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Khan H, Miller M, Barber C, Azrael D. Fatal Police Shootings of Victims with Mental Health Crises: A Descriptive Analysis of Data from the 2014-2015 National Violent Death Reporting System. J Urban Health 2024; 101:262-271. [PMID: 38453763 PMCID: PMC11052937 DOI: 10.1007/s11524-024-00833-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/09/2024]
Abstract
One in five fatal police shooting victims may have been experiencing a mental health crisis (MHC) at the time of their death [1]. We use data on fatal police shootings from the National Violent Death Reporting System (2014-2015) to (a) identify incidents where the victim is reported to have experienced an MHC at the time of their death, (b) describe the characteristics of these incidents, and (c) compare the characteristics of MHC to fatal police shootings where the victim was not experiencing an MHC at the time of their death. We systematically coded 633 fatal police shootings from 27 states. Descriptive statistics characterized fatal police shootings, including victim characteristics; their mental health status; and contextual information regarding the police encounter (e.g., reason for police call). Overall, 203 of 633 fatal police encounters (32%) involved victims who showed signs of an MHC at the time of their death. Victims were predominantly white, male, and in possession of a firearm. In 3 of 4 cases, the MHC manifested as suicidal ideation despite any relevant documented history among most victims. Among half of suicidal victims, suicidal ideation was expressed verbally and in-person to a family member/intimate partner who subsequently called the police. Dispatch was aware of the MHC in 1 of 4 of total police calls. Overall, fatal police encounters involving those experiencing an MHC accounted for 1 in 3 of our caseloads. Approximately, 3 of 4 mental health calls involved a suicidal person who mainly expressed intent to a loved one in-person.
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Affiliation(s)
- Harun Khan
- Harvard Injury Control Research Center, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Matthew Miller
- Harvard Injury Control Research Center, 677 Huntington Avenue, Boston, MA, 02115, USA
- Bouve School of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Catherine Barber
- Harvard Injury Control Research Center, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, 677 Huntington Avenue, Boston, MA, 02115, USA
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Khan H, Barber C, Azrael D. Suicide by sodium nitrite poisoning: Findings from the National Violent Death Reporting System, 2018-2020. Suicide Life Threat Behav 2024; 54:310-316. [PMID: 38251179 DOI: 10.1111/sltb.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/19/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVES Suicide by sodium nitrite may be an emerging trend in the United States. Our mixed-methods study aims to: (1) describe the rates of suicides secondary to sodium nitrite self-poisoning in the United States between 2018 and 2020 and (2) characterize the use of sodium nitrite as a suicide method. METHODS Using NVDRS data, descriptive statistics, population-based incident rates/year and incidence estimates across 50 states were calculated. An inductive thematic analysis characterized the use of sodium nitrite as a suicide method on review of medical examiner and law enforcement reports. RESULTS 260 incidents were identified as suicides secondary to self-poisoning with sodium nitrite/nitrate across 37 states and 1 territory-69% of which occurred in 2020. The typical victim was a white male student with a known depressive disorder and a history of suicidal thoughts (n = 120). The annual suicide rate using sodium nitrite increased from 0.01-0.09/100,000 person-years over the three-year period. Online forums were used to share knowledge on the procurement and preparation of sodium nitrite poisoning. CONCLUSIONS Sodium nitrite self-poisoning is an increasingly used planned suicide method among young people. Further studies are required to identify the impact of means safety interventions on the incidence of sodium nitrite self-poisoning incidents.
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Affiliation(s)
- Harun Khan
- Harvard Injury Control Research Center, Boston, Massachusetts, USA
| | - Catherine Barber
- Harvard Injury Control Research Center, Boston, Massachusetts, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Boston, Massachusetts, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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MacPhaul E, Zhou L, Mooney SJ, Azrael D, Bowen A, Rowhani-Rahbar A, Yenduri R, Barber C, Goralnick E, Miller M. Classifying Firearm Injury Intent in Electronic Hospital Records Using Natural Language Processing. JAMA Netw Open 2023; 6:e235870. [PMID: 37022685 PMCID: PMC10080369 DOI: 10.1001/jamanetworkopen.2023.5870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Importance International Classification of Diseases-coded hospital discharge data do not accurately reflect whether firearm injuries were caused by assault, unintentional injury, self-harm, legal intervention, or were of undetermined intent. Applying natural language processing (NLP) and machine learning (ML) techniques to electronic health record (EHR) narrative text could be associated with improved accuracy of firearm injury intent data. Objective To assess the accuracy with which an ML model identified firearm injury intent. Design, Setting, and Participants A cross-sectional retrospective EHR review was conducted at 3 level I trauma centers, 2 from health care institutions in Boston, Massachusetts, and 1 from Seattle, Washington, between January 1, 2000, and December 31, 2019; data analysis was performed from January 18, 2021, to August 22, 2022. A total of 1915 incident cases of firearm injury in patients presenting to emergency departments at the model development institution and 769 from the external validation institution with a firearm injury code assigned according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM), in discharge data were included. Exposures Classification of firearm injury intent. Main Outcomes and Measures Intent classification accuracy by the NLP model was compared with ICD codes assigned by medical record coders in discharge data. The NLP model extracted intent-relevant features from narrative text that were then used by a gradient-boosting classifier to determine the intent of each firearm injury. Classification accuracy was evaluated against intent assigned by the research team. The model was further validated using an external data set. Results The NLP model was evaluated in 381 patients presenting with firearm injury at the model development site (mean [SD] age, 39.2 [13.0] years; 348 [91.3%] men) and 304 patients at the external development site (mean [SD] age, 31.8 [14.8] years; 263 [86.5%] men). The model proved more accurate than medical record coders in assigning intent to firearm injuries at the model development site (accident F-score, 0.78 vs 0.40; assault F-score, 0.90 vs 0.78). The model maintained this improvement on an external validation set from a second institution (accident F-score, 0.64 vs 0.58; assault F-score, 0.88 vs 0.81). While the model showed some degradation between institutions, retraining the model using data from the second institution further improved performance on that site's records (accident F-score, 0.75; assault F-score, 0.92). Conclusions and Relevance The findings of this study suggest that NLP ML can be used to improve the accuracy of firearm injury intent classification compared with ICD-coded discharge data, particularly for cases of accident and assault intents (the most prevalent and commonly misclassified intent types). Future research could refine this model using larger and more diverse data sets.
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Affiliation(s)
- Erin MacPhaul
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Li Zhou
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen J Mooney
- Firearm Injury & Policy Research Program, University of Washington, Seattle
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Andrew Bowen
- Firearm Injury & Policy Research Program, University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, University of Washington, Seattle
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
| | - Ravali Yenduri
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Eric Goralnick
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
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Houtsma C, Powers J, Raines AM, Bailey M, Barber C, True G. Engaging stakeholders to develop a suicide prevention learning module for Louisiana firearm training courses. Inj Epidemiol 2023; 10:3. [PMID: 36631823 PMCID: PMC9832758 DOI: 10.1186/s40621-023-00413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Firearm suicide is a significant public health problem in the United States of America among the general and veteran populations. Broad-based preventive strategies, including lethal means safety, have been emphasized as a key approach to suicide prevention. Prior research has identified ways to improve the reach and uptake of lethal means safety messages. However, few resources have been created with these lessons in mind. METHODS Louisiana firearm owners and instructors were recruited through a larger project, Veteran-Informed Safety Intervention and Outreach Network, as well as a publicly available database of firearm instructors to participate in focus groups to provide feedback on an existing suicide prevention learning module (developed in Utah) for use by firearm instructors. Their feedback was used to adapt the module, which included a brief video and PowerPoint presentation. Firearm owners and instructors were then invited back for another round of focus groups to provide feedback on this adapted learning module. Team-based rapid qualitative analysis was conducted to identify themes across transcripts from these four focus groups. RESULTS Firearm owners and instructors agreed on several key themes, including the importance of messenger relatability and aligning the lethal means safety message with firearm owner values. Feedback suggested these themes were adequately addressed in the adapted learning module and contributed to overall module acceptability. The final theme, present across the original and adapted learning modules (i.e., Utah and Louisiana), was openness to further information and training on firearm suicide prevention. CONCLUSION Consistent with a public health approach to suicide prevention, the current study used stakeholder engagement to develop a suicide prevention learning module perceived as representative, accurate, and acceptable to Louisiana firearm owners and instructors. These findings can be used to inform firearm suicide prevention efforts in other states.
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Affiliation(s)
- Claire Houtsma
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
- South Central Mental Illness Research, Education and Clinical Center, New Orleans, LA USA
- Louisiana State University Health Sciences Center, New Orleans, LA USA
| | - Jeffrey Powers
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
- Louisiana State University, Baton Rouge, LA USA
| | - Amanda M. Raines
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
- South Central Mental Illness Research, Education and Clinical Center, New Orleans, LA USA
- Louisiana State University Health Sciences Center, New Orleans, LA USA
| | - Matthew Bailey
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
| | | | - Gala True
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
- South Central Mental Illness Research, Education and Clinical Center, New Orleans, LA USA
- Louisiana State University Health Sciences Center, New Orleans, LA USA
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Miller M, Azrael D, Yenduri R, Barber C, Bowen A, MacPhaul E, Mooney SJ, Zhou L, Goralnick E, Rowhani-Rahbar A. Assessment of the Accuracy of Firearm Injury Intent Coding at 3 US Hospitals. JAMA Netw Open 2022; 5:e2246429. [PMID: 36512356 PMCID: PMC9856424 DOI: 10.1001/jamanetworkopen.2022.46429] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE The absence of reliable hospital discharge data regarding the intent of firearm injuries (ie, whether caused by assault, accident, self-harm, legal intervention, or an act of unknown intent) has been characterized as a glaring gap in the US firearms data infrastructure. OBJECTIVE To use incident-level information to assess the accuracy of intent coding in hospital data used for firearm injury surveillance. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional retrospective medical review study was conducted using case-level data from 3 level I US trauma centers (for 2008-2019) for patients presenting to the emergency department with an incident firearm injury of any severity. EXPOSURES Classification of firearm injury intent. MAIN OUTCOMES AND MEASURES Researchers reviewed electronic health records for all firearm injuries and compared intent adjudicated by team members (the gold standard) with International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM) codes for firearm injury intent assigned by medical records coders (in discharge data) and by trauma registrars. Accuracy was assessed using intent-specific sensitivity and positive predictive value (PPV). RESULTS Of the 1227 cases of firearm injury incidents seen during the ICD-10-CM study period (October 1, 2015, to December 31, 2019), the majority of patients (1090 [88.8%]) were male and 547 (44.6%) were White. The research team adjudicated 837 (68.2%) to be assaults. Of these assault incidents, 234 (28.0%) were ICD coded as unintentional injuries in hospital discharge data. These miscoded patient cases largely accounted for why discharge data had low sensitivity for assaults (66.3%) and low PPV for unintentional injuries (34.3%). Misclassification was substantial even for patient cases described explicitly as assaults in clinical notes (sensitivity of 74.3%), as well as in the ICD-9-CM study period (sensitivity of 77.0% for assaults and PPV of 38.0% for unintentional firearm injuries). By contrast, intent coded by trauma registrars differed minimally from researcher-adjudicated intent (eg, sensitivity for assault of 96.0% and PPV for unintentional firearm injury of 93.0%). CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study underscore questions raised by prior work using aggregate count data regarding the accuracy of ICD-coded discharge data as a source of firearm injury intent. Based on our observations, researchers and policy makers should be aware that databases drawn from hospital discharge data (most notably, the Nationwide Emergency Department Sample) cannot be used to reliably count or characterize intent-specific firearm injuries.
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Affiliation(s)
- Matthew Miller
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Ravali Yenduri
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Andrew Bowen
- Firearm Injury and Policy Research Program, University of Washington, Seattle
| | - Erin MacPhaul
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen J. Mooney
- Firearm Injury and Policy Research Program, University of Washington, Seattle
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
| | - Li Zhou
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric Goralnick
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ali Rowhani-Rahbar
- Firearm Injury and Policy Research Program, University of Washington, Seattle
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
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Abstract
For every fatal shooting in the United States, detailed information from reports of coroners or medical examiners, police departments, and other sources is recorded in the National Violent Death Reporting System. There is no such system in place for nonfatal shootings, which far outnumber fatalities. Hospital data systems are in place that could, with some improvements, provide access to reliable local, state and national estimates of firearm injuries. Such estimates are possible because most firearms injuries are treated in hospitals, and hospitals routinely assign "external cause of injury" codes to all injury encounters. Federal health agencies supervise a number of data systems that centralize hospital data. Challenges currently being addressed are public access, timeliness, and accuracy of coding of intent. (Hospitals misclassify many firearm assaults as accidents.) Law enforcement agencies provide detailed data on shootings in criminal circumstances, including shootings that are not treated in a hospital. The FBI's Uniform Crime Reports (UCR) system aggregates data from agencies. The FBI instituted a radical reform of this system beginning in 2021, resulting in a sharp agency participation drop that prevents valid national estimates. The reform requires agencies to report incident-level data instead of summary counts, which is all that was required for the previous 90 years. There are ongoing efforts to increase participation in the new system and restore its former status as the leading source of national crime estimates. In the meantime, data on nonfatal gunshot cases are available from a number of police departments. We discuss additional reforms needed to generate timely, accurate, publicly accessible data from hospitals and police.
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Affiliation(s)
- Catherine Barber
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States of America.
| | - Philip J Cook
- Sanford School of Public Policy, Duke University, Durham, NC 27708, United States of America.
| | - Susan T Parker
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America.
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Barber C, Azrael D, Miller M, Hemenway D. Who owned the gun in firearm suicides of men, women, and youth in five US states? Prev Med 2022; 164:107066. [PMID: 35461957 DOI: 10.1016/j.ypmed.2022.107066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/29/2022] [Accepted: 04/17/2022] [Indexed: 12/16/2022]
Abstract
One way to reduce firearm suicide is to keep household guns away from a person at risk for suicide. To learn who owned (and presumably controlled access to) the guns used in suicide and which broad gun type they were, we examined National Violent Death Reporting System (NVDRS) data from 2015 to 2017 for five US states that supplied information on gun owner in over 80% of firearm suicides (AK, IA, NH, UT, WI). For adult males, 88% used their own gun; for women, 52% used their own gun and 32% used their partner's gun; for youth ages 18-20, 42% used their own gun, 43% used a family member's, and 8% used a friend's; for children, 19% used their own gun (usually a long gun) and 79% used a family member's gun. Almost 3/4 of firearm suicides involved a handgun, ranging from 62% for youth to 92% for women. In times of suicide risk, interventions for a youth should address not only the parents' guns, but those of other family members and the youth's own rifle or shotgun. For a woman, interventions need to address her own and her partner's guns. For a man, locking guns alone will confer little protection if he controls the keys or combination. Storing firearms-or a critical component-away from home or having someone else control the locks may be safer. Five NVDRS states provided useful data on who owned the gun used in firearm suicides. More NVDRS states should follow suit.
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Affiliation(s)
- Catherine Barber
- Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Healt, United States of America.
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Healt, United States of America
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Healt, United States of America; Bouve College of Health Sciences, Northeastern University, United States of America
| | - David Hemenway
- Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Healt, United States of America
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Conner A, Miller M, Barber C, Azrael D. Homicides by law enforcement: case definitions matter. Lancet 2022; 399:1693. [PMID: 35490685 DOI: 10.1016/s0140-6736(22)00167-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/26/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Andrew Conner
- Frank H Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Matthew Miller
- Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115, USA; Harvard Injury Control Research Center, Harvard T H Chan School of Public Health, Harvard University, Boston, MA.
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard T H Chan School of Public Health, Harvard University, Boston, MA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard T H Chan School of Public Health, Harvard University, Boston, MA
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Barber C, Azrael D, Berrigan J, Betz ME, Brandspigel S, Runyan C, Salhi C, Vriniotis M, Miller M. Selection and Use of Firearm and Medication Locking Devices in a Lethal Means Counseling Intervention. Crisis 2022. [PMID: 35485394 DOI: 10.1027/0227-5910/a000855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: While some suicide prevention initiatives distribute locking devices for firearms and medication, little evidence exists to guide the selection of devices. Aims: This study aimed to describe safety standards for locking devices and compare parental acceptance rates for different types of devices. Method: As part of the larger SAFETY Study, behavioral health clinicians provided free locking devices to parents whose child was evaluated in the emergency department (ED) for a suicide-related or behavioral health-related problem. For logistical reasons, we changed the specific devices offered midstudy. Data on device use came from follow-up interviews with 226 parents. Results: Few effective standards exist for locking devices for home use; we could easily break into some. At follow-up, twice as many gun-owning parents were using ED-provided handgun lockboxes as cable locks (28% vs. 14%, p = .02). Overall, 55% of parents reported using an ED-provided medication lockbox, with more using the drawer-sized lockbox than the larger, steel toolbox (60% vs. 42%, p < .01). Limitations: Storage outcomes are from parents' self-report and from one state only. Conclusion: Parents appeared to prefer some devices over others. Our findings suggest the need for (a) effective safety standards, (b) affordable devices meeting these standards, and (c) further research on consumer preferences to ensure use.
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Affiliation(s)
- Catherine Barber
- Department of Health Policy, Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Deborah Azrael
- Department of Health Policy, Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - John Berrigan
- Department of Health Policy, Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
| | - Sara Brandspigel
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Carol Runyan
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Carmel Salhi
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Mary Vriniotis
- Department of Health Policy, Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Matthew Miller
- Department of Health Policy, Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
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Berrigan J, Miller M, Zhang W, Azrael D, Barber C. Hospital visit histories of suicide decedents: a study in Utah. Inj Prev 2022; 28:259-261. [PMID: 35273068 DOI: 10.1136/injuryprev-2022-044524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/26/2022] [Indexed: 11/05/2022]
Abstract
The study aims to describe the 3-year hospital visit histories of suicide decedents in Utah grouped by the suicide method they used. Hospital visit histories from the Utah Office of Health Care Statistics were linked to a census of suicide mortality data from the National Violent Death Reporting System in 2014 and 2015. Overall, 14% of suicide decedents had visited a hospital for deliberate self-harm (DSH) and 49% for a behavioural health issue (BHI), including DSH, suicidal ideation, mental health and substance abuse, prior to their death. Firearms suicide decedents made up over half of all suicides but were the least likely to have a history of DSH or BHI prior to their death (8% and 41%, respectively). Few suicide decedents visited a hospital for DSH prior to their death, although half had visits for BHI. Hospital-based interventions that aim to prevent suicide should not be limited to visits for DSH.
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Affiliation(s)
- John Berrigan
- University of Kansas School of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA .,Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Wilson Zhang
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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Abstract
OBJECTIVE To identify suicide rates by occupation category in Utah and describe the hospital history and circumstances of suicide decedents in the occupation category that had the state's highest rate and highest number of suicides: Construction and Extraction. METHOD We used data on suicide decedents from the National Violent Death Reporting System (NVDRS) for 2005-2015 (n = 4,590) to calculate sex- and occupation-specific suicide rates among adults 18-65 years old in Utah. For working-age men who died by suicide during the years 2014-2015 (n = 623), we linked NVDRS data with decedents' hospital histories. RESULTS One in five working-age men who took their life in Utah worked in Construction and Extraction, the single Bureau of Labor Statistics occupation category with both the highest number (n = 719) and rate of suicides (86.4/100,000 men vs. a range of 15.3-66.2 for other occupations). For females, there was no occupation group that had both high rates of suicide and high numbers of suicides compared with other occupations, so there was no clear occupation group to focus on in the same way there was for men. Using linked data for 2014-2015 deaths, 58% of men in Construction and Extraction who died by suicide had been diagnosed in the hospital in the past three years with a substance abuse or mental health problem, and a quarter (25%) tested positive for opioids on post-mortem examination. Nearly half (48%) of 2014-2015 male suicide decedents in Construction and Extraction were reported to have intimate partner problems, about a quarter (26%) had a criminal problem, a quarter (25%) were unemployed, and over half (54%) died by gunshot. CONCLUSIONS Linked data identified Construction and Extraction as a potentially high-impact occupation group for suicide prevention and suggested potential contexts for intervention.HIGHLIGHTSConstruction and Extraction stands out as an occupation group with a very high number and rate of suicides.Two-thirds of male decedents in Construction and Extraction had a substance abuse problem.For Utah females, there were no occupations with both high rates and high numbers of suicides.
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13
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Hoops K, Fahimi J, Khoeur L, Studenmund C, Barber C, Barnhorst A, Betz ME, Crifasi CK, Davis JA, Dewispelaere W, Fisher L, Howard PK, Ketterer A, Marcolini E, Nestadt PS, Rozel J, Simonetti JA, Spitzer S, Victoroff M, Williams BH, Howley L, Ranney ML. Consensus-Driven Priorities for Firearm Injury Education Among Medical Professionals. Acad Med 2022; 97:93-104. [PMID: 34232149 DOI: 10.1097/acm.0000000000004226] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PURPOSE Firearm injury is a leading cause of morbidity and mortality in the United States. However, many medical professionals currently receive minimal or no education on firearm injury or its prevention. The authors sought to convene a diverse group of national experts in firearm injury epidemiology, injury prevention, and medical education to develop consensus on priorities to inform the creation of learning objectives and curricula for firearm injury education for medical professionals. METHOD In 2019, the authors convened an advisory group that was geographically, demographically, and professionally diverse, composed of 33 clinicians, researchers, and educators from across the United States. They used the nominal group technique to achieve consensus on priorities for health professions education on firearm injury. The process involved an initial idea-generating phase, followed by a round-robin sharing of ideas and further idea generation, facilitated discussion and clarification, and the ranking of ideas to generate a prioritized list. RESULTS This report provides the first national consensus guidelines on firearm injury education for medical professionals. These priorities include a set of crosscutting, basic, and advanced learning objectives applicable to all contexts of firearm injury and all medical disciplines, specialties, and levels of training. They focus on 7 contextual categories that had previously been identified in the literature: 1 category of general priorities applicable to all contexts and 6 categories of specific contexts, including intimate partner violence, mass violence, officer-involved shootings, peer (nonpartner) violence, suicide, and unintentional injury. CONCLUSIONS Robust, data- and consensus-driven priorities for health professions education on firearm injury create a pathway to clinician competence and self-efficacy. With an improved foundation for curriculum development and educational program-building, clinicians will be better informed to engage in a host of firearm injury prevention initiatives both at the bedside and in their communities.
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Affiliation(s)
- Katherine Hoops
- K. Hoops is assistant professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jahan Fahimi
- J. Fahimi is associate professor, Department of Emergency Medicine, University of California, San Francisco School of Medicine and Institute for Health Policy Studies, San Francisco, California
| | - Lina Khoeur
- L. Khoeur is a third-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Christine Studenmund
- C. Studenmund is a third-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Catherine Barber
- C. Barber is senior researcher, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Amy Barnhorst
- A. Barnhorst is associate professor, Department of Psychiatry and Behavioral Sciences and Department of Emergency Medicine, University of California, Davis School of Medicine, Davis, California
| | - Marian E Betz
- M.E. Betz is associate professor, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Cassandra K Crifasi
- C.K. Crifasi is assistant professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John A Davis
- J.A. Davis is professor and associate dean for curriculum, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - William Dewispelaere
- W. Dewispelaere is a resident, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Lynn Fisher
- L. Fisher is assistant professor, Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, Kansas
| | - Patricia K Howard
- P.K. Howard is adjunct assistant professor, University of Kentucky, Lexington, Kentucky
| | - Andrew Ketterer
- A. Ketterer is clinical instructor, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Evie Marcolini
- E. Marcolini is assistant professor, Department of Emergency Medicine and Department of Neurology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Paul S Nestadt
- P.S. Nestadt is assistant professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John Rozel
- J. Rozel is associate professor, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph A Simonetti
- J.A. Simonetti is assistant professor, Department of Medicine, University of Colorado School of Medicine, and Veterans Health Administration, Aurora, Colorado
| | - Sarabeth Spitzer
- S. Spitzer is a resident, Department of Surgery, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Victoroff
- M. Victoroff is clinical professor, Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian H Williams
- B.H. Williams is associate professor, Department of Surgery, University of Chicago Pritzker School of Medicine and Biological Sciences, Chicago, Illinois
| | - Lisa Howley
- L. Howley is senior director of strategic initiatives and partnerships, Association of American Medical Colleges, Washington, DC
| | - Megan L Ranney
- M.L. Ranney is associate professor, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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14
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Salhi C, Berrigan J, Azrael D, Beatriz E, Barber C, Runyan C, Miller M. ' It's changed how we have these conversations': emergency department clinicians' experiences implementing firearms and other lethal suicide methods counseling for caregivers of adolescents. Int Rev Psychiatry 2021; 33:617-625. [PMID: 33496204 DOI: 10.1080/09540261.2020.1870938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Counseling parents to reduce access to firearms and other potentially lethal suicide methods is commonly known as lethal means counseling (LMC). The current study explores the experiences that emergency department-based behavioural health clinicians described having as they provided lethal means counseling to parents of adolescents at risk for suicide. Clinicians were purposively sampled from four hospital networks in Colorado after their hospitals adopted LMC protocols as part of an intervention that also included online training in LMC and provision of free medication and firearm lockboxes. Twenty-three clinicians were interviewed using semi-structured interviews. Data were analysed using a modified grounded theory-based approach. Clinicians felt more comfortable and effective in their abilities to provide LMC after the intervention. Clinicians also described how being able to offer free storage devices helped them engage in LMC. In advising parents to make guns and medications inaccessible to their at-risk child, most clinicians pointed to at least one of three research findings highlighted in the online training: (1) Suicide attempts with guns rarely afford second chances, (2) medication overdoses can kill, (3) suicidal behaviour is always unpredictable and often impulsive. All clinicians described a desire to continue LMC as currently protocolized at their hospital after the study ended.
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Affiliation(s)
- C Salhi
- Department of Health Sciences, Northeastern University, Boston, MA, USA.,Colorado School of Public Health, Aurora, CO, USA
| | - J Berrigan
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA
| | - D Azrael
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA
| | - E Beatriz
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - C Barber
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA
| | | | - M 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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15
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Thomas NM, Barber C, Miller M. A cohort study of initial self-harm events: method-specific case fatality of index events, predictors of fatal and nonfatal repetition, and frequency of method-switching. Int Rev Psychiatry 2021; 33:598-606. [PMID: 34238099 DOI: 10.1080/09540261.2021.1901668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Most studies evaluating self-harm repetition risk factors are from Asia and Europe, use cohorts of people who self-injure without differentiating incident and prevalent self-harm episodes, and do not stratify by suicide method. The current study uses an incident user design to (a) examine case fatality at index self-harm events and at each repeat event, by method, (b) describe method-switching, and (c) identify factors associated with repetition of self-harm among those who survive their index hospitalization. Specifically, this study reports psychiatric history and method-specific case fatality for the initial self-harm event among Utah residents with an index event in 2014 or 2015 and who have no history of prior self-harm in hospital records. For survivors of the index self-harm episode, we use Accelerated Failure Time models to identify risk factors for nonfatal repetition and separately for suicide. Key findings: 10,521 Utah residents with no 3-year self-harm hospital history experienced a 2014 or 2015 index event. Of the 9.5% with index deaths, 53.6% used firearms. Of the 90.5% who survived, 63.1% used drugs. Among the index nonfatal cases, over an average 1-year follow-up, 11.7% experienced a nonfatal repetition and 0.8% died by suicide. Most subsequent nonfatal repetitions (59.7%) and suicides (56.8%) had presented with an index drug poisoning; over half (56.8%) of those who died switched methods. For those who subsequently fatally self-harmed, most used poisoning by drugs (33.8%), hanging/strangulation (28.4%), or firearms (24.3%) in the terminal episode. Nonfatal repetition was associated with younger age, index cutting/piercing instruments, and past-year psychiatric and drug abuse diagnoses. Subsequent suicide was associated with male gender, older age, and index gas poisoning and hanging/suffocation. Of the 56 people who survived an index firearm event, none subsequently died by suicide during the study period.
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Affiliation(s)
- Nicole M Thomas
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Catherine Barber
- Department of Health Policy and Management, Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Matthew Miller
- Department of Health Sciences, Harvard T.H. Chan School of Public Health, Northeastern University, Boston, MA, USA
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16
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Affiliation(s)
- Catherine Barber
- Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Eric Goralnick
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - 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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17
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Barber C, Berrigan JW, Sobelson Henn M, Myers K, Staley M, Azrael D, Miller M, Hemenway D. Linking Public Safety And Public Health Data For Firearm Suicide Prevention In Utah. Health Aff (Millwood) 2020; 38:1695-1701. [PMID: 31589528 DOI: 10.1377/hlthaff.2019.00618] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In Utah, a state with a high rate of gun ownership, the shared concerns of diverse stakeholders generated bipartisan support for a state-funded study that tracked patterns of firearm suicide. The study linked sensitive public health and public safety data and identified opportunities for firearm suicide prevention. Findings reported to the state legislature included the proportion of suicide decedents who could have passed a background check for legal firearm possession at their time of death, had a permit to carry a concealed firearm, or had been seen in the hospital for a previous suicide attempt or self-harm. Within six months of the report's release, the legislature, health care and religious groups, and state agencies had launched diverse, major initiatives to reduce firearm suicide that were informed by the report's findings. We present the Utah experience as a case study in bringing diverse stakeholders-particularly gun owners-together to find common ground on firearm suicide prevention and in using linked data to support and guide their efforts.
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Affiliation(s)
- Catherine Barber
- Catherine Barber ( cbarber@hsph. harvard. edu ) is a senior researcher in the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - John W Berrigan
- John W. Berrigan is a research assistant in the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health
| | - Morissa Sobelson Henn
- Morissa Sobelson Henn is director of the Community Health Program at Intermountain Healthcare, in Salt Lake City, Utah
| | - Kim Myers
- Kim Myers is a suicide prevention coordinator in the Division of Substance Abuse and Mental Health, Utah Department of Health Services, in Salt Lake City
| | - Michael Staley
- Michael Staley is a psychological autopsy examiner in the Utah Office of the Medical Examiner, in Salt Lake City
| | - Deborah Azrael
- Deborah Azrael is research director in the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health
| | - Matthew Miller
- Matthew Miller is a professor of health sciences and epidemiology in the Bouve College of Health Sciences, Northeastern University, in Boston
| | - David Hemenway
- David Hemenway is a professor of health policy in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health
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18
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Barber C, Dellavalle R, Coolman T, Ranpariya V. 461 Emojis in dermatology: Changing the faces in medicine. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Wertz J, Azrael D, Berrigan J, Barber C, Nelson E, Hemenway D, Salhi C, Miller M. A Typology of Civilians Shot and Killed by US Police: a Latent Class Analysis of Firearm Legal Intervention Homicide in the 2014-2015 National Violent Death Reporting System. J Urban Health 2020; 97:317-328. [PMID: 32212060 PMCID: PMC7305287 DOI: 10.1007/s11524-020-00430-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Approximately 1000 people are killed by police acting in the line of duty each year. Historically, research on these deaths, known as legal intervention homicides (LIH), has been limited by data that is either contextually rich but narrow in scope and not readily available to the public (e.g., police department reports from a single city), or detail-poor but geographically broad, large, and readily available (and maintained by federal agencies) (e.g., vital statistics and supplemental homicide reports). Over the past 5 years, however, researchers have turned to the National Violent Death Reporting System (NVDRS), which captures nearly all lethal police shootings in participating states while providing detailed incident and victim information. The current study extends prior work on police-involved lethal shootings in three important ways. First, we use latent class analysis to construct a data-driven, exhaustive, mutually exclusive typology of these events, using NVDRS data 2014-2015. Second, rather than fitting some, but not all cases into predefined sub-types, every case is assigned membership to a particular emergent class. Third, we use a validated case identification process in NVDRS to identify incidents of lethal police-involved shootings. Seven classes emerge. Classes differ across important incident and victim characteristics such as the event that brought the victim and law enforcement together, the highest level of force used by the victim against law enforcement, and the kind of weapon, if any, used by the victim during the incident. Demographic variables do not distribute uniformly across classes (e.g., the latent class in which the victim appeared to pose minimal threat to law enforcement was the only class in which the plurality of victims was a non-white race). Our approach to generating these typologies illustrates how data-driven techniques can complement subjective classification schemes and lay the groundwork for analogous analyses using police encounter data that include fatal and non-fatal outcomes.
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Affiliation(s)
- Joseph Wertz
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - John Berrigan
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Eliot Nelson
- Department of Pediatrics, The Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, 05401, USA
| | - David Hemenway
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Carmel Salhi
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, USA
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. .,Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, USA.
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20
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Hemenway D, Berrigan J, Azrael D, Barber C, Miller M. Fatal police shootings of civilians, by rurality. Prev Med 2020; 134:106046. [PMID: 32145239 DOI: 10.1016/j.ypmed.2020.106046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/21/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
In the United States, firearm homicides disproportionately occur in urban areas. We examine whether the same is true for fatal police shootings. We use data on fatal police shootings from Washington Post's "Fatal Force Database" (2015-2017). Using Census population estimates, we examine rates of fatal police shootings, stratified by race/ethnicity (White, Black, Hispanic), across urban and rural areas using five different classification schemes. Two classification schemes-from the National Center for Health Statistics and the US Department of Agriculture-use counties as the basic unit. Three classification schemes-from the National Center for Education Statistics, the US Census Bureau, and the website "FiveThirtyEight" use zip codes. There were just under 1000 fatal police shootings per year from 2015 to 2017, a rate of 0.31 per 100,000 population. Black victimization rates were more than twice those for Whites, with Hispanic victimization rates in between. Across all classification schemes there was little difference in rates of fatal police shootings between urban and rural areas, with suburbs having somewhat lower rates. Among Whites, rates of fatal police shooting victimization were higher in rural areas compared to urban areas, while among Blacks the rates were higher in more urban areas. Our results suggest that efforts to reduce police shootings of civilians should include rural and suburban as well as urban areas.
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Affiliation(s)
- David Hemenway
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, MA, United States of America.
| | - John Berrigan
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, MA, United States of America; Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States of America
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21
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Abstract
Background: Some shooting ranges have adopted policies to prevent suicides at their facilities. Little data have been available to guide them. Aim: We aimed to describe the incidence and characteristics of suicides at public shooting ranges. Method: We conducted text searches of 63,710 firearm suicides in the 16 states participating in the National Violent Death Reporting System from 2004 to 2015 to identify those occurring at public shooting ranges. Results: A total of 118 (or 0.18%) occurred at a shooting range, or 0.12 per million population. If that rate held for the nation as a whole, there would have been roughly 35 shooting range suicides per year during the study period. In total, 88% of decedents arrived alone. When gun ownership was noted, 86% of guns were rented from the range. In some cases, people drove to the range and took their lives in the parking lot with their own gun. Limitations: Our search strategy may have missed cases, and the data may not be nationally representative. Conclusion: Suicides at shooting ranges are rare. Policies that some ranges have adopted - such as allowing rentals only if the person is not alone - are responsive to the actual characteristics of these deaths and could potentially prevent most.
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Affiliation(s)
- Catherine Barber
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Hannah Walters
- Department of Sociology, Boston University, Boston, MA, USA
| | | | - David Hemenway
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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22
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Miller M, Salhi C, Barber C, Azrael D, Beatriz E, Berrigan J, Brandspigel S, Betz ME, Runyan C. Changes in Firearm and Medication Storage Practices in Homes of Youths at Risk for Suicide: Results of the SAFETY Study, a Clustered, Emergency Department-Based, Multisite, Stepped-Wedge Trial. Ann Emerg Med 2020; 76:194-205. [PMID: 32307124 DOI: 10.1016/j.annemergmed.2020.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/16/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE We evaluate whether a counseling intervention implemented at the hospital level resulted in safer firearm and medication storage by caregivers of youths aged 10 to 17 years after their child's evaluation in the emergency department (ED) for a behavioral health concern. METHODS We used a stepped-wedge clustered design rolled out at 4 hospital sites to assess primary preregistered outcomes (self-reported storage changes caregivers made to household firearms and medications), assessed by survey 2 weeks after the ED visit. Three logistic models provided estimates of the intervention effect: an unadjusted model, a model with hospital-level fixed effects, and a model that further adjusts for time. RESULTS Of the 575 caregiver participants, 208 were firearm owners (123 in usual care, 85 in the intervention). Baseline (pre-ED visit) characteristics did not differ between usual care and intervention phases. During the 2-year study period, twice as many caregivers whose child visited the ED after (compared with before) a hospital adopted the intervention improved firearm storage and 3 times as many improved medication storage (odds ratio [OR]=2.1 [95% confidence interval {CI} 1.0 to ∞] and OR=3.0 [95% CI 2.2 to ∞], respectively). After adjusting for time, the intervention effect for medications persisted (OR=2.0 [95% CI 1.0 to ∞]); the effect on firearms did not (OR=0.7 [95% CI 0.1 to ∞]). CONCLUSION To our knowledge, this study is the first controlled trial to estimate the effectiveness of an intervention on firearm and medication storage in homes of youths at elevated risk of suicide. We found evidence that caregivers' medication storage improved after their child's ED visit, with evidence suggestive of improvement for firearm storage.
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Affiliation(s)
- Matthew Miller
- Northeastern University, Boston, MA; Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA.
| | | | - Catherine Barber
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA
| | | | - John Berrigan
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA
| | | | - Marian E Betz
- University of Colorado School of Medicine, Aurora, CO
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Barber C. New Evidence to Help to Prevent Lethal Outcomes in Intentional Overdoses. JAMA Netw Open 2020; 3:e201131. [PMID: 32202639 DOI: 10.1001/jamanetworkopen.2020.1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Catherine Barber
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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24
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Conner A, Azrael D, Lyons VH, Barber C, Miller M. Validating the National Violent Death Reporting System as a Source of Data on Fatal Shootings of Civilians by Law Enforcement Officers. Am J Public Health 2019; 109:578-584. [PMID: 30789773 DOI: 10.2105/ajph.2018.304904] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the National Violent Death Reporting System (NVDRS) as a surveillance system for fatal shootings of civilians by law enforcement in the United States. METHODS We cross-linked individual-level mortality data from the 2015 NVDRS and 5 open-source data sets ( FatalEncounters.org , Mapping Police Violence, the Guardian's "The Counted," Gun Violence Archive, and The Washington Post's "Fatal Force Database"). Using the comprehensive cross-linked data set, we assessed the proportion of study-identified fatal police shootings that were captured by NVDRS, overall and by state, and by each open-source data set. RESULTS There were 404 unique study-identified fatal shootings by law enforcement in the 27 states for which data were available from NVDRS, 393 (97%) of which were captured in NVDRS. The proportion of shootings captured by NVDRS varied only slightly by state. CONCLUSIONS The NVDRS provides a comprehensive count of fatal police shootings. Public Health Implications. Expanding NVDRS to all 50 states would provide comprehensive counts of fatal police shootings and detailed circumstantial information about these deaths at the national level. Open-source data can continue to provide real-time data collection as well as more complete information about nonfirearm officer-involved deaths.
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Affiliation(s)
- Andrew Conner
- Andrew Conner, Deborah Azrael, Catherine Barber, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Vivian H. Lyons is with Department of Epidemiology, University of Washington, and Harborview Injury Prevention & Research Center, Seattle
| | - Deborah Azrael
- Andrew Conner, Deborah Azrael, Catherine Barber, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Vivian H. Lyons is with Department of Epidemiology, University of Washington, and Harborview Injury Prevention & Research Center, Seattle
| | - Vivian H Lyons
- Andrew Conner, Deborah Azrael, Catherine Barber, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Vivian H. Lyons is with Department of Epidemiology, University of Washington, and Harborview Injury Prevention & Research Center, Seattle
| | - Catherine Barber
- Andrew Conner, Deborah Azrael, Catherine Barber, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Vivian H. Lyons is with Department of Epidemiology, University of Washington, and Harborview Injury Prevention & Research Center, Seattle
| | - Matthew Miller
- Andrew Conner, Deborah Azrael, Catherine Barber, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Vivian H. Lyons is with Department of Epidemiology, University of Washington, and Harborview Injury Prevention & Research Center, Seattle
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Merchant H, Barber C, Barrett G. Anaylsis of an Aquather-assisted swimming service for post-laryngectomy patients. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ashack K, Burton K, Barber C, St. Claire K, Mounessa J, Dunnick C, Norris D, Dellavalle R. Dermatology training across the globe, part II: a summary of the literature. Br J Dermatol 2018; 178:1460-1461. [DOI: 10.1111/bjd.16465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K.A. Ashack
- Department of Dermatology; University of Illinois at Chicago College of Medicine; Chicago IL U.S.A
| | - K.A. Burton
- Department of Dermatology; Colorado School of Public Health; University of Colorado Anschutz Medical Campus; Aurora CO U.S.A
| | - C. Barber
- Michigan State University College of Human Medicine; Grand Rapids MI U.S.A
| | - K. St. Claire
- Department of Dermatology; University of Illinois at Chicago College of Medicine; Chicago IL U.S.A
| | - J. Mounessa
- Department of Dermatology; Colorado School of Public Health; University of Colorado Anschutz Medical Campus; Aurora CO U.S.A
| | - C.A. Dunnick
- Department of Dermatology; Colorado School of Public Health; University of Colorado Anschutz Medical Campus; Aurora CO U.S.A
- Dermatology Service; U.S. Department of Veterans Affairs; Eastern Colorado Health Care System; Denver CO U.S.A
| | - D.A. Norris
- Department of Dermatology; Colorado School of Public Health; University of Colorado Anschutz Medical Campus; Aurora CO U.S.A
| | - R.P. Dellavalle
- Department of Dermatology; Colorado School of Public Health; University of Colorado Anschutz Medical Campus; Aurora CO U.S.A
- Dermatology Service; U.S. Department of Veterans Affairs; Eastern Colorado Health Care System; Denver CO U.S.A
- Department of Epidemiology; Colorado School of Public Health; University of Colorado Anschutz Medical Campus; Aurora CO U.S.A
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Affiliation(s)
- C. Barber
- Michigan State University College of Human Medicine; Grand Rapids MI U.S.A
| | - K. St. Claire
- Department of Dermatology; University of Illinois at Chicago College of Medicine; Chicago IL U.S.A
| | - K.A. Ashack
- Department of Dermatology; University of Illinois at Chicago College of Medicine; Chicago IL U.S.A
| | - R.P. Dellavalle
- Department of Dermatology; University of Colorado Anschutz Medical Campus; Aurora CO U.S.A
- Dermatology Service; U.S. Department of Veterans Affairs; Eastern Colorado Health Care System; 1055 Clermont Street, Box 165 Denver CO 80220 U.S.A
- Department of Epidemiology; Colorado School of Public Health; University of Colorado Anschutz Medical Campus; Aurora CO U.S.A
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Saxena D, Li Y, Devota A, Pushalkar S, Abrams W, Barber C, Corby P, Poles M, Phelan J, Malamud D. Modulation of the orodigestive tract microbiome in HIV-infected patients. Oral Dis 2017; 22 Suppl 1:73-8. [PMID: 27109275 DOI: 10.1111/odi.12392] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
More than 37 million people are living with human immunodeficiency virus 1 (HIV), and more people than ever received lifesaving antiretroviral therapy worldwide. HIV-1 infection disrupts the intestinal immune system, leading to microbial translocation and systemic immune activation. We investigated the impact of HIV-1 infection on the GI microbiome and its association with host immune activation. The data indicated that the microbiome was different in HIV-positive and HIV-negative individuals. The initial sequence analysis of saliva indicated that there were major differences in the phyla of Bacteroidetes, Firmicutes, Proteobacteria, and TM7. Phylum Tenericutes was only seen in HIV-positive saliva. At the family level, we identified differences in Streptococcacea, Prevotellaceae, Porphyromonadaceae, and Neisseriaceae, whereas data from various sites in GI tract indicated that Prevotella melaninigencia, Fusobacterium necrophorum, Burkholderia, Bradyrhizobium, Ralstonia, and Eubacterium biforme were predominant but differentially present at various sites. Furthermore, there was a decrease in seven proteins associated with the alternative complement pathway and an increase in 6 proteins associated with the lectin and classical complement pathways. The correlation with a shift in complement pathways suggests that compromised immunity could be responsible for the observed dysbiosis in the GI microbiome.
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Affiliation(s)
- D Saxena
- Department of Basic Science, New York University College of Dentistry, New York, NY, USA
| | - Y Li
- Department of Basic Science, New York University College of Dentistry, New York, NY, USA
| | - A Devota
- Department of Basic Science, New York University College of Dentistry, New York, NY, USA
| | - S Pushalkar
- Department of Basic Science, New York University College of Dentistry, New York, NY, USA
| | - W Abrams
- Department of Basic Science, New York University College of Dentistry, New York, NY, USA
| | - C Barber
- Department of Basic Science, New York University College of Dentistry, New York, NY, USA
| | - P Corby
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - M Poles
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - J Phelan
- Department of Basic Science, New York University College of Dentistry, New York, NY, USA
| | - D Malamud
- Department of Basic Science, New York University College of Dentistry, New York, NY, USA.,Department of Medicine, New York University School of Medicine, New York, NY, USA
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Gangwar RS, Minai-Fleminger Y, Seaf M, Gutgold A, Shikotra A, Barber C, Chauhan A, Holgate S, Bradding P, Howarth P, Eliashar R, Berkman N, Levi-Schaffer F. CD48 on blood leukocytes and in serum of asthma patients varies with severity. Allergy 2017; 72:888-895. [PMID: 27859399 DOI: 10.1111/all.13082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND CD48 is a membrane receptor (mCD48) on eosinophils and mast cells and exists in a soluble form (sCD48). CD48 has a pivotal role in murine asthma and in the proinflammatory interactions of mast cells with eosinophils via its ligand CD244. Thus, CD48 might be important in human asthma. METHODS Therefore, two separate cohorts (IL and UK) comprising mild, moderate, and severe asthma and healthy volunteers were evaluated for blood leukocyte mCD48 expression and sCD48 in serum. Asthmatic bronchial biopsies were immunostained for CD48. sCD48 effect on CD244-dependent eosinophil activation was evaluated. RESULTS Eosinophil mCD48 expression was significantly elevated in moderate while downregulated in severe asthma. mCD48 expression on B, T, and NK cells and monocytes in severe asthma was significantly increased. sCD48 levels were significantly higher in mild while reduced in severe asthma. sCD48 optimal cutoff values for differentiating asthma from health were identified as >1482 pg/ml (IL) and >1619 pg/ml (UK). In asthmatic bronchial biopsies, mCD48 was expressed predominantly by eosinophils. sCD48 inhibited anti-CD244-induced eosinophil activation. CONCLUSIONS mCD48 and sCD48 are differentially expressed in the peripheral blood of asthma patients of varying severity. sCD48 inhibits CD244-mediated eosinophil activation. These findings suggest that CD48 may play an important role in human asthma.
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Affiliation(s)
- R. S. Gangwar
- Pharmacology & Experimental Therapeutics Unit; Institute for Drug Research; School of Pharmacy; Faculty of Medicine; The Hebrew University of Jerusalem; Jerusalem Israel
| | - Y. Minai-Fleminger
- Pharmacology & Experimental Therapeutics Unit; Institute for Drug Research; School of Pharmacy; Faculty of Medicine; The Hebrew University of Jerusalem; Jerusalem Israel
| | - M. Seaf
- Pharmacology & Experimental Therapeutics Unit; Institute for Drug Research; School of Pharmacy; Faculty of Medicine; The Hebrew University of Jerusalem; Jerusalem Israel
| | - A. Gutgold
- Pharmacology & Experimental Therapeutics Unit; Institute for Drug Research; School of Pharmacy; Faculty of Medicine; The Hebrew University of Jerusalem; Jerusalem Israel
| | - A. Shikotra
- Department of Infection, Immunity and Inflammation; Institute for Lung Health; University of Leicester; Leicester UK
| | - C. Barber
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
- NIHR Respiratory Biomedical Research Unit; Southampton General Hospital; Southampton UK
| | - A. Chauhan
- Portsmouth Hospitals NHS Trust; Portsmouth UK
| | - S. Holgate
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
- NIHR Respiratory Biomedical Research Unit; Southampton General Hospital; Southampton UK
| | - P. Bradding
- Department of Infection, Immunity and Inflammation; Institute for Lung Health; University of Leicester; Leicester UK
| | - P. Howarth
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
- NIHR Respiratory Biomedical Research Unit; Southampton General Hospital; Southampton UK
| | - R. Eliashar
- Department of Otolaryngology/Head and Neck Surgery; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - N. Berkman
- Institute of Pulmonary Medicine; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - F. Levi-Schaffer
- Pharmacology & Experimental Therapeutics Unit; Institute for Drug Research; School of Pharmacy; Faculty of Medicine; The Hebrew University of Jerusalem; Jerusalem Israel
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Przybylak K, Madden J, Covey-Crump E, Gibson L, Barber C, Patel M, Cronin M. Characterisation of data resources for in silico modelling: benchmark datasets for ADME properties. Expert Opin Drug Metab Toxicol 2017; 14:169-181. [DOI: 10.1080/17425255.2017.1316449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- K.R. Przybylak
- School of Pharmacy and Chemistry, Liverpool John Moores University, Liverpool, UK
| | - J.C. Madden
- School of Pharmacy and Chemistry, Liverpool John Moores University, Liverpool, UK
| | | | - L. Gibson
- Lhasa Limited, Granary Wharf House, Leeds, UK
| | - C. Barber
- Lhasa Limited, Granary Wharf House, Leeds, UK
| | - M. Patel
- Lhasa Limited, Granary Wharf House, Leeds, UK
| | - M.T.D. Cronin
- School of Pharmacy and Chemistry, Liverpool John Moores University, Liverpool, UK
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Affiliation(s)
- Catherine Barber
- Department of Health Policy and Management, Harvard Injury Control Research Center's Means Matter Project, Harvard T. H. Chan School of Public Health, Boston, Massachusetts2New Hampshire Firearm Safety Coalition, Concord
| | - Elaine Frank
- Department of Health Policy and Management, Harvard Injury Control Research Center's Means Matter Project, Harvard T. H. Chan School of Public Health, Boston, Massachusetts2New Hampshire Firearm Safety Coalition, Concord
| | - Ralph Demicco
- New Hampshire Firearm Safety Coalition, Concord3Riley's Sport Shop, Hooksett, New Hampshire
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Barber C, Gagnon D, Fonda J, Cho K, Hermos J, Miller M. Assessing the impact of prescribing directives on opioid prescribing practices among Veterans Health Administration providers. Pharmacoepidemiol Drug Saf 2017; 26:40-46. [PMID: 27530106 DOI: 10.1002/pds.4066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/13/2016] [Accepted: 06/28/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE The study aimed to test whether directives on opioid prescribing released by the Veterans Health Administration (VHA) or the Food and Drug Administration (FDA) had an impact on prescribing among VHA providers. METHODS We used the VHA's linked pharmacy and patient medical records database to identify new prescriptions written for propoxyphene, fentanyl, and controlled release (CR) oxycodone between 1/1/2000 and 12/31/2009. We plotted the monthly proportion of these prescriptions that complied with components of four specific safety alerts or directives for these substances issued by the VHA or FDA between 1/1/2001 and 12/31/2008. We modeled compliance using interrupted time series analysis and a generalized additive model with the addition of an indicator variable to flag prescriptions that followed the directive's release date. RESULTS A total of 32.2 million new prescriptions for fentanyl, oxycodone CR, and propoxyphene were written for VHA patients meeting inclusion criteria. Compliance with guidelines in the directives increased steadily throughout the entire study period, with no clinically meaningful inflection point near the date of each directive's release. Generalized additive modeling and interrupted time series analysis found that the indicator flag slightly improved the fit of the data, but visual inspection of the plots revealed no change at a level of practical significance. CONCLUSIONS While prescribing compliance increased throughout the period, release of FDA and VHA alerts and guidelines did not appear to contribute to this change. Given the fivefold increase in the rate of drug-related overdose deaths since 1990, identifying effective methods to communicate safety messages and change prescriber behavior remains a priority for future work. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Catherine Barber
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA, USA
| | - David Gagnon
- VA Boston Healthcare System, Massachusetts Area Veterans Research and Information Center (MAVERIC), Boston, MA, USA
| | - Jennifer Fonda
- VA Boston Healthcare System, Massachusetts Area Veterans Research and Information Center (MAVERIC), Boston, MA, USA
| | - Kelly Cho
- VA Boston Healthcare System, Massachusetts Area Veterans Research and Information Center (MAVERIC), Boston, MA, USA
| | - John Hermos
- VA Boston Healthcare System, Massachusetts Area Veterans Research and Information Center (MAVERIC), Boston, MA, USA
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA, USA
- Department of Health Sciences, Northeastern University, Boston, MA, USA
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Fishwick D, Sen D, Barber C, Bradshaw L, Robinson E, Sumner J. Occupational chronic obstructive pulmonary disease: a standard of care. Occup Med (Lond) 2016; 65:270-82. [PMID: 25972608 DOI: 10.1093/occmed/kqv019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Consistent evidence from population studies report that 10-15% of the total burden of chronic obstructive pulmonary disease (COPD) is associated with workplace exposures. This proportion of COPD could be eliminated if harmful workplace exposures were controlled adequately. AIMS To produce a standard of care for clinicians, occupational health professionals, employers and employees on the identification and management of occupational COPD. METHODS A systematic literature review was used to identify published data on the prevention, identification and management of occupational COPD. Scottish Intercollegiate Guidance Network grading and the Royal College of General Practitioner three star grading system were used to grade the evidence. RESULTS There are a number of specific workplace exposures that are established causes of COPD. Taking an occupational history in patients or workers with possible or established COPD will identify these. Reduction in exposure to vapours, gases, dusts and fumes at work is likely to be the most effective method for reducing occupational COPD. Identification of workers with rapidly declining lung function, irrespective of their specific exposure, is important. Individuals can be identified at work by accurate annual measures of lung function. CONCLUSIONS Early identification of cases with COPD is important so that causality can be considered and action taken to reduce causative exposures thereby preventing further harm to the individual and other workers who may be similarly exposed. This can be achieved using a combination of a respiratory questionnaire, accurate lung function measurements and control of exposures in the workplace.
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Affiliation(s)
- D Fishwick
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK,
| | - D Sen
- Health and Safety Executive, Bootle, Merseyside, UK
| | - C Barber
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK
| | - L Bradshaw
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK
| | - E Robinson
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK
| | - J Sumner
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK
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Azrael D, Mukamal A, Cohen AP, Gunnell D, Barber C, Miller M. Identifying and Tracking Gas Suicides in the U.S. Using the National Violent Death Reporting System, 2005-2012. Am J Prev Med 2016; 51:S219-S225. [PMID: 27745610 DOI: 10.1016/j.amepre.2016.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/28/2016] [Accepted: 08/03/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Identifying the source and specific type of gas used in suicides is difficult using most data systems owing to limitations in ICD-10 coding. The National Violent Death Reporting System (NVDRS), with its rich collection of both coded and free-text variables, has the potential to overcome these limitations. This study used a multipronged approach to identify gas-specific suicides in NVDRS and to track the incidence of these suicides over time. METHODS Using suicide cases from the 16 NVDRS states that participated throughout 2005-2012, free-text and code searches were conducted for four types of variables-incident narratives, coroner/medical examiner cause-of-death statements, cause-of-death codes, and substance names-to identify suicides by carbon monoxide, helium, hydrogen sulfide, and four other gases. All analyses were conducted in 2015. RESULTS Approximately 4% (3,242 of 80,715) of suicides recorded in NVDRS over the study period were the result of gas inhalation. Of these, the majority (73%) were carbon monoxide suicides (almost exclusively from motor vehicle exhaust and charcoal burning). Other types of gas (most notably helium), once rare, are now more common: At the start of the study period non-carbon monoxide gas suicides represented 15% of all gas suicides; at the end of the study period, they represented 40%. CONCLUSIONS Public health policies to reduce a suicidal person's access to more lethal suicide methods require a reliable source of surveillance data on specific methods used in suicide. Small changes to NVDRS could make it an efficient and nimble surveillance system for tracking these deaths.
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Affiliation(s)
- Deborah Azrael
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Bouve School of Health Sciences, Northeastern University, Boston, Massachusetts.
| | - Alexander Mukamal
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Yale College, Yale University, New Haven, Connecticut
| | - Amy P Cohen
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - David Gunnell
- Bouve School of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; School of Social and Community Medicine, Faculty of Medicine and Dentistry, University of Bristol, Bristol, United Kingdom
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Hanser T, Barber C, Marchaland JF, Werner S. Applicability domain: towards a more formal definition. SAR QSAR Environ Res 2016; 27:893-909. [PMID: 27827546 DOI: 10.1080/1062936x.2016.1250229] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/16/2016] [Indexed: 06/06/2023]
Abstract
In recent years the applicability domain (AD) of a prediction system has become an important concern in (Q)SAR modelling, especially in the context of human safety assessment. Today AD is an active research topic, and many methods have been designed to estimate the adequacy of a model and the confidence in its outcome for a given prediction task. Unfortunately, the wide spectrum of techniques developed for this purpose is based on various definitions of the concept of AD, often taking into account different types of information. This variety of methodologies confuses the end users and makes the comparison of the AD for different models almost impossible. In this article, we demonstrate that AD is not a monolithic concept and can be broken down into three well-defined sub-domains assessing confidence at the model, prediction and decision levels, respectively. By leveraging this separation of concerns we have an opportunity to clarify, formalize and extend the definition of AD. We propose a framework that captures this new vision with the aim to initiate a global effort to converge towards a common AD definition within the (Q)SAR community.
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Affiliation(s)
- T Hanser
- a Research Group, Lhasa Limited (UK) , Leeds , UK
| | - C Barber
- a Research Group, Lhasa Limited (UK) , Leeds , UK
| | | | - S Werner
- a Research Group, Lhasa Limited (UK) , Leeds , UK
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Betz ME, Azrael D, Barber C, Miller M. Public Opinion Regarding Whether Speaking With Patients About Firearms Is Appropriate: Results of a National Survey. Ann Intern Med 2016; 165:543-550. [PMID: 27455516 DOI: 10.7326/m16-0739] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Health care providers have been encouraged to discuss firearms with patients; whether patients view these discussions as appropriate is unclear. OBJECTIVE To estimate, in a national sample, the perceived appropriateness of provider discussions about firearms. DESIGN Probability-based online survey conducted in April 2015. Analyses used survey weights to generate nationally representative estimates. SETTING U.S. adults. PARTICIPANTS 3914 English-speaking adults (55% participation rate). MEASUREMENTS Participants were asked, "In general, would you think it is never, sometimes, usually, or always appropriate for physicians and other health professionals to talk to their patients about firearms?" RESULTS A majority (66% [95% CI, 63% to 69%]) of participants said that it is at least sometimes appropriate for providers to talk to patients about firearms. Specifically, 23% (CI, 20% to 25%) said that provider discussions about firearms were always appropriate, 14% (CI, 11% to 16%) said that they were usually appropriate, and 30% (CI, 27% to 33%) thought they were sometimes appropriate; 34% (CI, 31% to 37%) felt that such discussions were never appropriate. Views varied by firearm ownership: 54% (CI, 52% to 57%) of gun owners said that provider discussions are at least sometimes appropriate, compared with 67% (CI, 62% to 71%) of nonowners living with an owner and 70% (CI, 66% to 74%) of nonowners not living with an owner. Firearm owners who were more likely to think that firearm discussions are at least sometimes appropriate included those with children at home (62% [CI, 57% to 67%]), those who thought that having a gun at home increases suicide risk (75% [CI, 67% to 83%), and those who thought that provider discussions of seat belts are at least sometimes appropriate (73% [CI, 70% to 75%]). LIMITATIONS The provider discussion question did not specify clinical context. CONCLUSION Two thirds of non-firearm owners and over one half of firearm owners in the United States believe that health care provider discussions about firearms are at least sometimes appropriate. The observed heterogeneity underscores the need to better understand assumptions that may underlie these views, particularly among firearm owners. PRIMARY FUNDING SOURCE Fund for a Safer Future and Joyce Foundation.
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Affiliation(s)
- Marian E Betz
- From the University of Colorado School of Medicine, Aurora, Colorado, and Injury Control Research Center, Harvard School of Public Health and Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Deborah Azrael
- From the University of Colorado School of Medicine, Aurora, Colorado, and Injury Control Research Center, Harvard School of Public Health and Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Catherine Barber
- From the University of Colorado School of Medicine, Aurora, Colorado, and Injury Control Research Center, Harvard School of Public Health and Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Matthew Miller
- From the University of Colorado School of Medicine, Aurora, Colorado, and Injury Control Research Center, Harvard School of Public Health and Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
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Barber C, Hemenway D, Miller M. How Physicians Can Reduce Suicide-Without Changing Anyone's Mental Health. Am J Med 2016; 129:1016-7. [PMID: 27321974 DOI: 10.1016/j.amjmed.2016.05.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Catherine Barber
- Harvard Injury Control Research Center, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Mass.
| | - David Hemenway
- Harvard Injury Control Research Center, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Mass
| | - Matthew Miller
- Harvard Injury Control Research Center, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Mass; Department of Health Sciences, Northeastern University, Boston, Mass
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Betz ME, Miller M, Barber C, Beaty B, Miller I, Camargo CA, Boudreaux ED. LETHAL MEANS ACCESS AND ASSESSMENT AMONG SUICIDAL EMERGENCY DEPARTMENT PATIENTS. Depress Anxiety 2016; 33:502-11. [PMID: 26989850 PMCID: PMC4800489 DOI: 10.1002/da.22486] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/12/2016] [Accepted: 02/22/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Reducing access to lethal means (especially firearms) might prevent suicide, but counseling of at-risk individuals about this strategy may not be routine. Among emergency department (ED) patients with suicidal ideation or attempts (SI/SA), we sought to describe home firearm access and examine ED provider assessment of access to lethal means. METHODS This secondary analysis used data from the Emergency Department Safety Assessment and Follow-up Evaluation, a three-phase, eight-center study of adult ED patients with SI/SA (2010-2013). Research staff surveyed participants about suicide-related factors (including home firearms) and later reviewed the ED chart (including documented assessment of lethal means access). RESULTS Among 1,358 patients with SI/SA, 11% (95% CI: 10-13%) reported ≥1 firearm at home; rates varied across sites (range: 6-26%) but not over time. On chart review, 50% (95% CI: 47-52%) of patients had documentation of lethal means access assessment. Frequency of documented assessment increased over study phases (40-60%, P < .001) but was not associated with state firearm ownership rates. Among the 337 (25%, 95% CI: 23-27%) patients discharged to home, 55% (95% CI: 49-60%) had no documentation of lethal means assessment; of these, 13% (95% CI: 8-19%; n = 24) actually had ≥1 firearm at home. Among all those reporting ≥1 home firearm to study staff, only half (50%, 95% CI: 42-59%) had provider documentation of assessment of lethal means access. CONCLUSIONS Among these ED patients with SI/SA, many did not have documented assessment of home access to lethal means, including patients who were discharged home and had ≥1 firearm at home.
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Affiliation(s)
- Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine; Aurora, CO
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA
| | - Brenda Beaty
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Edwin D. Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Barber C, Azrael D, Cohen A, Miller M, Thymes D, Wang DE, Hemenway D. Homicides by Police: Comparing Counts From the National Violent Death Reporting System, Vital Statistics, and Supplementary Homicide Reports. Am J Public Health 2016; 106:922-7. [PMID: 26985611 DOI: 10.2105/ajph.2016.303074] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the National Violent Death Reporting System (NVDRS) as a surveillance system for homicides by law enforcement officers. METHODS We assessed sensitivity and positive predictive value of the NVDRS "type of death" variable against our study count of homicides by police, which we derived from NVDRS coded and narrative data for states participating in NVDRS 2005 to 2012. We compared state counts of police homicides from NVDRS, Vital Statistics, and Federal Bureau of Investigation Supplementary Homicide Reports. RESULTS We identified 1552 police homicides in the 16 states. Positive predictive value and sensitivity of the NVDRS "type of death" variable for police homicides were high (98% and 90%, respectively). Counts from Vital Statistics and Supplementary Homicide Reports were 58% and 48%, respectively, of our study total; gaps varied widely by state. The annual rate of police homicide (0.24/100,000) varied 5-fold by state and 8-fold by race/ethnicity. CONCLUSIONS NVDRS provides more complete data on police homicides than do existing systems. POLICY IMPLICATIONS Expanding NVDRS to all 50 states and making 2 improvements we identify will be an efficient way to provide the nation with more accurate, detailed data on homicides by law enforcement.
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Affiliation(s)
- Catherine Barber
- Catherine Barber, Deborah Azrael, Amy Cohen, and David Hemenway are with the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is with the Department of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Deonza Thymes was a master's of public health student at the Harvard T. H. Chan School of Public Health. David Enze Wang is a student at Harvard Medical School, Boston, MA
| | - Deborah Azrael
- Catherine Barber, Deborah Azrael, Amy Cohen, and David Hemenway are with the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is with the Department of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Deonza Thymes was a master's of public health student at the Harvard T. H. Chan School of Public Health. David Enze Wang is a student at Harvard Medical School, Boston, MA
| | - Amy Cohen
- Catherine Barber, Deborah Azrael, Amy Cohen, and David Hemenway are with the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is with the Department of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Deonza Thymes was a master's of public health student at the Harvard T. H. Chan School of Public Health. David Enze Wang is a student at Harvard Medical School, Boston, MA
| | - Matthew Miller
- Catherine Barber, Deborah Azrael, Amy Cohen, and David Hemenway are with the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is with the Department of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Deonza Thymes was a master's of public health student at the Harvard T. H. Chan School of Public Health. David Enze Wang is a student at Harvard Medical School, Boston, MA
| | - Deonza Thymes
- Catherine Barber, Deborah Azrael, Amy Cohen, and David Hemenway are with the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is with the Department of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Deonza Thymes was a master's of public health student at the Harvard T. H. Chan School of Public Health. David Enze Wang is a student at Harvard Medical School, Boston, MA
| | - David Enze Wang
- Catherine Barber, Deborah Azrael, Amy Cohen, and David Hemenway are with the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is with the Department of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Deonza Thymes was a master's of public health student at the Harvard T. H. Chan School of Public Health. David Enze Wang is a student at Harvard Medical School, Boston, MA
| | - David Hemenway
- Catherine Barber, Deborah Azrael, Amy Cohen, and David Hemenway are with the Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Boston, MA. Matthew Miller is with the Department of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Deonza Thymes was a master's of public health student at the Harvard T. H. Chan School of Public Health. David Enze Wang is a student at Harvard Medical School, Boston, MA
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Sanfilippo N, Vasconcelos R, Moya J, Malamud D, Barber C, Smith B, DeLacure M, Kerr R, Schmidt B, Myssiorek D, Corby P. The Effect of an Oral Care Intervention in Decreasing the Expression of Proinflammatory Cytokines in Patients Receiving Chemoradiation for Oral Cancer: A Randomized Clinical Trial. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Runyan CW, Becker A, Brandspigel S, Barber C, Trudeau A, Novins D. Lethal Means Counseling for Parents of Youth Seeking Emergency Care for Suicidality. West J Emerg Med 2016; 17:8-14. [PMID: 26823923 PMCID: PMC4729425 DOI: 10.5811/westjem.2015.11.28590] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/30/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION A youth's emergency department (ED) visit for suicidal behaviors or ideation provides an opportunity to counsel families about securing medications and firearms (i.e., lethal means counseling). METHODS In this quality improvement project drawing on the Counseling on Access to Lethal Means (CALM) model, we trained 16 psychiatric emergency clinicians to provide lethal means counseling with parents of patients under age 18 receiving care for suicidality and discharged home from a large children's hospital. Through chart reviews and follow-up interviews of parents who received the counseling, we examined what parents recalled, their reactions to the counseling session, and actions taken after discharge. RESULTS Between March and July 2014, staff counseled 209 of the 236 (89%) parents of eligible patients. We conducted follow-up interviews with 114 parents, or 55% of those receiving the intervention; 48% of those eligible. Parents had favorable impressions of the counseling and good recall of the main messages. Among the parents contacted at follow up, 76% reported all medications in the home were locked as compared to fewer than 10% at the time of the visit. All who had indicated there were guns in the home at the time of the visit reported at follow up that all were currently locked, compared to 67% reporting this at the time of the visit. CONCLUSION Though a small project in just one hospital, our findings demonstrate the feasibility of adding a counseling protocol to the discharge process within a pediatric psychiatric emergency service. Our positive findings suggest that further study, including a randomized control trial in more facilities, is warranted.
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Affiliation(s)
- Carol W Runyan
- Colorado School of Public Health, Departments of Epidemiology and of Community and Behavioral Health, Program for Injury Prevention, Education and Research, Aurora, Colorado
| | - Amy Becker
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, Colorado
| | - Sara Brandspigel
- Colorado School of Public Health, Program for Injury Prevention, Education and Research, Aurora, Colorado
| | - Catherine Barber
- Harvard University, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Aimee Trudeau
- Colorado Department of Public Health, Denver, Colorado
| | - Douglas Novins
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, Colorado
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Eaden JA, Barber C, Bianchi SM. S111 Does rate of decline in lung function predict response to Pirfenidone therapy in patients with Idiopathic Pulmonary Fibrosis? Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Betz ME, Arias SA, Miller M, Barber C, Espinola JA, Sullivan AF, Manton AP, Miller I, Camargo CA, Boudreaux ED. Change in emergency department providers' beliefs and practices after use of new protocols for suicidal patients. Psychiatr Serv 2015; 66:625-31. [PMID: 25726978 PMCID: PMC4852852 DOI: 10.1176/appi.ps.201400244] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined changes in self-reported attitudes and practices related to suicide risk assessment among providers at emergency departments (EDs) during a three-phase quasi-experimental trial involving implementation of ED protocols for suicidal patients. METHODS A total of 1,289 of 1,828 (71% response rate) eligible providers at eight EDs completed a voluntary, anonymous survey at baseline, after introduction of universal suicide screening, and after introduction of suicide prevention resources (nurses) and a secondary risk assessment tool (physicians). RESULTS Among participants, the median age was 40 years old, 64% were female, and there were no demographic differences across study phases; 68% were nurses, and 32% were attending physicians. Between phase 1 and phase 3, increasing proportions of nurses reported screening for suicide (36% and 95%, respectively, p<.001) and increasing proportions of physicians reported further assessment of suicide risk (63% and 80%, respectively, p<.01). Although increasing proportions of providers said universal screening would result in more psychiatric consultations, decreasing proportions said it would slow down clinical care. Increasing proportions of nurses reported often or almost always asking suicidal patients about firearm access (18%-69%, depending on the case), although these numbers remained low relative to ideal practice. Between 35% and 87% of physicians asked about firearms, depending on the case, and these percentages did not change significantly over the study phases. CONCLUSIONS These findings support the feasibility of implementing universal screening for suicide in EDs, assuming adequate resources, but providers should be educated to ask suicidal patients about firearm access.
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Affiliation(s)
- Marian E Betz
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Sarah A Arias
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Matthew Miller
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Catherine Barber
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Janice A Espinola
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Ashley F Sullivan
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Anne P Manton
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Ivan Miller
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Carlos A Camargo
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Edwin D Boudreaux
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
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Vriniotis M, Barber C, Frank E, Demicco R. A suicide prevention campaign for firearm dealers in New Hampshire. Suicide Life Threat Behav 2015; 45:157-63. [PMID: 25348506 DOI: 10.1111/sltb.12123] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/16/2014] [Indexed: 11/30/2022]
Abstract
A spate of suicides involving a just-purchased firearm led a statewide coalition of firearm dealers, firearm rights advocates, and suicide prevention professionals to discuss the role of gun shops in preventing suicide. The group developed and mailed materials for (1) firearm retailers on avoiding sales to suicidal customers and (2) their customers on suicide and firearm safety. All storefront retailers were identified (n = 65), visited unannounced 6 months after receiving materials, and asked to complete a survey. Nearly half (48%) had at least one campaign product on display. Belief that reducing a suicidal person's access to firearms might save a life was associated with displaying materials (69% vs. 41%, p = .06). Public health and gun groups can successfully collaborate on suicide prevention activities.
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Affiliation(s)
- Mary Vriniotis
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA, USA
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Barber C, Wiggans R, Fishwick D. S4 Relationship Between Historic Uk Asbestos Imports And Annual Mortality Due To Mesothelioma, Asbestosis And Idiopathic Pulmonary Fibrosis. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- Catherine Barber
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA 02115, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA 02115, USA
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Opoliner A, Azrael D, Barber C, Fitzmaurice G, Miller M. Explaining geographic patterns of suicide in the US: the role of firearms and antidepressants. Inj Epidemiol 2014; 1:6. [PMID: 27747669 PMCID: PMC5005708 DOI: 10.1186/2197-1714-1-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/10/2014] [Indexed: 12/04/2022] Open
Abstract
Background Suicide rates vary more than 3-fold across the fifty states. Previous ecological studies have pointed, separately, to covariation of suicide mortality with rates of a) household firearm ownership, and b) antidepressant prescriptions. Methods An ecologic study using panel data from 2001-2005 was used to evaluate the joint and separate association of household firearm ownership and antidepressant prescription rates with the distribution of suicide rates across the United States. Key exposures were household firearm ownership prevalence (using data from the 2004 Behavioral Risk Factor Surveillance System) and antidepressant prescription rates (using data supplied by IMS health). Negative binomial mixed-effect models were used to estimate the association between household firearm ownership prevalence and antidepressant prescriptions rates and state level suicide rates (using data from the National Vital Statistics System), overall and by method of suicide (firearm vs. non-firearm). Sensitivity analyses examined analogous county-level data for those counties for which firearm ownership measures were available. All analyses were adjusted for median income, unemployment rate, and percent of population in urban areas. Results In adjusted analyses, household firearm prevalence is significantly associated with overall suicide rates (adjusted incidence rate ratio (IRRa) = 1.28, 95% confidence interval (CI): 1.18, 1.38) and firearm suicides rates (IRRa = 1.61, CI: 1.45, 1.80), but not with non-firearm suicide rates (IRRa = 1.05, 95% CI: 0.95, 1.16). By contrast, adjusted analyses find no relationship between suicide rates and antidepressant prescription rates. Findings from county-level analyses were consistent with state-level results. Conclusion The prevalence of household firearm ownership is strongly and significantly associated with overall suicide rates, due to its association with firearm suicide rates. This association is robust to consideration of the role of antidepressant prescription rates. A relationship between antidepressant prescription rates and suicide rates was not observed before or after adjusting for firearm ownership.
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Affiliation(s)
- April Opoliner
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Deborah Azrael
- Department of Health Policy and Management and Harvard Injury Control Research Center, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Catherine Barber
- Department of Health Policy and Management and Harvard Injury Control Research Center, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Garrett Fitzmaurice
- Department of Biostatistics, Harvard School of Public Health, McLean Hospital, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Matthew Miller
- Department of Health Policy and Management and Harvard Injury Control Research Center, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
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Miller M, Azrael D, Barber C, Bossarte R. Losing the forest for the trees. Am J Public Health 2014; 104:e1. [PMID: 24625158 DOI: 10.2105/ajph.2013.301843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Matthew Miller
- Matthew Miller, Deborah Azrael, and Catherine Barber are with the Harvard Injury Control Research Center, Boston, MA. Matthew Miller is also with the Department of Health Policy and Management, Harvard School of Public Health, Boston. Robert Bossarte is with the Center of Excellence for Suicide Prevention, Veterans Affairs Medical Center, Canandaigua, NY
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Betz ME, Miller M, Barber C, Miller I, Sullivan AF, Camargo CA, Boudreaux ED. Lethal means restriction for suicide prevention: beliefs and behaviors of emergency department providers. Depress Anxiety 2013; 30:1013-20. [PMID: 23495002 PMCID: PMC4347862 DOI: 10.1002/da.22075] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/27/2012] [Accepted: 01/21/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We sought to examine the beliefs and behaviors of emergency department (ED) providers related to preventing suicide by reducing suicidal patients' access to lethal methods (means restriction) and identify characteristics associated with asking patients about firearm access. METHODS Physicians and nurses at eight EDs completed a confidential, voluntary survey. RESULTS The response rate was 79% (n = 631); 57% of respondents were females and 49% were nurses. Less than half believed, "most" or "all" suicides are preventable. More nurses (67%) than physicians (44%) thought "most" or "all" firearm suicide decedents would have died by another method had a firearm been unavailable (P < .001). The proportion of providers who reported they "almost always" ask suicidal patients about firearm access varied across five patient scenarios: suicidal with firearm suicide plan (64%), suicidal with no suicide plan (22%), suicidal with nonfirearm plan (21%), suicidal in past month but not today (16%), and overdosed but no longer suicidal (9%). In multivariable logistic regression, physicians were more likely than nurses to "almost always" or "often" ask about a firearm across all five scenarios, as were older providers and those who believed their own provider type was responsible for assessing firearm access. CONCLUSIONS Many ED providers are skeptical about the preventability of suicide and the effectiveness of means restriction, and most do not assess suicidal patients' firearm access except when a patient has a firearm suicide plan. These findings suggest the need for targeted staff education concerning means restriction for suicide prevention.
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Affiliation(s)
- Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine; Denver, Colorado
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts
| | | | - Ashley F. Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Edwin D. Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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