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Khazanov GK, Keddem S, Hoskins K, Wortzel HS, Simonetti JA. Increasing the Acceptability of Lethal Means Safety Counseling for Firearms: Tips and Scripts. J Psychiatr Pract 2024; 30:139-146. [PMID: 38526402 DOI: 10.1097/pra.0000000000000773] [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: 03/26/2024]
Abstract
In lethal means safety counseling (LMSC), clinicians encourage patients to limit their access to common and lethal means of suicide, especially firearms. However, previous studies have shown that clinicians may hesitate to deliver this evidence-based intervention, in part because of concerns that patients might not find such discussions acceptable. Based on a published review of 18 qualitative studies examining diverse perspectives on LMSC, we discuss strategies that may help clinicians increase the acceptability of LMSC among their patients and present supporting scripts, rationales, and resources. The studies included in the review examined the perspectives of clinicians, patients, firearm owners, and other relevant groups across a wide range of clinical settings on LMSC for firearms. The authors of these studies recommend that clinicians approach LMSC in a nonjudgmental manner with awareness of their own biases, demonstrate cultural competency by acknowledging the role of firearms in patients' lives, and adapt LMSC to patients' previous experiences with firearms, safety, and injury. Clinicians may also want to contextualize and provide a rationale for LMSC, decide whether or not to directly ask about access to firearms, and recommend a range of storage options tailored to the patient. Free locking devices or discount coupons for purchasing such devices may increase the acceptability and efficacy of these discussions. The strategies recommended in this paper are the first to be based on a comprehensive set of relevant studies. Future research is needed to examine whether these strategies do in fact increase the acceptability of LMSC and promote other outcomes such as increased feasibility and efficacy.
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Trenaman L, Harrison M, Hoch JS. What is a star worth to Medicare beneficiaries? A discrete choice experiment of hospital quality ratings. HEALTH AFFAIRS SCHOLAR 2024; 2:qxad085. [PMID: 38756401 PMCID: PMC10986207 DOI: 10.1093/haschl/qxad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 05/18/2024]
Abstract
Hospital quality ratings are widely available to help Medicare beneficiaries make an informed choice about where to receive care. However, how beneficiaries' trade-off between different quality domains (clinical outcomes, patient experience, safety, efficiency) and other considerations (out-of-pocket cost, travel distance) is not well understood. We sought to study how beneficiaries make trade-offs when choosing a hypothetical hospital. We administered an online survey that included a discrete choice experiment to a nationally representative sample of 1025 Medicare beneficiaries. On average, beneficiaries were willing to pay $1698 more for a hospital with a 1-star higher rating on clinical outcomes. This was over twice the value of the patient experience ($691) and safety ($615) domains and nearly 8 times the value of the efficiency domain ($218). We also found that the value of a 1-star improvement depends not only on the quality domain but also the baseline level of performance of the hospital. Generally, it is more valuable for low-performing hospitals to achieve average performance than for average hospitals to achieve excellence.
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Affiliation(s)
- Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA 98195, United States
| | - Mark Harrison
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, Vancouver, BC V6Z 1Y6Canada
| | - Jeffrey S Hoch
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA 95817, United States
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, CA 95616, United States
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Glasser NJ, Baker NA, Pollack HA, Hussaini SS, Tung EL. Age Trends And State Disparities In Firearm-Related Suicide In The US, 1999-2020. Health Aff (Millwood) 2023; 42:1551-1558. [PMID: 37931189 DOI: 10.1377/hlthaff.2023.00399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Using data from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System, we analyzed trends in firearm suicide across the life course, comparing age-related trends over time (2015-20 versus 1999-2014) and stratified by differences in state firearm policy environments. Overall, we found stable trends in firearm suicide rates across the life course, although with higher overall rates across all age groups in 2015-20 versus in 1999-2014. Ages 14-16 was the only age group with an accelerating life-course trend in firearm suicide rates in 2015-20 versus in 1999-2014. The state policy environment was associated with significant differences in firearm suicide, with an average of 4.62 more deaths per 100,000 people per year in states with less- versus more-strict environments. This was in contrast to nonfirearm suicides, for which we observed no consistent differences between states. The largest overall differences in firearm suicide between states occurred in adulthood through middle age. These findings can inform further research on health care-based approaches to reducing firearm suicide, such as health care screening for firearm ownership, screening for suicide risk among firearm owners, and motivational interviewing to promote safe firearm storage.
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Caves Sivaraman J, Tong G, Easter M, Swanson J, Copeland W. Violent Experiences and Patterns of Firearm Ownership From Childhood to Young Adulthood. JAMA Netw Open 2023; 6:e2336907. [PMID: 37851447 PMCID: PMC10585415 DOI: 10.1001/jamanetworkopen.2023.36907] [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] [Received: 05/17/2023] [Accepted: 08/23/2023] [Indexed: 10/19/2023] Open
Abstract
Importance Young adults in their 20s are at high relative risk for self- and other-directed firearm injury, but little is known about gun access patterns for this group. Objective To describe the longitudinal patterns of firearm access from childhood to young adulthood and to estimate whether violence experienced as a child or as an adult is associated with gun ownership in young adulthood. Design, Setting, and Participants The Great Smoky Mountains Study included participants from 11 contiguous, mostly rural counties in the Southeastern US. The first wave was completed in 1993 and the most recent in 2019. Periodic survey data were gathered in adolescence through participants' late 20s. In 2023, adjusted Poisson regression with incident rate ratios (IRRs) and 95% CIs were used to estimate associations between violence and gun ownership in young adulthood in 3 age cohorts from the original sample. Exposures Violent experiences in childhood (bullying, sexual and physical abuse, violent events, witnessing trauma, physical violence between parents, and school/neighborhood dangerousness) or adulthood (physical and sexual assault). Main Outcomes and Measures Initiating gun ownership was defined as no gun access or ownership in childhood followed by gun ownership at age 25 or 30 years. Maintaining gun ownership was defined as reporting gun access or ownership in at least 1 survey in childhood and ownership at age 25 or 30 years. Results Among 1260 participants (679 [54%] male; ages 9, 11, and 13 years), gun access or ownership was more common in childhood (women: 366 [63%]; men: 517 [76%]) than in adulthood (women: 207 [36%]; men: 370 [54%]). The most common longitudinal pattern was consistent access or ownership from childhood to adulthood (373 [35%]) followed by having access or ownership in childhood only (408 [32%]). Most of the violent exposures evaluated were not significantly associated with the outcomes. Being bullied at school was common and was associated with reduced ownership initiation (IRR, 0.76; 95% CI, 0.61-0.94). Witnessing a violent event was significantly associated with increased probability of becoming a gun owner in adulthood (IRR, 1.24; 95% CI, 1.03-1.49). Conclusions and Relevance In this cohort study, gun ownership and access were transitory, even in a geographic area where gun culture is strong. Early adulthood-when the prevalence of gun ownership was relatively low-may represent an opportune time for clinicians and communities to provide education on the risks associated with firearm access, as well as strategies for risk mitigation.
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Affiliation(s)
- Josie Caves Sivaraman
- RTI International, Research Triangle Park, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Guangyu Tong
- Department of Biostatistics, Yale School of Medicine, New Haven, Connecticut
| | - Michele Easter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Jeffrey Swanson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
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Salhi C, Beatriz E, Berrigan J, Azrael D, Houston A, Runyan C, Barber C, Betz M, Miller M. "Your son needs help … and we're gonna help him": A qualitative study of the experiences of gun-owning caregivers of adolescents receiving lethal means counseling in the emergency department. Soc Sci Med 2023; 335:116218. [PMID: 37738913 DOI: 10.1016/j.socscimed.2023.116218] [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: 03/27/2023] [Revised: 07/17/2023] [Accepted: 09/01/2023] [Indexed: 09/24/2023]
Abstract
Suicide attempts in adolescents are often transient and unpredictable, making preventative approaches crucial in reducing suicide deaths. One important approach is lethal means counseling (LMC), in which clinicians counsel caregivers to reduce access to methods used in suicide, specifically firearms and medications. Research on LMC has increasingly encouraged the use of the shared decision-making (SDM) model, which emphasizes information exchange, collaborative deliberation, and joint planning between caregivers and clinicians. We examine caregivers' experiences with LMC, using the SDM model as our analytic framework. We conducted qualitative interviews with 21 firearm-owning caregivers of adolescents who came to emergency departments (EDs) in Colorado for a behavioral health complaint. The implementation of LMC at these institutions had three central components: training for clinicians, materials (e.g., lockboxes and pamphlets) to support LMC, and the protocolization of LMC at the institution. Our semi-structured, hour-long interviews examined participants' reflections on and reactions to LMC provided in the ED and how that related to changes in their understanding of their medication and gun storage practices. We analyzed interviews using a phenomenological approach, focusing on experiences with LMC and informed by the tenets of the SDM model. Our analysis revealed that caregivers were receptive to the idea of LMC in the pediatric emergency care setting. Caregivers' engagement in LMC was reinforced by experiences with clinicians who sought to understand the circumstances of their household, shared the motivation behind LMC, and facilitated conversation around a shared concern for the child's safety. In contrast, counseling delivered mechanically and without considering the household context was tied to caregivers' confusion and alienation, both for LMC and their consideration of changes to home storage practices. These findings provide insight into adolescent caregivers' experiences with LMC implemented in EDs and how LMC may best be approached.
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Affiliation(s)
- Carmel Salhi
- Department of Health Sciences, Northeastern University, Boston, MA, USA; Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA.
| | | | - John Berrigan
- University of Kansas School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA; Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA.
| | - Deb Azrael
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA.
| | - Ashley Houston
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA.
| | - Carol Runyan
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA.
| | - Marian Betz
- Injury and Violence Prevention Center, Colorado School of Public Health, Aurora, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Matthew Miller
- Department of Health Sciences, Northeastern University, Boston, MA, USA; Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA.
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Lafferty M, O'Neill A, Cerra N, Maxim L, Mulcahy A, Wyse JJ, Carlson KF. Let's Talk About Firearms: Perspectives of Older Veterans and VA Clinicians on Universal and Dementia-Specific Firearm Safety Discussions. Clin Gerontol 2023:1-11. [PMID: 37665611 DOI: 10.1080/07317115.2023.2254292] [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] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Veterans experience high rates of fatal and non-fatal firearm injuries. This risk may be compounded among Veterans who are rural-residing, aging, and/or experiencing cognitive decline or dementia. Firearm safety discussions are not broadly implemented across Department of Veterans Affairs (VA) healthcare settings due, in part, to concerns of causing Veterans to disengage from care. This study examines perceptions about firearm safety discussions to inform healthcare-based harm-reduction efforts. METHODS We conducted interviews with 34 Veterans (median age 70) and 22 clinicians from four VA facilities that treat high rates of rural patients with firearm-related injuries. RESULTS Most Veterans accepted the idea of universal firearm safety discussions at the VA. Some reported they might not be forthright in such discussions, but raising the topic would not stop them from engaging with VA care. Veterans and clinicians unanimously endorsed firearm safety discussions for older patients experiencing cognitive decline or dementia. CONCLUSIONS VA patients and clinicians are amenable to firearm safety discussions during healthcare visits and especially endorse the need for such discussions among high-risk populations. CLINICAL IMPLICATIONS Universal firearm safety discussions could be incorporated into standard VA practice, particularly for Veterans experiencing cognitive decline or dementia, without risking Veteran disengagement from care.
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Affiliation(s)
- Megan Lafferty
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
| | - AnnaMarie O'Neill
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
| | - Nicole Cerra
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, USA
| | - Lauren Maxim
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
| | - Abigail Mulcahy
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, USA
| | - Jessica J Wyse
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, USA
| | - Kathleen F Carlson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, USA
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Ramsay I, Miranda-Cantellops NDM, Acosta O, Shapiro LT. Firearm injury prevention counseling for patients with traumatic brain injury: a survey of brain injury physicians. Front Neurol 2023; 14:1237095. [PMID: 37693749 PMCID: PMC10484094 DOI: 10.3389/fneur.2023.1237095] [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: 06/08/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Background Survivors of traumatic brain injury are at increased risk for firearm-related injuries, including suicide. Aims To determine current practices of Brain Injury Medicine (BIM) physicians and their rehabilitation teams in assessing patients' access to firearms and in providing firearm safety education, and the impact of having received training on this topic on physicians' likelihood of inquiring about patients' access to firearms. Methods 14-item web-based cross-sectional survey of 86 U.S. physiatrists board-certified in BIM. Results 81% of respondents indicated they believe BIM physicians should counsel their patients on firearm safety but only 12.9% reported always doing so. Fifteen percent reported always inquiring about their patients' access to firearms. 88.2% indicated having never received formal training on firearm injury prevention counseling. Physicians who received such training had 7.5 times higher odds of reporting at least sometimes inquiring about patients' access to firearms than those who were not trained [95% confidence interval (1.94, 28.64)]. They also had 5.7 times higher odds for reporting being at least moderately comfortable providing patients firearm safety counseling [95% CI: (1.39, 23.22)]. Conclusion While most BIM specialists who responded to this survey believe they should counsel patients on firearm safety, few always or usually do so. Moreover, most do not routinely inquire about their patients' access to firearms. The provision of firearm injury prevention training to BIM physicians was strongly associated with an increased likelihood they will inquire about their patients' access to guns and with an improved comfort level in providing counseling on this subject matter.
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Affiliation(s)
- Ian Ramsay
- MD/MPH Program, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | | | - Oliver Acosta
- Physical Medicine & Rehabilitation Residency Program, University of Miami/Jackson Health System, Miami, FL, United States
| | - Lauren T. Shapiro
- Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
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Aunon FM, Azrael D, Simonetti JA, Miller M. Beliefs Among Veteran Firearm Owners Regarding Whether Clinicians Should Discuss Firearm Safety With Patients. JAMA Netw Open 2023; 6:e2321219. [PMID: 37382951 PMCID: PMC10311384 DOI: 10.1001/jamanetworkopen.2023.21219] [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] [Received: 03/13/2023] [Accepted: 05/08/2023] [Indexed: 06/30/2023] Open
Abstract
Importance Veterans are at increased risk of suicide, and guidelines recommend assessing firearm access and counseling to reduce access among patients with elevated suicide risk. How veterans view such discussions is critical to the effectiveness of these interactions. Objective To assess whether veteran firearm owners believe clinicians should deliver firearm counseling when patients or their family members are being cared for in specific clinical contexts that suggest heightened risk of firearm injury. Design, Setting, and Participants In this cross-sectional study, data were from a probability-based online survey of self-identified veterans who reported owning at least 1 firearm (National Firearms Survey, July 1 to August 31, 2019) and were weighted to generate nationally representative estimates. Data were analyzed from June 2022 to March 2023. Main Outcomes and Measures Participants were asked, "As part of routine care, should physicians and/or other health care professionals talk with their patients about firearms and firearm safety if their patient or their patient's family member (is at risk of suicide; has mental health or behavioral problems; is abusing or addicted to alcohol or drugs; is a victim of domestic violence; has Alzheimer's disease or another dementia; or is going through a hard time)." Response options included "No," "Yes, sometimes," and "Yes, always." In addition, responses were dichotomized as "Yes, at least sometimes" and "No." Results Of 4030 adults who completed the survey (65% completion rate), 678 (mean [SD] age, 64.7 [13.1] years; 638 [92.9%] male) identified as veteran firearm owners. Across the 6 clinical contexts, support for clinicians "at least sometimes" discussing firearm safety as part of routine care ranged from 73.4% (95% CI, 69.1%-77.3%) when someone is "going through a hard time" to 88.2% (95% CI, 84.8%-90.9%) when someone has "mental health or behavioral problems." When a patient or family member is at risk for suicide, 79.4% (95% CI, 75.5%-82.8%) of veteran firearm owners responded that clinicians should "at least sometimes" discuss firearms and firearm safety. Conclusions and Relevance This study's findings suggest that most veteran firearm owners believe that clinicians should provide firearm counseling during routine care when a patient or family member is at heightened risk of firearm injury. These findings belie concerns that discussing firearm access with veteran firearm owners is an unacceptable practice.
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Affiliation(s)
- Frances M. Aunon
- Veterans Affairs Connecticut Health Care System, West Haven
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Joseph A. Simonetti
- Firearm Injury Prevention Initiative, University of Colorado Anschutz School of Medicine, Aurora
- Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Health Sciences, Northeastern University, Boston, Massachusetts
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Goel R, Zhu X, Makhani S, Josephson CD, White JL, Karam O, Nellis ME, Gehrie EA, Sherpa M, Crowe EP, Bloch EM, Tobian AA. Pediatric firearm injury related emergency department visits and hospitalizations: a population-based study in the United States. LANCET REGIONAL HEALTH. AMERICAS 2023; 22:100503. [PMID: 37214769 PMCID: PMC10192937 DOI: 10.1016/j.lana.2023.100503] [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] [Received: 10/27/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
Background Firearm injury (FI) is the leading cause of death in children and adolescents in the United States (US). We describe the epidemiology of pediatric FI-associated emergency department (ED) visits and hospitalizations in the US stratified by race and ethnicity. Methods Data on pediatric (0-17-year-olds) FI were analyzed using the 2019 Nationwide Emergency Department Sample (NEDS) and Kids' Inpatient Database (KID), the largest all-payer databases in the US for ED visits and pediatric hospitalizations, respectively. FI encounters were stratified by race and ethnicity. Poisson regression was used to identify factors associated with in-hospital mortality. Sampling weights were applied to generate nationally representative estimates. Findings There were 7017 pediatric ED visits with FI (NEDS); 85.0% (5961/7017) were male and 73.0% (5125/7017) were adolescents (15-17 years). Overall, 5.5% (384/7017) died in the ED; 53.1% (3727/7017) of ED encounters did not result in hospitalization. There were 2817 pediatric FI hospitalizations (KID); 84.1% (2369/2817) were male and 71.6% (2018/2817) were adolescents; 51.4% (1447/2817) of FI were unintentional, 42.8% (1207/2817) were assault-related, and 5.8% (163/2817) were self-inflicted. Black children had the highest proportion (52.6%; 1481/2817) of hospitalizations among all race and ethnicities (p < 0.0001 vs. White). White children had the highest proportion of hospitalizations for self-inflicted injuries (16.6% [91/551] vs. 4.9% [25/504; p < 0.0001] in Hispanics and 1.7% [24/1481] in Blacks; p < 0.0001). The majority (56.5%; 1591/2817) of hospitalizations were patients from low-income zip codes (median annual-household-income <$44,000); 70% (1971/2817) had Medicaid as the primary insurance payer. Overall, 8.0% (225/2817) died during FI-associated hospitalizations. Self-inflicted injuries had the highest in-hospital mortality (prevalence ratio = 8.20, 95% CI = 6.06-11.10 vs. unintentional). Interpretation Black children and children with lower household incomes were disproportionately impacted by FI resulting from assaults and accidents, while White children had the highest proportion of self-inflicted FI injuries. Public health and legal policy interventions are needed to prevent pediatric FI. Funding US National Institutes of Health.
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Affiliation(s)
- Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Simmons Cancer Institute at SIU School of Medicine, Springfield, IL, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Makhani
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Cassandra D. Josephson
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Jodie L. White
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oliver Karam
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Eric A. Gehrie
- American Red Cross, Biomedical Services Division, National Headquarters, Washington, DC, USA
| | | | - Elizabeth P. Crowe
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sakran JV, Bornstein SS, Dicker R, Rivara FP, Campbell BT, Cunningham RM, Betz M, Hargarten S, Williams A, Horwitz JM, Nehra D, Burstin H, Sheehan K, Dreier FL, James T, Sathya C, Armstrong JH, Rowhani-Rahbar A, Charles S, Goldberg A, Lee LK, Stewart RM, Kerby JD, Turner PL, Bulger EM. Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach. J Am Coll Surg 2023; 236:1242-1260. [PMID: 36877809 DOI: 10.1097/xcs.0000000000000662] [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: 03/08/2023]
Affiliation(s)
- Joseph V Sakran
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Johns Hopkins Medicine, Baltimore, MD (Sakran)
| | - Sue S Bornstein
- American College of Physicians, Philadelphia, PA (Bornstein)
| | - Rochelle Dicker
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of California Los Angeles, Los Angeles, CA (Dicker)
| | - Frederick P Rivara
- Department of Pediatrics, University of Washington, Seattle, WA (Rivara)
| | - Brendan T Campbell
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT (Campbell)
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI (Cunningham)
| | - Marian Betz
- Department of Emergency Medicine, University of Colorado, Aurora, CO (Betz)
| | - Stephen Hargarten
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (Hargarten)
| | - Ashley Williams
- Department of Surgery, University of South Alabama, Mobile, AL (Williams)
| | - Joshua M Horwitz
- Johns Hopkins Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Horwitz)
| | - Deepika Nehra
- Department of Surgery, University of Washington, Seattle, WA (Nehra, Bulger)
| | - Helen Burstin
- Council of Medical Specialty Societies, Washington, DC (Burstin)
| | - Karen Sheehan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL (Sheehan)
| | - Fatimah L Dreier
- The Health Alliance for Violence Intervention, Jersey City, NJ (Dreier)
| | - Thea James
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA (James)
| | - Chethan Sathya
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Cohen Children's Medical Center, Northwell Health, Queens, NY (Sathya)
| | - John H Armstrong
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL (Armstrong)
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA (Rowhani-Rahbar)
| | - Scott Charles
- Department of Surgery, Temple University, Philadelphia, PA (Charles, Goldberg)
| | - Amy Goldberg
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Temple University, Philadelphia, PA (Charles, Goldberg)
| | - Lois K Lee
- Department of Emergency Medicine, Boston Children's Hospital, Boston, MA (Lee)
| | - Ronald M Stewart
- Department of Surgery, University of Texas San Antonio, San Antonio, TX (Stewart)
| | - Jeffrey D Kerby
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL (Kerby)
| | - Patricia L Turner
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
| | - Eileen M Bulger
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of Washington, Seattle, WA (Nehra, Bulger)
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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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12
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Abstract
This Viewpoint discusses lethal means safety (LMS), an approach to reducing suicide risk by reducing access to firearms by at-risk individuals; highlights challenges in implementing LMS interventions in clinical settings; and provides examples of programs and resources for preventing firearm suicide at the individual, patient group, and population level.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado Anschutz School of Medicine, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora
| | | | - Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Veterans Health Administration, Aurora, Colorado
- Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora
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13
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Simonetti JA, Azrael D, Zhang W, Miller M. Perspectives on clinician-delivered firearm safety counseling during routine care: Results of a national survey. Prev Med 2022; 158:107039. [PMID: 35398367 DOI: 10.1016/j.ypmed.2022.107039] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/09/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
Abstract
Only 7.5% of United States (U.S.) adults report ever having spoken with a clinician about firearm safety. One reason that clinicians may infrequently counsel patients about firearm safety is that they are unsure whether patients are open to these discussions. The aim of this study was to assess public opinion about whether clinicians should provide firearm safety counseling for patients in specific clinical contexts. We conducted a cross-sectional analysis of online survey data collected in 2019 from a nationally representative sample of U.S. adults residing in households with firearms (n = 4030, response 65%). Participants were asked "As part of routine care, should physicians and/or other health care professionals talk with their patients about firearms and firearm safety if their patient or their patient's family member (is at risk of suicide; has mental health or behavioral problems; is abusing or addicted to alcohol or drugs; is a victim of domestic violence; has Alzheimer's disease or another dementia; is going through a hard time)?" Across the six contexts, 76-89% of adults reported that clinicians should "sometimes" or "always" discuss firearm safety with patients. These findings demonstrate that a large majority of U.S. adults who live in households with firearms believe that clinicians should discuss firearm safety when patients or their family members are experiencing specific clinical scenarios. Clinicians' and healthcare systems' concerns that patients might object to discussing firearm safety in these contexts should not impede efforts to integrate such interventions into routine care.
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Affiliation(s)
- Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States of America; Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration, United States of America; Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, United States of America.
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Wilson Zhang
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America; Northeastern University, Department of Health Sciences, Boston, MA 02115, United States of America
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14
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Miller M, Zhang W, Azrael D. Firearm Purchasing During the COVID-19 Pandemic: Results From the 2021 National Firearms Survey. Ann Intern Med 2022; 175:219-225. [PMID: 34928699 PMCID: PMC8697522 DOI: 10.7326/m21-3423] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The surge in background checks beginning in March 2020 suggested an acceleration in firearm purchases. Little was known about the people who bought these guns. OBJECTIVE To estimate the number and describe characteristics of firearm purchasers over a period spanning prepandemic and pandemic time, characterize new gun owners, and estimate the number of persons newly exposed to household firearms. DESIGN Probability-based online survey conducted in April 2021. Survey weights generated nationally representative estimates. SETTING United States, 1 January 2019 to 26 April 2021. PARTICIPANTS 19 049 of 29 985 (64%) English-speaking adults responded to the survey invitation; 5932 owned firearms, including 1933 who had purchased firearms since 2019, of whom 447 had become new gun owners. MEASUREMENTS The estimated number and characteristics of adults who, since 2019, have purchased firearms, distinguishing those who became new gun owners from those who did not, and the estimated number of household members newly exposed to firearms. RESULTS An estimated 2.9% of U.S. adults (7.5 million) became new gun owners from 1 January 2019 to 26 April 2021. Most (5.4 million) had lived in homes without guns, collectively exposing, in addition to themselves, over 11 million persons to household firearms, including more than 5 million children. Approximately half of all new gun owners were female (50% in 2019 and 47% in 2020 to 2021), 20% were Black (21% in 2019 and in 2020-2021), and 20% were Hispanic (20% in 2019 and 19% in 2020-2021). By contrast, other recent purchasers who were not new gun owners were predominantly male (70%) and White (74%), as were gun owners overall (63% male, 73% White). LIMITATIONS Retrospective assessment of when respondents purchased firearms. National estimates about new gun owners were based on 447 respondents. CONCLUSION Efforts to reduce firearm injury should consider the recent acceleration in firearm purchasing and the characteristics of new gun owners. PRIMARY FUNDING SOURCE The Joyce Foundation.
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Affiliation(s)
- Matthew Miller
- Northeastern University and Harvard Injury Control Research Center, Boston, Massachusetts (M.M.)
| | - Wilson Zhang
- Harvard Injury Control Research Center, Boston, Massachusetts (W.Z., D.A.)
| | - Deborah Azrael
- Harvard Injury Control Research Center, Boston, Massachusetts (W.Z., D.A.)
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15
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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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16
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The contribution of method choice to gender disparity in suicide mortality: A population-based study in Hong Kong and the United States of America. J Affect Disord 2021; 294:17-23. [PMID: 34256181 DOI: 10.1016/j.jad.2021.06.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In most countries, more females than males attempt suicide, yet suicide mortality is typically higher for males. The aim of this study was to investigate how suicide method choice contributed to gender disparity in suicide mortality. METHODS This study used population-based data collected in Hong Kong (HK) and the United States of America (USA) (2007-2014), comprising suicide deaths and medically treated suicide attempts. We calculated suicide rates, suicide act rates, and case fatality rates (CFRs), by gender and suicide method in HK and the USA respectively. Decomposition analysis was used to quantify the contribution of gender differences in method choice and method-specific CFRs to the excess male suicide rates in each region. RESULTS Gender disparity in suicide mortality was mostly driven by gender differences in method used in suicide acts. In HK, gender difference in choosing jumping as the method in suicide acts explained 44.5% of the gender imbalance in suicide rates, whilst in USA, 62.4% of male excess in suicide rates was explained by gender difference in using firearms in suicide acts. LIMITATIONS Cases of suicide attempts in this study were restricted to those severe enough to require medical attention. CONCLUSION Gender-specific suicide method choice largely determined gender patterns in suicide. Our findings highlighted the importance of developing locally tailored suicide prevention strategies targeting commonly used and highly lethal suicide methods. Future research is needed to explore underlying reasons for gender differences in method choice.
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17
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Pallin R, Barnhorst A. Clinical strategies for reducing firearm suicide. Inj Epidemiol 2021; 8:57. [PMID: 34607607 PMCID: PMC8489372 DOI: 10.1186/s40621-021-00352-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
Suicide is complex, with psychiatric, cultural, and socioeconomic roots. Though mental illnesses like depression contribute to risk for suicide, access to lethal means such as firearms is considered a key risk factor for suicide, and half of suicides in the USA are by firearm. When a person at risk of suicide has access to firearms, clinicians have a range of options for intervention. Depending on the patient, the situation, and the access to firearms, counseling on storage practices, temporary transfer of firearms, or further intervention may be appropriate. In the USA, ownership of and access to firearms are common and discussing added risk of access to firearms for those at risk of suicide is not universally practiced. Given the burden of suicide (particularly by firearm) in the USA, the prevalence of firearm access, and the lethality of suicide attempts with firearms, we present the existing evidence on the burden of firearm suicide and what clinicians can do to reduce their patients' risk. Specifically, we review firearm ownership in the USA, firearm injury epidemiology, risk factors for firearm-related harm, and available interventions to reduce patients' risk of firearm injury and death.
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Affiliation(s)
- Rocco Pallin
- University of California Firearm Violence Research Center at UC Davis, 2315 Stockton Blvd, Sacramento, CA, USA.
- Department of Emergency Medicine, UC Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, USA.
| | - Amy Barnhorst
- University of California Firearm Violence Research Center at UC Davis, 2315 Stockton Blvd, Sacramento, CA, USA
- Department of Emergency Medicine, UC Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, USA
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18
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Goel R, Zhu X, Makhani S, Petersen MR, Josephson CD, Katz LM, Shaz BH, Austin R, Crowe EP, Ness PM, Gehrie EA, Frank SM, Bloch EM, Tobian AAR. Blood transfusions in gunshot-wound-related emergency department visits and hospitalizations in the United States. Transfusion 2021; 61:2277-2289. [PMID: 34213026 DOI: 10.1111/trf.16552] [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: 03/09/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The United States (US) leads all high-income countries in gunshot wound (GSW) deaths. However, previous US studies have not evaluated the national blood transfusion utilization patterns in hospitalized GSW patients. METHODS Data from 2016 to 2017 were analyzed from the Nationwide Emergency Department Sample (NEDS) and Nationwide Inpatient Sample (NIS), the largest all-payer emergency department (ED) and inpatient databases, respectively. Using stratified probability sampling, weights were applied to generate nationally representative estimates. Multivariable Poisson-regression models were used to estimate prevalence ratios (PR) of blood transfusion. RESULTS There were 168,315 ED visits and 58,815 hospitalizations (age = 18-90 years) following a GSW. The majority of hospitalizations were men (88.5%), age 18-24 years (31.8%), and assault-related GSW (51.3%). Blacks had the largest proportion (48.7%) overall of all GSW hospitalizations; Whites accounted for the highest proportion of intentional self-harm injuries (72.4%). Blood transfusions occurred in 12.7% of hospitalizations (12.0% red blood cell [RBC], 4.9% plasma, and 2.5% platelet transfusions). Only 1.9% of cases were associated with transfusion of all three blood components. Hospitalizations with major/extreme severity of illness had significantly higher prevalence of transfusion versus those with mild/moderate severity [crude PR = 4.79 (95%CI:4.15-5.33, p < .001)]. Overall, 8.2% of hospitalizations with GSW died, of whom 26.8% required blood transfusions, which was significantly higher than survivors [crude PR = 2.34 (95%CI:2.10-2.61, p < .001)]. The vast majority (95%) of the transfusions among those who died were within 48 h since admission. CONCLUSIONS Gun-related violence is a public health emergency in the US, and GSWs are a source of significant mortality, blood utilization, and health care costs.
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Affiliation(s)
- Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Simmons Cancer Institute at SIU School of Medicine and Mississippi Valley Regional Blood Center, Springfield, Illinois, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Makhani
- Herbert Wertheim College of Medicine at Florida International University, Miami, Florida, USA
| | - Molly R Petersen
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cassandra D Josephson
- Departments of Pathology and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Louis M Katz
- Mississippi Valley Regional Blood Center, Davenport, Iowa, USA
| | - Beth H Shaz
- Duke University, Durham, North Carolina, USA
| | - Richard Austin
- Department of Emergency Medicine, SIU School of Medicine, Springfield, Illinois, USA
| | - Elizabeth P Crowe
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul M Ness
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Steven M Frank
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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