from 1997 onwards (p < 10-6), significantly greater than the 1.5% for those without spinal involvement (p = 0.0001) from 1999 onwards. Conclusions This nation-wide study of spinal injuries associated with firearms covering all ages can be used as baseline data for future firearm studies. A reduction in the incidence of such injuries can be guided by our findings but may be difficult due to sociopolitical barriers (e.g. socioeconomic status of the injured patients, differences in political opinion regarding gun control in the US, and geospatial patterns of firearm injury).
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Affiliation(s)
- Randall T Loder
- Orthopaedic Surgery, Riley Hospital for Children, Indianapolis, USA
| | - Abhipri Mishra
- Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Bradley Atoa
- Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Allison Young
- Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, USA
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20
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Farcy DA, Doria N, Moreno-Walton L, Gordon H, Sánchez J, Cubeddu LX, Ranney ML. Emergency Physician Survey on Firearm Injury Prevention: Where Can We Improve? West J Emerg Med 2021; 22:257-265. [PMID: 33856309 PMCID: PMC7972360 DOI: 10.5811/westjem.2020.11.49283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/16/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Firearm injury and death is increasingly prevalent in the United States. Emergency physicians (EP) may have a unique role in firearm injury prevention. The aim of this study was to describe EPs' beliefs, attitudes, practices, and barriers to identifying risk of and counseling on firearm injury prevention with patients. A secondary aim was assessment of perceived personal vulnerability to firearm injury while working in the emergency department (ED). METHODS We conducted a cross-sectional survey of a national convenience sample of EPs, using questions adapted from the American College of Surgeons' Committee on Trauma 2017 survey of surgeons. Descriptive statistics and chi-square tests were calculated as appropriate. RESULTS A total of 1901 surveys were completed by EPs from across the United States. Among respondents, 42.9% had a firearm at home, and 56.0% had received firearm safety training. Although 51.4% of physicians in our sample were comfortable discussing firearm access with their high-risk patients, more than 70% agreed or strongly agreed that they wanted training on procedures to follow when they identify that a patient is at high risk of firearm injury. Respondents reported a variety of current practices regarding screening, counseling, and resource use for patients at high risk of firearm injury; the highest awareness and self-reported screening and counseling on firearm safety was with patients with suicidal ideation. Although 92.3% of EPs reported concerns about personal safety associated with firearms in the ED, 48.1% reported that there was either no protocol for dealing with a firearm in the ED, or if there was a protocol, they were not aware of it. Differences in demographics, knowledge, attitudes, and behavior were observed between respondents with a firearm in the home, and those without a firearm in the home. CONCLUSIONS Among respondents to this national survey of a convenience sample of EPs, approximately 40% had a firearm at home. The majority reported wanting increased education and training to identify and counsel ED patients at high risk for firearm injury. Improved guidance on personal safety regarding firearms in the ED is also needed.
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Affiliation(s)
- David A Farcy
- Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida.,Florida International University Herbert Wertheim College of Medicine, Department of Emergency Medicine & Critical Care, Miami Florida
| | - Nicole Doria
- Dalhousie University, School of Health and Human Performance, Halifax, Canada
| | - Lisa Moreno-Walton
- Louisiana State University Health Sciences Center, Department of Emergency Medicine, New Orleans, Louisiana
| | - Hannah Gordon
- Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida
| | - Jesus Sánchez
- NOVA Southeastern University, Department of Socio Behavioral Sciences, COP, Davie, Florida
| | - Luigi X Cubeddu
- NOVA Southeastern University, Department of Pharmaceutical Sciences, COP, Davie, Florida
| | - Megan L Ranney
- Brown University, Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island
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21
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Penetrating Trauma in Baltimore: An Analysis of the Effect of a Rise in Localized Violence by Age Group. J Surg Res 2021; 262:38-46. [PMID: 33545620 DOI: 10.1016/j.jss.2020.11.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Incidence of firearm mortality in the United States is increasing. Baltimore, MD saw a substantial increase in violence in April 2015. We analyzed the effect of this localized surge in violence on the pediatric population. METHODS Using the Maryland Health Services Cost Review Commission database, initial hospital encounters for gunshot wound (GSW) or stab wound (SW) were identified. Baltimore Police Department victim-based crime data and homicide data on GSW and SW assault were used to capture those not seen at hospitals. Changes in incidence rate ratios from before/after April 2015 were analyzed using Poisson regression. RESULTS No change in mortality was seen in hospital-evaluated GSW patients. The pediatric population showed decreased incidence of SW (P < 0.001) and increase in GSW (P < 0.001) but no change in total penetrating trauma (tPT). The young adult population had decreased SW incidence (P < 0.001) without change in GSW or tPT. The pediatric populations saw no difference in SW/GSW deaths or homicide rate. However, in young adults, there were increased homicides (P < 0.001) and GSW deaths (P < 0.001) with unchanged SW deaths. CONCLUSIONS After a surge in violence, the shifted mechanism of penetrating trauma in the pediatric population did not increase mortality or tPT. By contrast, GSW incidence is increasing in young adults with more lethal injuries. Intervention could be aimed at gun control and targeted education/intervention in the at-risk younger age group.
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22
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Ranney ML, Herges C, Metcalfe L, Schuur JD, Hain P, Rowhani-Rahbar A. Increases in Actual Health Care Costs and Claims After Firearm Injury. Ann Intern Med 2020; 173:949-955. [PMID: 32986488 DOI: 10.7326/m20-0323] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The incidence of firearm injury and death in the United States is increasing. Although the health care-related effect of firearm injury is estimated to be high, existing data are largely cross-sectional, do not include data on preinjury and postinjury health care visits and related costs, and use hospital charges rather than actual monetary payments. OBJECTIVE To compare actual health care costs (that is, actual monetary payments) and utilizations within the 6 months before and after an incident (index) firearm injury. DESIGN Before-after study. SETTING Blue Cross Blue Shield plans of Illinois, Texas, Oklahoma, New Mexico, and Montana. PARTICIPANTS Plan members continuously enrolled for at least 12 months before and after an index firearm injury sustained between 1 January 2015 and 31 December 2017. MEASUREMENTS Eligible costs, out-of-pocket costs, and firearm injury-related International Classification of Diseases, Ninth or 10th Revision, codes. RESULTS Total initial (emergency department [ED]) health care costs for persons with index firearm injuries who were discharged from the ED were $8 158 786 ($5686 per member). Total initial (hospital admission) costs for persons with index firearm injuries who required hospitalization were $41 255 916 ($70 644 per member). Compared with the 6 months before the index firearm injury, in the 6 months after, per-member costs increased by 347% (from $3984 to $17 806 per member) for those discharged from the ED and 2138% (from $4118 to $92 151 per member) for those who were hospitalized. The number of claims increased by 187% for patients discharged from the ED and 608% for those who were hospitalized. LIMITATION Firearm injury intent was not specified because of misclassification concerns. CONCLUSION In the 6 months after a firearm injury, patient-level health care visits and costs increased by 3 to 20 times compared with the 6 months prior. The burden of firearm injury on the health care system is large and quantifiable. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Megan L Ranney
- Brown University and Rhode Island Hospital, Providence, Rhode Island (M.L.R., J.D.S.)
| | - Curtis Herges
- Health Care Services Corporation, Chicago, Illinois (C.H., L.M.)
| | - Leanne Metcalfe
- Health Care Services Corporation, Chicago, Illinois (C.H., L.M.)
| | - Jeremiah D Schuur
- Brown University and Rhode Island Hospital, Providence, Rhode Island (M.L.R., J.D.S.)
| | - Paul Hain
- Blue Cross and Blue Shield of Texas, Richardson, Texas (P.H.)
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23
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Feinstein A, Choonara I. Arms sales and child health. BMJ Paediatr Open 2020; 4:e000809. [PMID: 32954017 PMCID: PMC7482471 DOI: 10.1136/bmjpo-2020-000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 01/11/2023] Open
Abstract
The adverse effects of armed conflict on child health are well recognised. The relationships among the arms trade, armed conflict and child health are less clearly defined. The arms trade is one of the largest industries in the world (total expenditure US$1917 billion in 2019), generating colossal profits to private companies and individuals at the expense of taxpayers throughout the world. The money wasted on weapons designed to kill and maim should be used for more socially useful products, such as clean water, food, health and education. The sustainable development goals can be funded by diverting money from the arms companies. Health professionals and their organisations have a responsibility to children to try and curb the ever-expanding arms industry.
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Affiliation(s)
- Andrew Feinstein
- Shadow World Investigations (formerly Corruption Watch UK), London, UK
| | - Imti Choonara
- Child Health, University of Nottingham School of Medicine, Derby, UK
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24
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Lyons VH, Benson LR, Griffin E, Floyd AS, Kiche SW, Haggerty KP, Whiteside L, Conover S, Herman DB, Rivara FP, Rowhani-Rahbar A. Fidelity Assessment of a Social Work-Led Intervention Among Patients with Firearm Injuries. RESEARCH ON SOCIAL WORK PRACTICE 2020; 30:678-687. [PMID: 32973371 PMCID: PMC7508463 DOI: 10.1177/1049731520912002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To support future development and refinement of social work-led intervention programs among patients with firearm injuries and to demonstrate how a fidelity assessment can be used to adjust and refine intervention delivery in an ongoing trial. METHODS We conducted a fidelity assessment of a randomized controlled trial of a social work-led intervention among patients with a firearm injury. RESULTS We found that our study intervention was well implemented, meeting 70% of the fidelity assessment score items, however noted lower fidelity with client-based items. DISCUSSION As a result of fidelity assessment findings, we refined intervention delivery to improve implementation fidelity including beginning to review cases of all patients each month, rather than focusing on patients in crisis. Our fidelity assessment process and findings offer insight into the challenges of implementing an intervention among patients with firearm injuries and highlights the value of monitoring intervention fidelity during an ongoing trial.
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Affiliation(s)
- Vivian H. Lyons
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Lina R. Benson
- The Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA
| | - Elizabeth Griffin
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Anthony S. Floyd
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- The Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA
| | - Sharon W. Kiche
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Kevin P. Haggerty
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- School of Social Work, University of Washington, Seattle, WA
- Social Development Research Group, University of Washington, Seattle, WA
| | - Lauren Whiteside
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Sarah Conover
- Center for the Advancement of Critical Time Intervention, Hunter College, NY
- Silberman School of Social Work, Hunter College, NY
| | - Daniel B. Herman
- Center for the Advancement of Critical Time Intervention, Hunter College, NY
- Silberman School of Social Work, Hunter College, NY
| | - Frederick P. Rivara
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
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25
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A systematic review of the causes and prevention strategies in reducing gun violence in the United States. Am J Emerg Med 2020; 38:2169-2178. [PMID: 33071102 DOI: 10.1016/j.ajem.2020.06.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Approximately 100 lives are lost each day as a result of gun violence in the United States (US) with civilian mass shootings increasing annually. The gun violence rate in the US is almost 20 times higher than other comparable developed countries and has the most gun ownership per capita of any nation in the world. Understanding the causes and risk factors are paramount in understanding gun violence and reducing its incidence. METHODS A literature search of all published articles relating to gun violence and mass shootings in the US was conducted using the Medline and PMC databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used in conducting this study. Rayyan statistical software was utilized for analysis. Statistical significant was defined as p < .05. RESULTS Of the initial 2304 eligible manuscripts identified, 22 fulfilled our selection criteria. A variety of common causal and contributory factors were identified including but not limited to mental illness, suicidal ideation, intimate partner violence, socioeconomic status, community distress, family life, childhood trauma, current or previous substance abuse, and firearm access. CONCLUSION Gun violence is pervasive and multi-factorial. Interventions aimed at reducing gun violence should be targeted towards the most common risk factors cited in the literature such as access, violent behavioral tendencies due to past exposure or substance abuse, and mental illness including suicidal ideation.
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26
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Kuo T, Barragan NC, Kim-Farley R. Letter Regarding: Policy and Other Opportunities to Intervene on Firearm Injury in the United States. J Surg Res 2020; 253:252-253. [PMID: 32388387 DOI: 10.1016/j.jss.2020.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/15/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Tony Kuo
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California; Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, California.
| | - Noel C Barragan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California
| | - Robert Kim-Farley
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
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27
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Silver AH, Andrews AL, Azzarone G, Bhansali P, Hjelmseth E, Hogan AH, O'Connor KM, Romo N, Parikh K. Engagement and Leadership in Firearm-Related Violence Prevention: The Role of the Pediatric Hospitalist. Hosp Pediatr 2020; 10:523-530. [PMID: 32366383 DOI: 10.1542/hpeds.2019-0327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Gun violence is a US public health crisis. Approximately 7000 children are hospitalized each year because of firearm-related injuries. As pediatric hospitalists, we are poised to address this crisis, whether we care directly for patients who are victims of gun violence. In this article, we aim to provide practical tools and opportunities for pediatric hospitalists to address the epidemic of gun safety and gun violence prevention, including specifics related to the inpatient setting. We provide a framework to act within 4 domains: clinical care, advocacy, education and research.
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Affiliation(s)
- Alyssa H Silver
- Division of Hospital Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York .,Albert Einstein College of Medicine, Bronx, New York
| | - Annie L Andrews
- Division of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Gabriella Azzarone
- Division of Hospital Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Priti Bhansali
- Division of Hospitalist Medicine, Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University and Children's National Hospital, Washington, District of Columbia
| | | | - Alexander H Hogan
- Division of Hospital Medicine, Connecticut Children's Medical Center, Hartford, Connecticut; and
| | - Katherine M O'Connor
- Division of Hospital Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Noé Romo
- Albert Einstein College of Medicine, Bronx, New York.,Jacobi Medical Center, Bronx, New York
| | - Kavita Parikh
- Division of Hospitalist Medicine, Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University and Children's National Hospital, Washington, District of Columbia
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Culyba AJ, Sigel E. Firearms and substance use: bringing synergy to counseling and intervention. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:263-265. [PMID: 32338070 DOI: 10.1080/00952990.2020.1741003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Alison J Culyba
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine , Pittsburgh, PA, USA
| | - Eric Sigel
- Department of Pediatrics, Section of Adolescent Medicine, Children's Hospital Colorado, University of Colorado School of Medicine , Aurora, CO, USA
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29
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Tolat ND, Naik-Mathuria BJ, McGuire AL. Physician Involvement in Promoting Gun Safety. Ann Fam Med 2020; 18:262-264. [PMID: 32393563 PMCID: PMC7213995 DOI: 10.1370/afm.2516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/12/2019] [Accepted: 11/21/2019] [Indexed: 12/25/2022] Open
Abstract
Firearm-related deaths are on the rise in the United States, especially among our youth. Tragically, proper firearm storage and safety could have prevented a great number of these deaths. Professional and public health organizations have thus encouraged physicians to provide direct patient counseling on firearm safety. Yet, even with these recommendations, the majority of physicians are still not talking to their patients about this issue. There may be many reasons for this, including concerns about liability, feeling unprepared, patient discomfort, and lack of time during office visits. Despite these concerns, we argue that physicians have an ethical obligation to discuss firearm safety with their patients. Making these discussions a part of routine clinical care would go a long way in the bipartisan effort to protect public safety and improve public health.
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Affiliation(s)
| | - Bindi Jayendra Naik-Mathuria
- Baylor College of Medicine, Houston, Texas
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
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30
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Webster JR. Firearm-Related Injury and Death in the United States. Ann Intern Med 2020; 172:367-368. [PMID: 32120387 DOI: 10.7326/l19-0743] [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: 11/22/2022] Open
Affiliation(s)
- James R Webster
- Feinberg School of Medicine of Northwestern University, Santa Fe, New Mexico (J.R.W.)
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31
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Nestadt PS, MacKrell K, McCourt AD, Fowler DR, Crifasi CK. Prevalence of long gun use in Maryland firearm suicides. Inj Epidemiol 2020; 7:4. [PMID: 32127045 PMCID: PMC6996182 DOI: 10.1186/s40621-019-0230-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/20/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Firearms account for the majority of US suicides, largely due to lethality and accessibility. Under Federal and Maryland law, long guns are less regulated than handguns which is a concern for increased suicide risk. This study uses Maryland data to ascertain the impact of long guns on suicides in the state. We hypothesize that the prevalence of long gun use among firearm suicides will be increased in rural and young populations. METHODS This is a cross sectional study using police and medical examiner narratives to identify firearm type involved in all 3931 Maryland gun suicides from 2003 to 2018. Proportions of firearm suicides utilizing long guns were calculated. Urban-rural differences were determined using the National Center for Health Statistics' classification system. Logistic regression was used to calculate odds ratios of long gun to handgun suicides across the urban-rural spectrum, controlling for decedent demographics. RESULTS From 2003 to 2018, 28.4% of Maryland gun suicides used long guns. The proportion of long guns used was highest in the most rural counties, where 51.6% of firearm suicides were by long gun, compared to 16.8% in the most urban counties. Long guns were disproportionately used by the young. For decedents 18 or younger, 44.6% used long guns, compared to 20.2% in those 65 or older. Compared to the most urban counties, firearm suicide decedents in the most rural counties were 3.74x more likely to use long guns (OR = 3.74; 95% CI 2.19, 6.40; p < .001) after adjusting for demographics, intoxication, and hunting season. CONCLUSIONS Long guns are used in a large proportion of Maryland firearm suicides, particularly in rural areas and disproportionately in youth suicides. Long guns must be considered as part of access to lethal means or policy strategies in efforts to reduce the burden of firearm suicide.
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Affiliation(s)
- Paul S. Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Kevin MacKrell
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Alexander D. McCourt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - David R. Fowler
- Office of the Chief Medical Examiner of Maryland, Baltimore, USA
| | - Cassandra K. Crifasi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Stawicki S, Le N, Garg M, Izurieta R, Garg S, Papadimos T, Arquilla B, Miller A, Khan A, Worlton T, Firstenberg M, Galwankar S, Raina S, Anderson H, Jeanmonod R, Kaufmann K, Jeanmonod D, De Wulf A, McCallister D, Bloem C, Opara I, Martin N, Asensio J. What's new in Academic International Medicine? International health security agenda – Expanded and re-defined. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2020. [DOI: 10.4103/ijam.ijam_113_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hoffer EP. The American Health Care System Is Broken. Part 7: How Can We Fix It? Am J Med 2019; 132:1381-1385. [PMID: 31668898 DOI: 10.1016/j.amjmed.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
Abstract
Previous articles have outlined the many problems that confront America in trying to humanely and efficiently deliver health care to our citizens. First among these is that health care is unaffordable for too many. This final article describes how to expand coverage to all Americans and identifies many specific areas in which changes can be made to both improve care and lower costs. There are many ways to reduce the cost of medications, to improve hospital care while lowering costs, to eliminate "surprise" medical bills, and to cut down fraud and waste. The socioeconomic factors that contribute heavily to our poor health outcomes must be addressed.
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Affiliation(s)
- Edward P Hoffer
- Associate Professor of Medicine, part-time, Harvard, Cambridge, Mass; Laboratory of Computer Science, Massachusetts General Hospital, Boston.
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Hathi S, Sacks CA. #ThisIsOurLane: Incorporating Gun Violence Prevention into Clinical Care. CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-00174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tanne JH. Gun violence: US doctors' groups call for action. BMJ 2019; 366:l5105. [PMID: 31399434 DOI: 10.1136/bmj.l5105] [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: 11/03/2022]
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