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Stanley IH, Knoepke CE, Hom MA, Wright A, Betz ME. Emergency medical services (EMS) clinicians' awareness of extreme risk protection orders. Gen Hosp Psychiatry 2024; 88:86-87. [PMID: 38448349 DOI: 10.1016/j.genhosppsych.2024.02.013] [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: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Ian H Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO, USA; Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Christopher E Knoepke
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, CO, USA; Division of Cardiology, School of Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Melanie A Hom
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Angela Wright
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, CO, USA
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Richards JA, Kuo E, Stewart C, Shulman L, Parrish R, Whiteside U, Boggs JM, Simon GE, Rowhani-Rahbar A, Betz ME. Reducing Firearm Access for Suicide Prevention: Implementation Evaluation of the Web-Based "Lock to Live" Decision Aid in Routine Health Care Encounters. JMIR Med Inform 2024; 12:e48007. [PMID: 38647319 PMCID: PMC11063417 DOI: 10.2196/48007] [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: 04/07/2023] [Revised: 10/12/2023] [Accepted: 02/27/2024] [Indexed: 04/25/2024] Open
Abstract
Background "Lock to Live" (L2L) is a novel web-based decision aid for helping people at risk of suicide reduce access to firearms. Researchers have demonstrated that L2L is feasible to use and acceptable to patients, but little is known about how to implement L2L during web-based mental health care and in-person contact with clinicians. Objective The goal of this project was to support the implementation and evaluation of L2L during routine primary care and mental health specialty web-based and in-person encounters. Methods The L2L implementation and evaluation took place at Kaiser Permanente Washington (KPWA)-a large, regional, nonprofit health care system. Three dimensions from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model-Reach, Adoption, and Implementation-were selected to inform and evaluate the implementation of L2L at KPWA (January 1, 2020, to December 31, 2021). Electronic health record (EHR) data were used to purposefully recruit adult patients, including firearm owners and patients reporting suicidality, to participate in semistructured interviews. Interview themes were used to facilitate L2L implementation and inform subsequent semistructured interviews with clinicians responsible for suicide risk mitigation. Audio-recorded interviews were conducted via the web, transcribed, and coded, using a rapid qualitative inquiry approach. A descriptive analysis of EHR data was performed to summarize L2L reach and adoption among patients identified at high risk of suicide. Results The initial implementation consisted of updates for clinicians to add a URL and QR code referencing L2L to the safety planning EHR templates. Recommendations about introducing L2L were subsequently derived from the thematic analysis of semistructured interviews with patients (n=36), which included (1) "have an open conversation," (2) "validate their situation," (3) "share what to expect," (4) "make it accessible and memorable," and (5) "walk through the tool." Clinicians' interviews (n=30) showed a strong preference to have L2L included by default in the EHR-based safety planning template (in contrast to adding it manually). During the 2-year observation period, 2739 patients reported prior-month suicide attempt planning or intent and had a documented safety plan during the study period, including 745 (27.2%) who also received L2L. Over four 6-month subperiods of the observation period, L2L adoption rates increased substantially from 2% to 29% among primary care clinicians and from <1% to 48% among mental health clinicians. Conclusions Understanding the value of L2L from users' perspectives was essential for facilitating implementation and increasing patient reach and clinician adoption. Incorporating L2L into the existing system-level, EHR-based safety plan template reduced the effort to use L2L and was likely the most impactful implementation strategy. As rising suicide rates galvanize the urgency of prevention, the findings from this project, including L2L implementation tools and strategies, will support efforts to promote safety for suicide prevention in health care nationwide.
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Affiliation(s)
- Julie Angerhofer Richards
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Elena Kuo
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Christine Stewart
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Lisa Shulman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Rebecca Parrish
- Department of Mental Health & Wellness, Kaiser Permanente Washington, Seattle, WA, United States
| | - Ursula Whiteside
- NowMattersNow.org, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, United States
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Department of Mental Health & Wellness, Kaiser Permanente Washington, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
- Firearm Injury and Policy Research Program, University of Washington, Seattle, WA, United States
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Walsh A, Ghahramanlou-Holloway M, Stanley IH, Betz ME, Heintz Morrissey B, Godin S, Morgenstein J, LaCroix J, Cobb E, Grammer J, Button CJ. Firearm leadership: Development, analysis, and application of a novel concept to message secure storage of firearms in the military. Mil Psychol 2024:1-7. [PMID: 38592404 DOI: 10.1080/08995605.2024.2336641] [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: 11/02/2023] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
Suicide remains a leading cause of death in the United States (U.S.) Armed Forces. Access to firearms increases the risk of death by suicide due to the high lethality of firearm-related injuries (~90% in suicide attempts) and the highly dynamic nature of suicide which includes rapid change from low- to high-risk states. Critical gaps remain in research, programming, and communication amongst scientists, Department of Defense (DoD) programmatic leaders, front-line commanders, and service members. To enhance communication and coordination, in June 2022, the first-ever national "Firearm Suicide Prevention in the Military: Messaging and Interventions Summit" was held, with discussion of Firearm Leadership, a concept that emphasizes the importance of communication about lethal means safety (LMS) among military leaders and service members. Through a discussion of scientific literature, the points identified during the Summit, as well as presenting illustrative case examples derived from suicide death reviews, we aim to provide a conceptual model for the benefits of Firearm Leadership and how some barriers can be overcome. Following the Summit, further discussions on "Firearm Leadership" led to the development of a Firearm Leadership Factsheet.
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Affiliation(s)
- Adam Walsh
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Ian H Stanley
- Department of Emergency Medicine, Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, Colorado
| | - Marian E Betz
- Department of Emergency Medicine, Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado
| | - Brooke Heintz Morrissey
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shira Godin
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Joshua Morgenstein
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jessica LaCroix
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Erin Cobb
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Joseph Grammer
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Fowler NR, Johnson RL, Peterson R, Schroeder MW, Omeragic F, DiGuiseppi C, Han SD, Hill L, Betz ME. Relationship of Decisional Conflict About Driving Habits Between Older Adult Drivers and Their Family Members and Close Friends. J Appl Gerontol 2024; 43:454-464. [PMID: 38087851 PMCID: PMC10922263 DOI: 10.1177/07334648231211742] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
This study examines the relationship of decisional conflict about driving habits between older adult drivers (≥70 years old) and their family members and close friends. This secondary analysis utilizes data originating from a multi-site randomized controlled trial assessing the effect of a driving decision aid (DDA) intervention. Decisional conflict about stopping or changing driving habits for drivers was measured with the Decisional Conflict Scale (DCS). Dyadic associations between drivers' and study partners' (SPs') DCS scores were analyzed using an actor-partner interdependence model. Among 228 driver-SP dyads, Dyadic DCS was correlated at baseline (r = .18, p < .01), and pre-intervention DCS was associated with post-intervention DCS (p < .001 for SPs [β = .73] and drivers [β = .73]). Drivers' baseline DCS and SPs' post-intervention DCS were slighly correlated (β = .10; p = .036). Higher decisional conflict about driving among older drivers is frequently shared by their SPs. Shared decisional conflict may persist beyond intervening to support decision-making about driving cessation.
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Affiliation(s)
- Nicole R. Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Rachel L. Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ryan Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Faris Omeragic
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - S. Duke Han
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Linda Hill
- School of Public Health, University of California San Diego, San Diego, California, USA
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
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Knoepke CE, Barnard LM, Batta N, McCarthy M, Thies K, Olivencia C, Robinson C, Kettering S, Huss S, Betz ME. Petitions for Extreme Risk Protection Orders and Second Amendment Sanctuary Status in Colorado. JAMA Netw Open 2024; 7:e244381. [PMID: 38558140 PMCID: PMC10985551 DOI: 10.1001/jamanetworkopen.2024.4381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 09/21/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024] Open
Abstract
Importance Extreme risk protection orders (ERPOs) temporarily bar individuals adjudicated as being at risk of violence (including suicide) from buying or possessing firearms. In protest, many US jurisdictions have declared themselves "Second Amendment sanctuaries" (2A sanctuaries). Many 2A sanctuaries continue to use ERPOs in low numbers, suggesting a poorly defined risk threshold at which they are acceptable. Objective To characterize circumstances under which ERPOs are used in 2A sanctuaries, highlighting their most broadly acceptable applications. Design, Setting, and Participants This cross-sectional study of civil court documents analyzed petitions for ERPOs filed in Colorado from January 2020 to December 2022. All petitions during the study period were included following de-duplication. These include petitions filed by law enforcement and family members against adults allegedly at risk of firearm violence across the state. Data were analyzed on a rolling basis between January 2020 and June 2023. Exposure ERPO petition filed in Colorado. Main Outcomes and Measures Seventy-seven data elements defined a priori were abstracted from all petitions and case files, including respondent demographics, petitioner types (family or law enforcement), types of threats (self, other, mass violence, combination), violence risk factors, and case outcomes (granted, denied). Results Of a total 338 ERPOs filed in Colorado, 126 (37.3%) occurred in 2A sanctuaries. Sixty-one of these 2A petitions were granted emergency orders, and 40 were full 1-year ERPOs after a hearing. Forty ERPOs (31.7%) were petitioned for by law enforcement. Petitions in non-2A counties were more likely to have been filed by law enforcement (138 of 227 [64.9%] vs 40 of 126 [31.7%]; P < .001) and to have had an emergency order granted (177 of 227 [78.0%] vs 61 of 126 [48.4%]; P < .001) than in 2A sanctuaries. Qualitative analysis of cases in 2A sanctuaries revealed common aggravating risk characteristics, including respondents experiencing hallucinations, histories of police interaction, and substance misuse. ERPOs have been granted in 2A sanctuaries against individuals threatening all forms of violence we abstracted for (themselves, others, and mass violence). Conclusions and Relevance In this examination of ERPO petitions across Colorado, more than a third of filings occurred in 2A sanctuaries. Nonetheless, law enforcement represent proportionately fewer petitions in these areas, and petitions are less likely to be granted. Serious mental illness, substance misuse, and prior interactions with law enforcement featured prominently in 2A sanctuary petitions. These case circumstances highlight dangerous situations in which ERPOs are an acceptable risk-prevention tool, even in areas politically predisposed to opposing them.
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Affiliation(s)
- Christopher E. Knoepke
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora
- Division of Cardiology, University of Colorado School of Medicine, Aurora
- Adult and Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora
| | - Leslie M. Barnard
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora
- Department of Epidemiology, University of Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Injury and Violence Prevention Center, University of Colorado School of Medicine and University of Colorado School of Public Health, Aurora
| | - Nisha Batta
- Injury and Violence Prevention Center, University of Colorado School of Medicine and University of Colorado School of Public Health, Aurora
| | - Megan McCarthy
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora
- Department of Epidemiology, University of Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Injury and Violence Prevention Center, University of Colorado School of Medicine and University of Colorado School of Public Health, Aurora
| | - Kimberly Thies
- Injury and Violence Prevention Center, University of Colorado School of Medicine and University of Colorado School of Public Health, Aurora
| | - Christian Olivencia
- Adult and Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora
| | - Caitlin Robinson
- Injury and Violence Prevention Center, University of Colorado School of Medicine and University of Colorado School of Public Health, Aurora
| | | | - Sheila Huss
- School of Public Affairs, University of Colorado, Denver
| | - Marian E. Betz
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora
- Injury and Violence Prevention Center, University of Colorado School of Medicine and University of Colorado School of Public Health, Aurora
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
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Isom CA, Baird S, Betz ME, DiGuiseppi CG, Eby DW, Li G, Lee KC, Molnar LJ, Moran R, Strogatz D, Hill L. Association of Depression and Antidepressant Use With Driving Behaviors in Older Adults: A LongROAD Study. J Appl Gerontol 2024:7334648241238313. [PMID: 38477230 DOI: 10.1177/07334648241238313] [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] [Indexed: 03/14/2024] Open
Abstract
Older adults aged 70 and older who drive have higher crash death rates per mile driven compared to middle aged (35-54 years) adults who drive in the US. Prior studies have found that depression and or antidepressant medication use in older adults are associated with an increase in the vehicular crash rate. Using data from the prospective multi-site AAA Longitudinal Research on Aging Drivers Study, this analysis examined the independent and interdependent associations of self-reported depression and antidepressant use with driving behaviors that can increase motor vehicle crash risk such as hard braking, speeding, and night-time driving in adults over age 65. Of the 2951 participants, 6.4% reported having depression and 21.9% were on an antidepressant medication. Correcting for age, race, gender, and education level, participants on an antidepressant had increased hard braking events (1.22 [1.10-1.34]) but self-reported depression alone was not associated with changes in driving behaviors.
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Affiliation(s)
- Chelsea A Isom
- Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Sara Baird
- Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
| | - Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David W Eby
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA
| | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kelly C Lee
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA, USA
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA
| | - Ryan Moran
- Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, San Diego, CA, USA
| | - David Strogatz
- Bassett Healthcare Network, Bassett Research Institute, Cooperstown, NY, USA
| | - Linda Hill
- Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, San Diego, CA, USA
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DiGuiseppi CG, Johnson RL, Betz ME, Hill LL, Eby DW, Jones VC, Mielenz TJ, Molnar LJ, Strogatz D, Li G. Migraine headaches are associated with motor vehicle crashes and driving habits among older drivers: Prospective cohort study. J Am Geriatr Soc 2024; 72:791-801. [PMID: 38133994 PMCID: PMC11045178 DOI: 10.1111/jgs.18719] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/14/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Migraine headache is common in older adults, often causing symptoms that may affect driving safety. This study examined associations of migraine with motor vehicle crashes (MVCs) and driving habits in older drivers and assessed modification of associations by medication use. METHODS In a multi-site, prospective cohort study of active drivers aged 65-79 (53% female), we assessed prevalent migraine (i.e., ever had migraine, reported at enrollment), incident migraine (diagnosis first reported at a follow-up visit), and medications typically used for migraine prophylaxis and treatment. During 2-year follow-up, we recorded self-reported MVCs and measured driving habits using in-vehicle GPS devices. Associations of prevalent migraine with driving outcomes were estimated in multivariable mixed models. Using a matched design, associations of incident migraine with MVCs in the subsequent year were estimated with conditional logistic regression. Interactions between migraine and medications were tested in all models. RESULTS Of 2589 drivers, 324 (12.5%) reported prevalent migraine and 34 (1.3%) incident migraine. Interactions between migraine and medications were not statistically significant in any models. Prevalent migraine was not associated with MVCs in the subsequent 2 years (adjusted OR [aOR] = 0.98; 95% CI: 0.72, 1.35), whereas incident migraine significantly increased the odds of having an MVC within 1 year (aOR = 3.27; 1.21, 8.82). Prevalent migraine was associated with small reductions in driving days and trips per month and increases in hard braking events in adjusted models. CONCLUSION Our results suggest substantially increased likelihood of MVCs in the year after newly diagnosed migraine, indicating a potential need for driving safety interventions in these patients. We found little evidence for MVC risk or substantial changes in driving habits associated with prevalent migraine. Future research should examine timing, frequency, and severity of migraine diagnosis and symptoms, and use of medications specifically prescribed for migraine, in relation to driving outcomes.
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Affiliation(s)
- Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Linda L Hill
- School of Public Health, University of California San Diego, La Jolla, California, USA
| | - David W Eby
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
| | - Vanya C Jones
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thelma J Mielenz
- Center for Injury Science and Prevention, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
| | | | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Stanley IH, Anestis MD, Bryan CJ, Moceri-Brooks J, Baker JC, Buck-Atkinson J, Bryan AO, Johnson M, Hunter K, Johnson RL, Xiao M, Betz ME. Project Safe Guard: Challenges and opportunities of a universal rollout of peer-delivered lethal means safety counseling at a US military installation. Suicide Life Threat Behav 2024. [PMID: 38380441 DOI: 10.1111/sltb.13050] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
INTRODUCTION The US Department of Defense recommends lethal means safety counseling (LMSC) to promote firearm injury prevention via secure storage of personal firearms. We describe the rollout of a universal, peer-delivered adaptation of Project Safe Guard (PSG)-a brief, single-session LMSC discussion-at a US Space Force installation. METHOD Program evaluation data were collected via anonymous, voluntary, and online surveys. Of approximately 862 eligible active-duty service members and embedded civilians, 324 completed the preprogram survey and 68 and 37 completed the 1- and 2-month follow-ups, respectively. RESULTS At preprogram, 69.1% agreed that peer-delivered LMSC is appropriate. After rollout, 100% of the 222 firearm locking devices available to service members were requested from the on-base Violence Prevention Integrator. The effectiveness of PSG was indeterminable due to the low survey response rates. CONCLUSIONS Despite strong preprogram support for peer-delivered LMSC and behavioral indicators of secure firearm storage (e.g., firearm locking device requests), several challenges limited the uptake and evaluability of the PSG program in this naturalistic environment, including military survey fatigue and competing mission priorities. Additional work is needed to determine the effectiveness of peer-delivered LMSC in a military context. Sustained base support and military-civilian collaborations will be critical.
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Affiliation(s)
- Ian H Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for COMBAT Research, University of Colorado School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
| | - Jayna Moceri-Brooks
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Justin C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jessica Buck-Atkinson
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - AnnaBelle O Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Megan Johnson
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Mengli Xiao
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
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Kennedy SR, Buck-Atkinson J, Moceri-Brooks J, Johnson ML, Anestis MD, Carrington M, Baker JC, Fisher ME, Nease DE, Bryan AO, Bryan CJ, Betz ME. Military community engagement to prevent firearm-related violence: adaptation of project safe guard for service members. Inj Epidemiol 2024; 11:7. [PMID: 38355727 PMCID: PMC10867994 DOI: 10.1186/s40621-024-00490-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Suicide, especially by firearm, remains a leading cause of death in military populations in the USA. Reducing access to firearms, especially during high risk times, may help prevent suicide and other forms of violence. The purpose of this study was to adapt a promising existing lethal means safety intervention (Project Safe Guard, PSG) for cross-cutting violence prevention and peer support in active-duty service communities using community engagement methods. METHODS A two-pronged community-engaged research approach was employed, including the Community Translation (CT) process that engaged 15 Service Members from one installation to help adapt PSG successfully. In addition, qualitative data was collected from 40 active-duty service members and military violence prevention specialists through in-depth interviews and focus group discussions. RESULTS Qualitative data and CT feedback led to site-specific PSG adaptations. Participants emphasized the importance of peer-to-peer discussions and highlighted resource allocation, leadership support, and stigma on firearm ownership as potential implementation challenges. CONCLUSIONS Findings demonstrate the feasibility of community-engaged research to adapt lethal means safety interventions within military populations. PSG implementation should consider resource allocation, leadership support, and addressing stigma. This study has implications for future policies and standards for performing research on sensitive topics, particularly among military populations.
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Affiliation(s)
- S Rachel Kennedy
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E 17th Ave B-215, Aurora, CO, 80045, USA
- Firearm Injury Prevention Initiative, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
- Injury and Violence Prevention Center, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Jessica Buck-Atkinson
- Firearm Injury Prevention Initiative, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
- Injury and Violence Prevention Center, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Jayna Moceri-Brooks
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
| | - Megan L Johnson
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E 17th Ave B-215, Aurora, CO, 80045, USA
| | - Michael D Anestis
- Firearm Injury Prevention Initiative, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
| | - Makala Carrington
- Injury and Violence Prevention Center, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Justin C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 1670 Upham Drive, Suite 130, Columbus, OH, 43210, USA
| | - Mary E Fisher
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Colorado Clinical and Translational Sciences Institute, Community Engagement and Health Equity, University of Colorado Anschutz Medical Campus, 1890 N Revere Ct, Campus Box B141, Aurora, CO, 80045, USA
| | - Donald E Nease
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Colorado Clinical and Translational Sciences Institute, Community Engagement and Health Equity, University of Colorado Anschutz Medical Campus, 1890 N Revere Ct, Campus Box B141, Aurora, CO, 80045, USA
| | - AnnaBelle O Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 1670 Upham Drive, Suite 130, Columbus, OH, 43210, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 1670 Upham Drive, Suite 130, Columbus, OH, 43210, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E 17th Ave B-215, Aurora, CO, 80045, USA.
- Firearm Injury Prevention Initiative, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
- Injury and Violence Prevention Center, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA.
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Boggs JM, Quintana LM, Beck A, Clarke CL, Richardson L, Conley A, Buckingham ET, Richards JE, Betz ME. A Randomized Control Trial of a Digital Health Tool for Safer Firearm and Medication Storage for Patients with Suicide Risk. Prev Sci 2024; 25:358-368. [PMID: 38206548 DOI: 10.1007/s11121-024-01641-6] [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] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Most patients with suicide risk do not receive recommendations to reduce access to lethal means due to a variety of barriers (e.g., lack of provider time, training). Determine if highly efficient population-based EHR messaging to visit the Lock to Live (L2L) decision aid impacts patient-reported storage behaviors. Randomized trial. Integrated health care system serving Denver, CO. Served by primary care or mental health specialty clinic in the 75-99.5th risk percentile on a suicide attempt or death prediction model. Lock to Live (L2L) is a web-based decision aid that incorporates patients' values into recommendations for safe storage of lethal means, including firearms and medications. Anonymous survey that determined readiness to change: pre-contemplative (do not believe in safe storage), contemplative (believe in safe storage but not doing it), preparation (planning storage changes) or action (safely storing). There were 21,131 patients randomized over a 6-month period with a 27% survey response rate. Many (44%) had access to a firearm, but most of these (81%) did not use any safe firearm storage behaviors. Intervention patients were more likely to be categorized as preparation or action compared to controls for firearm storage (OR = 1.30 (1.07-1.58)). When examining action alone, there were no group differences. There were no statistically significant differences for any medication storage behaviors. Selection bias in those who responded to survey. Efficiently sending an EHR invitation message to visit L2L encouraged patients with suicide risk to consider safer firearm storage practices, but a stronger intervention is needed to change storage behaviors. Future studies should evaluate whether combining EHR messaging with provider nudges (e.g., brief clinician counseling) changes storage behavior.ClinicalTrials.gov: NCT05288517.
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Affiliation(s)
- Jennifer M Boggs
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA.
| | - LeeAnn M Quintana
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA
| | - Christina L Clarke
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA
| | - Laura Richardson
- Department of Behavioral Health Services, Kaiser Permanente Colorado, 10350 E Dakota Ave. #125, Denver, CO, 80247, USA
| | - Amy Conley
- Department of Behavioral Health Services, Kaiser Permanente Colorado, 10350 E Dakota Ave. #125, Denver, CO, 80247, USA
| | - Edward T Buckingham
- Department of Behavioral Health Services, Kaiser Permanente Colorado, 10350 E Dakota Ave. #125, Denver, CO, 80247, USA
- Colorado Permanente Medical Group, Kaiser Permanente Colorado, 1835 Franklin St., Denver, CO, 80218, USA
| | - Julie E Richards
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Seattle, WA, 98101, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, 12505 E. 16th Ave., Anschutz Inpatient Pav. 2, 1st floor, Aurora, CO, 80045, USA
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Betz ME, Meza K, Friedman K, Moceri-Brooks J, Johnson ML, Simonetti J, Baker JC, Bryan CJ, Anestis MD. 'Whether it's your weapon or not, it's your home': US military spouse perspectives on personal firearm storage. BMJ Mil Health 2023:e002591. [PMID: 38135459 DOI: 10.1136/military-2023-002591] [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: 10/05/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION In the USA, an estimated 45% of veterans personally own firearms. Firearm access increases the risk of suicide, so suicide prevention efforts in the US Department of Defense (DoD) focus on lethal means safety, including reducing firearm access. Spouse input may enhance effective messaging and intervention delivery of lethal means safety. This study used qualitative methods to explore the perspectives of military spouses or partners on personal firearm storage, including at-home decisions, on-base storage and existing messaging from the DoD. MATERIALS AND METHODS Qualitative data were obtained using 1:1 interviews and focus groups with spouses/partners of US military service members (active duty, Reserve, National Guard, recently separated from the military) and representatives from military support organisations. Sessions focused on personal firearm storage (at home or on military installations) and military messaging around secure firearm storage and firearm suicide prevention. Data were analysed using a team-based, mixed deductive-inductive approach. RESULTS Across 56 participants (August 2022-March 2023), the themes were variability in current home firearm storage and spousal participation in decision-making; uncertainty about firearm storage protocols on military installations; mixed awareness of secure firearm storage messaging from the military; and uncertainty about procedures or protocols for removing firearm access for an at-risk person. CONCLUSION US military spouses are important messengers for firearm safety and suicide prevention, but they are currently underutilised. Tailored prevention campaigns should consider spousal dynamics and incorporate education about installation procedures.
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Affiliation(s)
- Marian E Betz
- Department Emergency Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - K Meza
- Department Emergency Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - K Friedman
- Department Emergency Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - J Moceri-Brooks
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - M L Johnson
- Department Emergency Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - J Simonetti
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Veterans Health Administration, Aurora, Colorado, USA
| | - J C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - C J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, New York, USA
| | - M D Anestis
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Piscataway, New Jersey, USA
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12
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Liang Z, Chihuri S, Andrews HF, Betz ME, DiGuiseppi C, Eby DW, Hill LL, Jones V, Mielenz TJ, Molnar LJ, Strogatz D, Li G. Interaction between benzodiazepines and prescription opioids on incidence of hard braking events in older drivers. J Am Geriatr Soc 2023; 71:3744-3754. [PMID: 37566203 DOI: 10.1111/jgs.18544] [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] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Polypharmacy use among older adults is of increasing concern for driving safety. This study assesses the individual and joint effects of benzodiazepines and prescription opioids on the incidence of hard braking events in older drivers. METHODS Data for this study came from the Longitudinal Research on Aging Drivers project-a multisite, prospective cohort study of 2990 drivers aged 65-79 years at enrollment (2015-2017). Adjusted incidence rate ratios (aIRRs) and 95% confidence intervals (CIs) of hard braking events (defined as maneuvers with deceleration rates ≥0.4 g and commonly known as near-crashes) were estimated through multivariable negative binominal modeling. RESULTS Of the 2929 drivers studied, 167 (5.7%) were taking benzodiazepines, 163 (5.6%) prescription opioids, and 23 (0.8%) both drugs at baseline. The incidence rates of hard braking events per 1000 miles driven were 1.14 (95% CI 1.10-1.18) for drivers using neither benzodiazepines nor prescription opioids, 1.25 (95% CI 1.07-1.43) for those using benzodiazepines only, 1.55 (95% CI 1.35-1.76) for those using prescription opioids only, and 1.63 (95% CI 1.11-2.16) for those using both medications. Multivariable modeling revealed that the use of prescription opioids was associated with a 19% increased risk of hard braking events (aIRR 1.19, 95% CI 1.03-1.36). There existed a positive interaction between the two drugs on the additive scale but not on the multiplicative scale. CONCLUSION Concurrent use of benzodiazepines and prescription opioids by older drivers appears to affect driving safety through increased incidence of hard braking events.
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Affiliation(s)
- Zipei Liang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Stanford Chihuri
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Howard F Andrews
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David W Eby
- University of Michigan Transportation Research Institute, College of Engineering, Ann Arbor, Michigan, USA
| | - Linda L Hill
- School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Vanya Jones
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thelma J Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Center for Injury Science and Prevention, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, College of Engineering, Ann Arbor, Michigan, USA
| | - David Strogatz
- Bassett Research Institute, Bassett Healthcare Network, Cooperstown, New York, USA
| | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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13
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Villarreal RI, Stanley IH, Anestis MD, Buck-Atkinson J, Betz ME. Older Adults' Preferences Regarding Firearm Locking Device Use: Results of a National Survey. Clin Gerontol 2023:1-11. [PMID: 37994864 DOI: 10.1080/07317115.2023.2285994] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVES Use of firearm locking devices may reduce the risk of suicide and injury among older adults. This study describes older adults' preferences when choosing a firearm locking device. METHODS We conducted a secondary analysis of a nationally representative survey of US adult firearm owners (N = 2,152). We compared older adults (≥65y) with relatively younger adults (<65y), stratified by self-reported gender. RESULTS The top three factors cited as impacting firearm locking device selection included speed (53.6%) and ease of firearm access from device (52.4%), and cost of the device (28.7%). These top factors were comparable for all adults across genders. A larger proportion of older vs younger males reported that a primary preference was whether the device allows the firearm to remain loaded with ammunition; smaller proportions of older vs younger males reported strength of device (device durability) and costs. CONCLUSIONS Preference among older adults, particularly older males, for locking devices that maintain the firearms easy to access - especially, loaded with ammunition - might impact firearm injury prevention efforts for this high-risk group. CLINICAL IMPLICATIONS For harm reduction, use of any firearm locking device may reduce the risk of firearm injury or death. Clinicians are encouraged to explore reasons for locking device selection within motivational interviewing frameworks.
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Affiliation(s)
- Ricardo I Villarreal
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Center for COMBAT Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ian H Stanley
- Center for COMBAT Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- School of Public Health, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
| | - Jessica Buck-Atkinson
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
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14
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Betz ME, Bowen DM, Rowhani-Rahbar A, McCourt AD, Rivara FP. State Reporting Requirements for Involuntary Holds, Court-Ordered Guardianship, and the US National Firearm Background Check System. JAMA Health Forum 2023; 4:e233945. [PMID: 37976049 PMCID: PMC10656649 DOI: 10.1001/jamahealthforum.2023.3945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/19/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Firearm violence is a leading cause of death in the US. There is broad public agreement that individuals at high risk of perpetrating violence should not be allowed to purchase or possess firearms. The National Instant Criminal Background Check System (NICS) is a national system intended to stop firearm purchases or possession by prohibited persons, but there is heterogeneity in how states interact with and report data to NICS. Objective To examine variability in state requirements for NICS reporting for mental health prohibitions. Design and Setting This cross-sectional study in the US reviewed current statutes for all 50 states and the District of Columbia (enacted through the 2021 legislative session) regarding reporting mental health prohibitions to NICS or state systems. Data were analyzed from October 2022 to April 2023. Main Outcomes and Measures For each state, the following were recorded: reliance on Federal Bureau of Investigation vs state point of contact for NICS checks; regulation requiring or allowing reporting to NICS for 3 hypothetical cases; and details on reporting responsibility and time frame. The number of NICS listings for adjudicated mental health reasons was obtained, and state rates per 1000 population were calculated. To compare states, we developed 3 hypothetical cases of individuals with risk of firearm violence, whether possibly temporary (involuntary commitment for decompensated psychosis, or involuntary short-term psychiatric hold for suicidal ideation) or chronic and progressive (court-appointed guardianship for dementia). Results A total of 39 states required and 5 allowed reporting to NICS for court-ordered, involuntary psychiatric hospitalization. Thirteen states required and 5 allowed reporting to NICS when a court determines an individual is mentally incompetent to manage their affairs (with or without guardianship). Two states required NICS reporting for short-term emergency psychiatric holds. Five states and the District of Columbia had no legislation explicitly requiring or allowing NICS reporting in the 3 scenarios. Conclusions and Relevance In this cross-sectional study of state laws, there was substantial heterogeneity in NICS reporting requirements and lack of clarity around processes. This raises questions about the ability of NICS to be used to block firearm purchases or possession by individuals with court-identified high risk of perpetrating violence toward themselves or others.
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Affiliation(s)
- Marian E. Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver
| | - Deirdre M. Bowen
- Seattle University School of Law, Seattle, Washington
- Firearm Injury and Policy Research Program, University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Firearm Injury and Policy Research Program, University of Washington, Seattle
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
| | - Alexander D. McCourt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Frederick P. Rivara
- Firearm Injury and Policy Research Program, University of Washington, Seattle
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
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15
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Liu Y, Chihuri S, Mielenz TJ, Andrews HF, Betz ME, DiGuiseppi C, Eby DW, Hill LL, Jones V, Molnar LJ, Strogatz D, Li G. Motor Vehicle Crash Risk in Older Adult Drivers With Attention-Deficit/Hyperactivity Disorder. JAMA Netw Open 2023; 6:e2336960. [PMID: 37792374 PMCID: PMC10551766 DOI: 10.1001/jamanetworkopen.2023.36960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/10/2023] [Accepted: 08/28/2023] [Indexed: 10/05/2023] Open
Abstract
Importance Symptoms of attention-deficit/hyperactivity disorder (ADHD), such as inattentiveness and impulsivity, could affect daily functioning and driving performance throughout the life span. Previous research on ADHD and driving safety is largely limited to adolescents and young adults. Objective To examine the prevalence of ADHD and the association between ADHD and crash risk among older adult drivers. Design, Setting, and Participants This prospective cohort study collected data from primary care clinics and residential communities in 5 US sites (Ann Arbor, Michigan; Baltimore, Maryland; Cooperstown, New York; Denver, Colorado; and San Diego, California) between July 6, 2015, and March 31, 2019. Participants were active drivers aged 65 to 79 years at baseline enrolled in the Longitudinal Research on Aging Drivers project who were studied for up to 44 months through in-vehicle data recording devices and annual assessments. The data analysis was performed between July 15, 2022, and August 14, 2023. Exposure Lifetime ADHD based on an affirmative response to the question of whether the participant had ever had ADHD or had ever been told by a physician or other health professional that he or she had ADHD. Main Outcomes and Measures The main outcomes were hard-braking events defined as maneuvers with deceleration rates of 0.4g or greater, self-reported traffic ticket events, and self-reported vehicular crashes. Multivariable negative binomial modeling was used to estimate adjusted incidence rate ratios (aIRRs) and 95% CIs of outcomes according to exposure status. Results Of the 2832 drivers studied, 1500 (53.0%) were women and 1332 (47.0%) were men with a mean (SD) age of 71 (4) years. The lifetime prevalence of ADHD in the study sample was 2.6%. Older adult drivers with ADHD had significantly higher incidence rates of hard-braking events per 1000 miles than those without ADHD (1.35 [95% CI, 1.30-1.41] vs 1.15 [95% CI, 1.14-1.16]), as well as self-reported traffic ticket events per 1 million miles (22.47 [95% CI, 16.06-31.45] vs 9.74 [95% CI, 8.99-10.55]) and self-reported vehicular crashes per 1 million miles (27.10 [95% CI, 19.95-36.80] vs 13.50 [95% CI, 12.61-14.46]). With adjustment for baseline characteristics, ADHD was associated with a significant 7% increased risk of hard-braking events (aIRR, 1.07; 95% CI, 1.02-1.12), a 102% increased risk of self-reported traffic ticket events (aIRR, 2.02; 95% CI, 1.42-2.88), and a 74% increased risk of self-reported vehicular crashes (aIRR, 1.74; 95% CI, 1.26-2.40). Conclusions and Relevance As observed in this prospective cohort study, older adult drivers with ADHD may be at a significantly elevated crash risk compared with their counterparts without ADHD. These findings suggest that effective interventions to improve the diagnosis and clinical management of ADHD among older adults are warranted to promote safe mobility and healthy aging.
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Affiliation(s)
- Yuxin Liu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Stanford Chihuri
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Thelma J. Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Center for Injury Science and Prevention, Columbia University Irving Medical Center, New York, New York
| | - Howard F. Andrews
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - David W. Eby
- University of Michigan Transportation Research Institute, Ann Arbor
| | - Linda L. Hill
- School of Public Health, University of California, San Diego, La Jolla
| | - Vanya Jones
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa J. Molnar
- University of Michigan Transportation Research Institute, Ann Arbor
| | | | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Center for Injury Science and Prevention, Columbia University Irving Medical Center, New York, New York
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16
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Haasz M, Sigel E, Betz ME, Leonard J, Brooks-Russell A, Ambroggio L. Acceptability of Long Versus Short Firearm Safety Education Videos in the Emergency Department: A Pilot Randomized Controlled Trial. Ann Emerg Med 2023; 82:482-493. [PMID: 37140494 DOI: 10.1016/j.annemergmed.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 05/05/2023]
Abstract
STUDY OBJECTIVE Safe firearm storage is protective against pediatric firearm injuries. We sought to compare a 3-minute versus 30-second safe firearm storage video in terms of acceptability of video content and use in the pediatric emergency department (PED). METHODS We conducted a randomized controlled trial in a large PED (from March to September 2021). Participants were English-speaking caregivers of noncritically ill patients. Participants were surveyed about child safety behaviors (including firearm storage), then shown 1 of 2 videos. Both videos described safe storage principles; the 3-minute video included temporary firearm removal and a survivor testimonial. The primary outcome was acceptability, measured by responses on a 5-point Likert scale (strongly disagree to strongly agree). A survey at 3 months evaluated information recall. Baseline characteristics and outcomes were compared between groups using Pearson chi-squared, Fisher exact, and Wilcoxon Mann Whitney tests as appropriate. Absolute risk difference for categoric variables and mean difference for continuous variables are reported with 95% confidence interval (CI). RESULTS Research staff screened 728 caregivers; 705 were eligible and 254 consented to participate (36%); 4 withdrew. Of 250 participants, most indicated acceptability in terms of setting (77.4%) and content (86.6%), and doctors discussing firearm storage (78.6%), with no difference between groups. More caregivers viewing the longer video felt the length appropriate (99.2%) compared with the shorter video (81.1%, difference 18.1%, 95% CI 11.1 to 25.1). CONCLUSIONS We show that video-based firearm safety education is acceptable among study participants. This can provide consistent education to caregivers in PEDs and needs further study in other settings.
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Affiliation(s)
- Maya Haasz
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
| | - Eric Sigel
- Department of Pediatrics, Section of Adolescent Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Jan Leonard
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Ashley Brooks-Russell
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lilliam Ambroggio
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO; Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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17
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Barnard LM, Knoepke CE, McCarthy M, Rowhani-Rahbar A, Siry-Bove BJ, Betz ME. Views of voluntary, temporary out-of-home firearm storage among individuals living in a firearm-owning home: results from a qualitative study in two states. Inj Prev 2023; 29:431-436. [PMID: 37451860 PMCID: PMC10529183 DOI: 10.1136/ip-2023-044868] [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] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Firearms account for the majority of suicide deaths in the USA. A recommended approach for suicide prevention is reducing access to firearms by temporarily removing them from the home. We sought to understand how firearm owners and those who reside with them view and might use voluntary, temporary out-of-home firearm storage. METHODS From July to November 2021, we interviewed English-speaking adults in Colorado and Washington who own firearms or reside with them, using semistructured interviews. We used a team-based mixed deductive and inductive approach to code transcripts and identify themes. RESULTS Half of the 38 interviewees were men (53%) aged 35-54 years (40%); 92% identified as white. The average age that participants reported first having a firearm was 20.4 years; 16% reported never owning a firearm themselves, only living in homes with firearms. Qualitative findings fell into broad themes: (1) storage with family members/friends, (2) concerns/challenges with storing a firearm with a business/organization, (3) importance of trust (4) outreach methods for out-of-home storage programmes. CONCLUSION Programmes for voluntary, temporary out-of-home firearm storage will not be impactful unless such storage is desired and used. Understanding views of potential storage users can help support development of acceptable and feasible programmes.
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Affiliation(s)
- Leslie M Barnard
- Epidemiology, University of Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christopher E Knoepke
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Cardiology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan McCarthy
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Marian E Betz
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Betz ME, Frattaroli S, Knoepke CE, Johnson R, Christy A, Schleimer JP, Pear VA, McCarthy M, Kapoor R, Norko MA, Rowhani-Rahbar A, Ma W, Wintemute GJ, Swanson JW, Zeoli AM. Extreme Risk Protection Orders in Older Adults in Six U.S. States: A Descriptive Study. Clin Gerontol 2023:1-8. [PMID: 37688772 DOI: 10.1080/07317115.2023.2254279] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
Abstract
OBJECTIVES Extreme Risk Protection Orders (ERPOs) allow a court to restrict firearm access for individuals ("respondents") at imminent risk of harm to self/others. Little is known about ERPOs use for older adults, a population with higher rates of suicide and dementia. METHODS We abstracted ERPO cases through June 30, 2020, from California, Colorado, Connecticut, Florida, Maryland, and Washington. We restricted our analysis to petitions for older (≥65 years) respondents, stratified by documented cognitive impairment. RESULTS Among 6,699 ERPO petitions, 672 (10.0%) were for older adults; 13.7% (n = 92) of these noted cognitive impairment. Most were white (75.7%) men (90.2%). Cognitively impaired (vs. non-impaired) respondents were older (mean age 78.2 vs 72.7 years) and more likely to have documented irrational/erratic behavior (30.4% vs 15.7%), but less likely to have documented suicidality (33.7% vs 55.0%). At the time of the petition, 56.2% of older adult respondents had documented firearm access (median accessible firearms = 3, range 1-160). CONCLUSIONS Approximately 14% of ERPO petitions for older adults involved cognitive impairment; one-third of these noted suicide risk. Studies examining ERPO implementation across states may inform usage and awareness. CLINICAL IMPLICATIONS ERPOs may reduce firearm access among older adults with cognitive impairment, suicidality, or risk of violence.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Shannon Frattaroli
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher E Knoepke
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel Johnson
- Center for Innovative Design & Analysis, Department of Biostatistics & Informatics, Colorado School of Public health, Aurora, Colorado, USA
| | - Annette Christy
- Department of Mental Health Law and Policy at the de la Parte Florida Mental Health Institute, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Julia P Schleimer
- Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Veronica A Pear
- Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA
| | - Megan McCarthy
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Reena Kapoor
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael A Norko
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Wenjuan Ma
- Center for Statistical Training and Consulting, Michigan State University, Lansing, Michigan, USA
| | - Garen J Wintemute
- Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA
| | - Jeffrey W Swanson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - April M Zeoli
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
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19
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Trinka T, Oesterle DW, Silverman AC, Vriniotis MG, Orchowski LM, Beidas R, Betz ME, Hudson C, Kesner T, Ranney ML. Bystander intervention to prevent firearm injury: A qualitative study of 4-H shooting sports participants. J Community Psychol 2023; 51:2652-2666. [PMID: 37294273 PMCID: PMC10644270 DOI: 10.1002/jcop.23069] [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] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
This qualitative study examines how youth and adult members of 4-H Shooting Sports clubs perceive firearm injury risk and risk reduction, and the applicability of a bystander intervention (BI) risk reduction framework in this community. Semistructured interviews were conducted with 11 youth and 13 adult members of 4-H Shooting Sports clubs across nine US states from March to December of 2021 until thematic saturation was reached. Deductive and inductive thematic qualitative analyses were performed. Six overarching themes emerged: (1) The tendency to view firearm injury as predominantly unintentional in nature; (2) Acknowledgment of a wide array of risks for firearm injury; (3) Perceived barriers to bystander action to prevent firearm injury including knowledge, confidence, and consequences of action; (4) Facilitators of bystander action including a sense of civic responsibility; (5) Direct and indirect strategies to address potential risks for firearm injury; and (6) Belief that BI skills training would be useful for 4-H Shooting Sports. Findings lay the groundwork for applying BI skills training as an approach to firearm injury prevention in 4-H Shooting Sports, similar to how BI has been applied to other types of injury (i.e., sexual assault). 4-H Shooting Sports club members' sense of civic responsibility is a key facilitator. Prevention efforts should attend to the broad array of ways in which firearm injury occurs, including suicide, mass shootings, homicide, and intimate partner violence, as well as unintentional injury.
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Affiliation(s)
- Teresa Trinka
- Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | | | - Amira C Silverman
- Brown-Lifespan Center for Digital Health, Alpert Medical School, Brown University, Providence, RI, USA
- Rhode Island Hospital, 593 Eddy St, Providence, RI, 02903 USA
| | - Mary G Vriniotis
- Brown-Lifespan Center for Digital Health, Alpert Medical School, Brown University, Providence, RI, USA
- Rhode Island Hospital, 593 Eddy St, Providence, RI, 02903 USA
| | - Lindsay M Orchowski
- Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Rhode Island Hospital, 593 Eddy St, Providence, RI, 02903 USA
| | - Rinad Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Marian E. Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, 80220, USA
| | - Craven Hudson
- University of Georgia Extension, Athens, GA, 30602, USA
| | - Todd Kesner
- Montana State University Extension, Bozeman MT, 59717, USA
| | - Megan L Ranney
- Brown-Lifespan Center for Digital Health, Alpert Medical School, Brown University, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Rhode Island Hospital, 593 Eddy St, Providence, RI, 02903 USA
- School of Public Health, Brown University, Providence, RI, 02903, USA
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20
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Betz ME, Stanley IH, Anestis MD, Bryan CJ, Buck-Atkinson J, Carey N, Ghahramanlou-Holloway M, Morrissey BH, Holloway K, Houtsma C, Kennedy R, Paine CM, Ramchand R, Simonetti J, Walsh A, Wright-Kelly E. Firearm Suicide Prevention in the U.S. Military: Recommendations From a National Summit. Mil Med 2023; 188:231-235. [PMID: 36472362 PMCID: PMC10464876 DOI: 10.1093/milmed/usac371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
The U.S. DoD has identified firearm suicide prevention as a key operational priority. One vital approach to addressing firearm suicides is through promoting lethal means safety, which involves the voluntary use of secure storage for personally owned firearms and/or temporarily moving firearms out of the home during risk periods. Despite promising approaches to lethal means safety, critical gaps remain in research, programming, and communication among and across scientists, DoD programmatic leaders, front-line commanders, and service members. To address these gaps, the first-ever national "Firearm Suicide Prevention in the Military: Messaging and Interventions Summit" was convened in June 2022, bringing together DoD personnel and researchers with expertise in firearm suicide prevention and lethal means safety. The Summit identified 10 recommendations to enhance firearm suicide prevention messaging and interventions in the U.S. military, including (1) repeal or amend prohibitions on questioning service members about personal firearms; (2) develop, examine, and use common language for firearm injury prevention; (3) implement a universal approach to training on comprehensive firearm injury prevention; (4) encourage leadership across disciplines and levels; (5) aim for broad culture change; (6) support innovative research; (7) consider various outcome measures; (8) promote "cultural competence" for better communication; (9) reduce territorialism; and (10) develop creative partnerships. Ultimately, these recommendations can facilitate productive partnerships with a shared goal: to develop, test, and implement strategies that standardize lethal means safety and reduce firearm suicides and other firearm injuries or harm among service members.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO 80045, USA
| | - Ian H Stanley
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Center for COMBAT Research, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, Piscataway, NJ 08854, USA
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43214, USA
| | - Jessica Buck-Atkinson
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Neil Carey
- CNA Corporation, Arlington, VA 22201, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Brooke Heintz Morrissey
- Center for the Study of Traumatic Stress (CSTS), Department of Psychiatry, Uniformed Service University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | | | - Claire Houtsma
- Southeast Louisiana Veterans Health Care System, New Orleans, LA 70119, USA
- South Central Mental Illness Research, Education and Clinical Center, New Orleans, LA 70119, USA
| | - Rachel Kennedy
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christopher M Paine
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX 78712, USA
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA
| | | | - Joseph Simonetti
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adam Walsh
- Center for the Study of Traumatic Stress (CSTS), Department of Psychiatry, Uniformed Service University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Erin Wright-Kelly
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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21
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Buck-Atkinson J, McCarthy M, Stanley IH, Harnke B, Anestis MD, Bryan CJ, Baker JC, Betz ME. Firearm locking device preferences among firearm owners in the USA: a systematic review. Inj Epidemiol 2023; 10:33. [PMID: 37415242 DOI: 10.1186/s40621-023-00436-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Preventing firearm-involved injuries is a critical public health priority. Firearm locking devices can prevent firearm injuries, such as suicide and unintentional shootings, as well as theft. Various firearm locking devices exist; however, little is known about firearm owners' preferred locking devices for secure firearm storage. In this systematic review, we examined existing literature on preferred locking devices for secure storage of personal firearms among United States (US) firearm owners with the purpose of understanding practical implications and needs for future research. METHODS We searched 8 major databases, as well as the grey literature, for English-language sources published on or before January 24, 2023, that empirically examined firearm locking device preferences. Following PRISMA guidelines, coders independently screened and reviewed 797 sources using pre-determined criteria. Overall, 38 records met inclusion criteria and were included in this review. RESULTS The majority of studies measure and report on participant use of various types of locking devices, but few go on to measure preference between device options and the attributes and features that may contribute to an individual's preference. Included studies suggest that a preference for larger devices, such as lockboxes and gun safes, may exist among US firearm owners. CONCLUSIONS Review of included studies suggests that current prevention efforts may not be aligned with firearm owners' preferences. Additionally, findings from this systematic review emphasize the need for additional methodological rigorous research to understand firearm locking device preferences. Expanded knowledge in this area will result in actionable data and foundational best practices for programming that encourages behavior change concerning secure storage of personal firearms to prevent injury and death.
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Affiliation(s)
- Jessica Buck-Atkinson
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA.
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA.
| | - Megan McCarthy
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA
| | - Ian H Stanley
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Center for COMBAT Research, Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, 12950 E Montview Blvd, Aurora, CO, 80045, USA
| | - Michael D Anestis
- Rutgers School of Public Health, New Jersey Gun Violence Research Center, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
- School of Public Health, The State University of New Jersey, 683 Hoes Lane West, Rutgers, Piscataway, NJ, 08854, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH, 43214, USA
| | - Justin C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH, 43214, USA
| | - Marian E Betz
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
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22
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Barnard LM, Wright-Kelly E, Brooks-Russell A, Betz ME. Characterization of Mass Shootings by State, 2014-2022. JAMA Netw Open 2023; 6:e2325868. [PMID: 37494046 PMCID: PMC10372703 DOI: 10.1001/jamanetworkopen.2023.25868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Affiliation(s)
- Leslie M Barnard
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Erin Wright-Kelly
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Ashley Brooks-Russell
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
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23
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Stanley IH, Lebeaut A, Betz ME, Wright A, Vujanovic AA. Firearm ownership and storage practices among United States firefighters and emergency medical services personnel. Psychol Serv 2023:2023-76315-001. [PMID: 37261761 PMCID: PMC10689572 DOI: 10.1037/ser0000780] [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] [Indexed: 06/02/2023]
Abstract
Compared with the general U.S. population, firefighters (FF) and emergency medical services (EMS) workers (FF + EMS personnel) are at increased risk for firearm suicide. Although secure firearm storage is associated with reduced risk of firearm suicide, no study has examined the prevalence and sociodemographic correlates of firearm ownership and storage practices among U.S. FF + EMS personnel. A total of 141 U.S. FF + EMS personnel completed a structured, web-based self-report questionnaire. Overall, 76.6% (n = 108) of FF + EMS personnel in our sample reported owning a personal firearm, among whom 85.2% (n = 92) reported owning more than one firearm. Among firearm owners, 42.6% (n = 46) reported secure firearm storage (i.e., unloaded and locked) and 57.4% (n = 62) reported nonsecure firearm storage (i.e., loaded and/or unlocked). FF + EMS personnel who cited personal safety as the only reason for firearm ownership, as opposed to reporting other or multiple reasons for ownership (e.g., hunting), were at increased odds of reporting nonsecure storage practices (69.4% vs. 47.5%; OR = 2.51, 95% CI [1.14, 5.55], p = .023). Most FF + EMS personnel in our sample reported firearm ownership, and approximately half of the firearm owners reported nonsecure firearm storage practices. Promoting secure firearm storage practices among FF + EMS personnel might decrease risk of firearm suicide and other forms of firearm-related injuries. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Ian H. Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
- Center for COMBAT Research, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Antoine Lebeaut
- Department of Psychology, University of Houston, Houston, TX
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Angela Wright
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
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Prater LC, Simonetti JA, Knoepke CE, Polzer ER, Nearing KA, Lee T, Betz ME. Older adults and planning for firearm safety: A qualitative study of healthcare providers. J Am Geriatr Soc 2023; 71:1275-1282. [PMID: 36550590 PMCID: PMC10089957 DOI: 10.1111/jgs.18188] [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] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE/BACKGROUND Firearm injury, particularly self-directed, is a major source of preventable morbidity and mortality among older adults. Older adults are at elevated risk of serious illness, cognitive impairment, and depression-all known risk factors for suicide and/or unintentional injury. Healthcare providers are often the first to identify these conditions and, although they commonly deliver safety guidance to such patients, little is known about how they approach firearm safety conversations with older adults. METHODS We conducted semi-structured interviews with healthcare providers who care for older adults (November 2020-May 2021). We used inductive and deductive thematic analyses to develop themes. We present themes and representative quotes from our analysis. RESULTS We interviewed 13 healthcare providers who regularly care for older adult firearm owners. Emergent themes were: circumstances that prompt firearm safety conversations; strategies for addressing firearm safety in routine and acute circumstances; barriers to addressing firearm safety; and available or desired resources. CONCLUSION Planning for firearm safety should occur "early and often" as part of a longitudinal relationship with older adult patients. Age-related safety issues such as driving are regularly addressed with older adult patients, likely because there are standard processes and established pathways. Establishing processes and provider/ patient resources would help improve provider efficacy to address firearm safety and relinquishment for older adult firearm owners. Integrating firearm safety conversations into routine encounters (e.g., Medicare Annual Wellness Visit, problem-focused visits) templates could be a promising initial step but resources for follow-up to the firearm screening must be available to both provider and patient.
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Affiliation(s)
- Laura C Prater
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA
| | - Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide, Prevention, Veterans Health Administration, Aurora, Colorado, USA
- Division of Hospital Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christopher E Knoepke
- Division of Cardiology, Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Evan R Polzer
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kathryn A Nearing
- Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado, School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Teresa Lee
- Department of Neurology, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
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25
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Davis S, Betz ME, Hill LL, Eby DW, Jones VC, Mielenz TJ, Molnar LJ, Strogatz D, Clancy K, Li G, DiGuiseppi CG. Associations of cannabis use with motor vehicle crashes and traffic stops among older drivers: AAA LongROAD study. Traffic Inj Prev 2023; 24:307-314. [PMID: 36939676 DOI: 10.1080/15389588.2023.2180736] [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] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Acute cannabis use is associated with a higher risk of motor vehicle crashes (MVC). This study aimed to determine if self-reported past-year cannabis use is associated with MVC or traffic stops among older drivers. METHODS This cross-sectional analysis used data from a multi-center study enrolling active drivers aged 65-79 years. Data regarding cannabis use, MVC, and traffic stops (i.e., being pulled over by police, whether ticketed or not) within the previous 12 months were collected through participant interviews. Log-binomial regression models examined associations of past-year cannabis use with MVC and traffic stops, adjusting for site and sociodemographic and mental health characteristics. RESULTS Of 2,095 participating older drivers, 186 (8.88%) used cannabis in the past year but only 10 (<0.5%) within an hour before driving in the last 30 days; 11.41% reported an MVC and 9.45% reported a traffic stop. Past-year cannabis users had a higher prevalence of MVC (adjusted prevalence ratio [aPR] = 1.38; 95%CI: 0.96, 2.00; p = 0.086) and traffic stops (aPR = 1.58; 1.06, 2.35; p = 0.024). CONCLUSIONS Past-year cannabis use was associated with increased traffic stops, which are correlated modestly with increased MVC in past studies and may indicate impaired driving performance. We did not find a statistically significant association of past-year cannabis use with MVC, which may indicate limited sustained effects on driving performance from periodic use among older adults, who report rarely driving immediately after use.
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Affiliation(s)
- Shelby Davis
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), Veterans Health Administration, Aurora, Colorado
| | - Linda L Hill
- School of Public Health, University of California San Diego, La Jolla, California
| | - David W Eby
- University of Michigan Transportation Research Institute, College of Engineering, University of Michigan, Ann Arbor, Michigan
| | - Vanya C Jones
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Thelma J Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University Center for Injury Science and Prevention, Columbia University, New York, New York
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, College of Engineering, University of Michigan, Ann Arbor, Michigan
| | - David Strogatz
- Bassett Research Institute, Bassett Healthcare Network, Cooperstown, New York
| | - Kate Clancy
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University Center for Injury Science and Prevention, Columbia University, New York, New York
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Abstract
IMPORTANCE Secure firearm storage may help reduce firearm injury and death. Broad implementation requires more granular assessments of firearm storage practices and greater clarity on circumstances that may prevent or promote the use of locking devices. OBJECTIVE To develop a more thorough understanding of firearm storage practices, obstacles to using locking devices, and circumstances in which firearm owners would consider locking unsecured firearms. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, nationally representative survey of adults residing in 5 US states who owned firearms was administered online between July 28 and August 8, 2022. Participants were recruited via probability-based sampling. MAIN OUTCOMES AND MEASURES Firearm storage practices were assessed via a matrix provided to participants in which firearm-locking devices were described both via text and images. Locking mechanisms (key/personal identification number [PIN]/dial vs biometric) were specified for each type of device. Obstacles to the use of locking devices and circumstances in which firearm owners would consider locking unsecured firearms were assessed via self-report items developed by the study team. RESULTS The final weighted sample included 2152 adult (aged ≥18 years), English-speaking firearm owners residing in the US; the sample was predominantly male (66.7%). Among the 2152 firearm owners, 58.3% (95% CI, 55.9%-60.6%) reported storing at least 1 firearm unlocked and hidden, with 17.9% (95% CI, 16.2%-19.8%) reporting storing at least 1 firearm unlocked and unhidden. Gun safes were the most frequently used device both among participants who use keyed/PIN/dial locking mechanisms (32.4%; 95% CI, 30.2%-34.7%) and those who use biometric locking mechanisms (15.6%; 95% CI, 13.9%-17.5%). Those who do not store firearms locked most frequently noted a belief that locks are unnecessary (49.3%; 95% CI, 45.5%-53.1%) and a fear that locks would prevent quick access in an emergency (44.8%; 95% CI, 41.1%-48.7%) as obstacles to lock usage. Preventing access by children was the most often reported circumstance in which firearm owners would consider locking unsecured firearms (48.5%; 95% CI, 45.6%-51.4%). CONCLUSIONS AND RELEVANCE In this survey study of 2152 firearm owners, consistent with prior research, unsecure firearm storage was common. Firearm owners appeared to prefer gun safes relative to cable locks and trigger locks, indicating that locking device distribution programs may not match firearm owners' preferences. Broad implementation of secure firearm storage may require addressing disproportionate fears of home intruders and increasing awareness of the risks associated with household firearm access. Furthermore, implementation efforts may hinge on broader awareness of the risks of ready firearm access beyond unauthorized access by children.
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Affiliation(s)
- Michael D. Anestis
- New Jersey Gun Violence Research Center, Piscataway
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway
| | - Jayna Moceri-Brooks
- New Jersey Gun Violence Research Center, Piscataway
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway
| | - Rachel L. Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Craig J. Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Ian H. Stanley
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Center for COMBAT Research, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | | | - Justin C. Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Marian E. Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver
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Betz ME, Stanley IH, Buck-Atkinson J, Johnson R, Bryan CJ, Baker JC, Bryan AO, Hunter K, Anestis MD. Firearm Owners' Preferences for Locking Devices: Results of a National Survey. Ann Intern Med 2023; 176:424-427. [PMID: 36745884 DOI: 10.7326/m22-3113] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, and VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado
| | - Ian H Stanley
- Firearm Injury Prevention Initiative and Center for COMBAT Research, Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jessica Buck-Atkinson
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rachel Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio
| | - Justin C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio
| | - AnnaBelle O Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Michael D Anestis
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey
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Betz ME, Simonetti JA. Approaches to Prevention of Firearm Violence-Reply. JAMA 2023; 329:513-514. [PMID: 36786794 DOI: 10.1001/jama.2022.21865] [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: 02/15/2023]
Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Joseph A Simonetti
- Rocky Mountain VA Mental Illness Research, Education, and Clinical Center for Suicide Prevention, University of Colorado School of Medicine, Aurora
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Leung T, Portz J, Fischer SM, Greenway E, Johnson RL, Knoepke CE, Matlock DD, Omeragic F, Peterson RA, Ranney ML, Betz ME. A Web-Based Decision Aid for Caregivers of Persons With Dementia With Firearm Access (Safe at Home Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e43702. [PMID: 36719721 PMCID: PMC9929727 DOI: 10.2196/43702] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Firearm safety among individuals with Alzheimer disease and related dementias (ADRD) is an underdiscussed and underresearched concern in the United States, especially given the growing population of community-dwelling adults with ADRD. The "Safety in Dementia" (SiD) web-based decision aid was developed to support caregivers in addressing firearm access; the efficacy of SiD is unknown. OBJECTIVE Through the SiD decision aid, the Safe at Home (S@H) study aims to support caregivers in making decisions about home safety that align with their goals and values, and behaviors regarding firearm access for persons with ADRD and firearm access. METHODS The S@H study is a 2-armed randomized controlled trial to test the effect of the SiD decision aid on caregivers of community-dwelling adults with ADRD who have firearm access. S@H aims to recruit 500 ADRD caregivers (age ≥18 years, fluent in English or Spanish, and in the United States) through online or social media advertisements and through relevant organizations. Participants are randomized to view SiD or a control website at their own pace; all participants complete web-based questionnaires at baseline, 2 weeks, 2 months, and 6 months. The primary outcome is immediate preparation for decision-making; secondary outcomes include longitudinal decision outcomes and self-reported modifications to firearm access. The relative reach and effectiveness of each recruitment method (online/social media and through relevant organizations) will be assessed by examining differences in caregiver participation, retention rates, and relative cost. RESULTS The study enrollment began in May 2022. As of December 2022, a total of 117 participants had enrolled. CONCLUSIONS The S@H study is the first randomized trial of a firearm safety decision aid for ADRD caregivers. The results from this study will inform how best to support caregivers in decision-making regarding firearm safety. Further, results may guide approaches for recruiting caregivers and for dissemination of resources. TRIAL REGISTRATION ClinicalTrials.gov NCT05173922; https://clinicaltrials.gov/ct2/show/NCT05173922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43702.
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Affiliation(s)
| | - Jennifer Portz
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Stacy M Fischer
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emily Greenway
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christopher E Knoepke
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel D Matlock
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States.,Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Faris Omeragic
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ryan A Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Megan L Ranney
- Brown-Lifespan Center for Digital Health, Brown University, Providence, RI, United States.,School of Public Health, Brown University, Providence, RI, United States.,Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
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30
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Fenton L, Han SD, DiGuiseppi CG, Fowler NR, Hill L, Johnson RL, Peterson RA, Knoepke CE, Matlock DD, Moran R, Karlawish J, Betz ME. Mild Cognitive Impairment is Associated with Poorer Everyday Decision Making. J Alzheimers Dis 2023; 94:1607-1615. [PMID: 37458034 DOI: 10.3233/jad-230222] [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] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Older adults are faced with many unique and highly consequential decisions such as those related to finances, healthcare, and everyday functioning (e.g., driving cessation). Given the significant impact of these decisions on independence, wellbeing, and safety, an understanding of how cognitive impairment may impact decision making in older age is important. OBJECTIVE To examine the impact of mild cognitive impairment (MCI) on responses to a modified version of the Short Portable Assessment of Capacity for Everyday Decision making (SPACED). METHODS Participants were community-dwelling, actively driving older adults (N = 301; M age = 77.1 years, SD = 5.1; 69.4% with a college degree or higher; 51.2% female; 95.3% White) enrolled in the Advancing Understanding of Transportation Options (AUTO) study. A generalized linear model adjusted for age, education, sex, randomization group, cognitive assessment method, and study site was used to examine the relationship between MCI status and decision making. RESULTS MCI status was associated with poorer decision making; participants with MCI missed an average of 2.17 times more points on the SPACED than those without MCI (adjusted mean ratio: 2.17, 95% CI: 1.02, 4.61, p = 0.044). CONCLUSION This finding supports the idea that older adults with MCI exhibit poorer decision-making abilities than cognitively normal older adults. It also suggests that older adults with MCI may exhibit poorer decision making across a wide range of decision contexts.
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Affiliation(s)
- Laura Fenton
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA
| | - S Duke Han
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
- Department of Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, USA
- USC School of Gerontology, Los Angeles, CA, USA
| | - Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicole R Fowler
- Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, Indianapolis, IN, USA
| | - Linda Hill
- School of Public Health, University of California San Diego, San Diego, CA, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ryan A Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christopher E Knoepke
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel D Matlock
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ryan Moran
- School of Public Health, University of California San Diego, San Diego, CA, USA
| | - Jason Karlawish
- Penn Memory Center, Departments of Medicine, Medical Ethics and Health Policy, and Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
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31
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DiGuiseppi CG, Hyde HA, Betz ME, Scott KA, Eby DW, Hill LL, Jones VC, Mielenz TJ, Molnar LJ, Strogatz D, Li G. Association of falls and fear of falling with objectively-measured driving habits among older drivers: LongROAD study. J Safety Res 2022; 83:96-104. [PMID: 36481041 PMCID: PMC10115437 DOI: 10.1016/j.jsr.2022.08.007] [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] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/28/2022] [Accepted: 08/09/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Falls in older adults are associated with increased motor vehicle crash risk, possibly mediated by driving behavior. We examined the relationship of falls and fear of falling (FOF) with subsequent objectively measured driving habits. METHODS This multi-site, prospective cohort study enrolled 2990 active drivers aged 65-79 (53% female). At enrollment, we assessed falls in the past year and FOF (Short Falls Efficacy Scale-International). Driving outcomes included exposure, avoidance of difficult conditions, and unsafe driving during one-year follow-up, using in-vehicle Global Positioning System devices. RESULTS Past-year falls were associated with more hard braking events (HBE). High FOF was associated with driving fewer days, miles, and trips, driving nearer home and more HBE. Differences were attenuated and not significant after accounting for health, function, medications and sociodemographics. DISCUSSION Differences in objectively measured driving habits according to past-year fall history and FOF were largely accounted for by differences in health and medications. Rather than directly affecting driving, falls and FOF may serve as markers for crash risk and reduced community mobility due to age-related changes and poor health.
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Affiliation(s)
- Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Hailey A Hyde
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kenneth A Scott
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David W Eby
- University of Michigan Transportation Research Institute, University of Michigan, Ann Arbor, MI, USA; Center for Advancing Transportation Leadership and Safety (ATLAS Center), University of Michigan, Ann Arbor, MI, USA
| | - Linda L Hill
- School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Vanya C Jones
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thelma J Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia's Injury Control Research Center, Columbia University, New York, NY, USA
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, University of Michigan, Ann Arbor, MI, USA; Center for Advancing Transportation Leadership and Safety (ATLAS Center), University of Michigan, Ann Arbor, MI, USA
| | - David Strogatz
- Bassett Research Institute, Bassett Healthcare Network, Cooperstown, NY, USA
| | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia's Injury Control Research Center, Columbia University, New York, NY, USA; Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Richards JE, Kuo ES, Whiteside U, Shulman L, Betz ME, Parrish R, Boggs JM, Rowhani-Rahbar A, Simon GE. Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention: A Qualitative Study. JAMA Health Forum 2022; 3:e224252. [PMID: 36416815 PMCID: PMC9685488 DOI: 10.1001/jamahealthforum.2022.4252] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Importance US residents report broad access to firearms, which are the most common means of suicide death in the US. Standardized firearm access questions during routine health care encounters are uncommon despite potential benefits for suicide prevention. Objective To explore patient and clinician experiences with a standard question about firearm access on a self-administered mental health questionnaire routinely used prior to primary care and mental health specialty encounters. Design, Setting, and Participants Qualitative semistructured interviews were conducted from November 18, 2019, to October 8, 2020, at Kaiser Permanente Washington, a large integrated care delivery system and insurance provider. Electronic health record data identified adult patients with a documented mental health diagnosis who had received a standard question about firearm access ("Do you have access to guns? yes/no") within the prior 2 weeks. A stratified sampling distribution selected 30% who answered "yes," 30% who answered "no," and 40% who left the question blank. Two groups of clinicians responsible for safety planning with patients at risk of suicide were also sampled: (1) licensed clinical social workers (LICSWs) in primary and urgent care settings and (2) consulting nurses (RNs). Main Outcomes and Measures Participants completed semistructured telephone interviews, which were recorded and transcribed. Directive (deductive) and conventional (inductive) content analyses were used to apply knowledge from prior research and describe new information. Thematic analysis was used to organize key content, and triangulation was used to describe the intersections between patient and clinician perspectives. Results Thirty-six patients were interviewed (of 76 sampled; mean [SD] age, 47.3 [17.9] years; 19 [53%] were male; 27 [75%] were White; 3 [8%] were Black; and 1 [3%] was Latinx or Hispanic. Sixteen participants had reported firearm access and 15 had reported thoughts of self-harm on the questionnaire used for sampling. Thirty clinicians were interviewed (of 51 sampled) (mean [SD] age, 44.3 [12.1] years; 24 [80%] were female; 18 [60%] were White; 5 [17%] were Asian or Pacific Islander; and 4 [13%] were Latinx or Hispanic) including 25 LICSWs and 5 RNs. Key organizing themes included perceived value of standardized questions about firearm access, challenges of asking and answering, and considerations for practice improvement. Clinician interview themes largely converged and/or complemented patient interviews. Conclusions and Relevance In this qualitative study using semistructured interviews with patients and clinicians, a standardized question about firearm access was found to encourage dialogue about firearm access. Respondents underscored the importance of nonjudgmental acknowledgment of patients' reasons for firearm access as key to patient-centered practice improvement.
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Affiliation(s)
- Julie E. Richards
- Kaiser Permanente Washington Health Research Institute, Seattle,Department of Health Systems & Population Health, School of Public Health, University of Washington, Seattle
| | - Elena S. Kuo
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Ursula Whiteside
- Psychiatry and Behavioral Sciences, University of Washington, Seattle,NowMattersNow.org, Seattle, Washington
| | - Lisa Shulman
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Rebecca Parrish
- Kaiser Permanente Washington Department of Mental Health & Wellness, Seattle
| | | | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle,Harborview Injury Prevention & Research Center, Seattle, Washington
| | - Gregory E. Simon
- Kaiser Permanente Washington Health Research Institute, Seattle,Psychiatry and Behavioral Sciences, University of Washington, Seattle,Kaiser Permanente Washington Department of Mental Health & Wellness, Seattle
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Thomas AC, Siry-Bove BJ, Barnard LM, Rooney L, McCarthy M, Mustafa A, Rowhani-Rahbar A, Rivara FP, Betz ME, Knoepke C. A Qualitative study on diverse perspectives and identities of firearm owners. Inj Prev 2022; 28:434-439. [PMID: 35470245 PMCID: PMC9492625 DOI: 10.1136/injuryprev-2022-044522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/05/2022] [Accepted: 04/01/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Research surrounding firearm ownership is often contextualised within the perspectives of older white men. We expand this description using the perceptions of a diverse group of firearm-owning stakeholders. METHODS We conducted semistructured interviews from October 2020 to May 2021 with Colorado/Washington State stakeholders representing (1) firearm ranges/retailers; (2) law enforcement agencies or (3) relevant state/national firearm organisations. Data were analysed using standard qualitative techniques and included 25 participants, representing varied sociocultural groups including racial and ethnic minorities, political minorities and sexual minorities. RESULTS Participants for this analysis were of different self-identified sociocultural groups including racial and ethnic minorities (African American, Hispanic and Asian), political minorities (liberal) and sexual minorities, defined as Lesbian, Gay, Bisexual, and Transgender (LGBT). Perspectives on firearm ownership included an idea of gun culture as a component of (1) personal identity, (2) an expression of full citizenship and (3) necessary for self-protection. A strong subtheme was the intersection of minority group and firearm owner identities, creating a need for divergent social communities because of ideas on traditional gun culture. These communities are a safe place for individuals belonging to minority groups to escape negative external and internal group associations with firearms. CONCLUSION Perspectives on firearms and firearm ownership in the secondary analysis were heterogeneous and related to personal experiences, external and internal group pressures that influence individual behaviour. Understanding the breadth of perspectives on firearm ownership is imperative to engaging individuals for risk reduction. This study adds to the literature by expanding an understanding of the motivation for firearm ownership among diverse communities.
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Affiliation(s)
- Arielle C Thomas
- American College of Surgeons, Chicago, Wisconsin, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bonnie J Siry-Bove
- Emergency Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Leslie M Barnard
- Department of Epidemiology, University of Colorado Health, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Lauren Rooney
- Firearm Injury and Policy Research, University of Washington School of Medicine, Seattle, Washington, USA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
| | - Megan McCarthy
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Ayah Mustafa
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
- Firearm Injury and Policy Research, University of Washington Seattle Campus, Seattle, Washington, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Frederick P Rivara
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Christopher Knoepke
- Department of Cardiology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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Abstract
This Viewpoint discusses lethal means safety (LMS), an approach to reducing suicide risk by reducing access to firearms by at-risk individuals; highlights challenges in implementing LMS interventions in clinical settings; and provides examples of programs and resources for preventing firearm suicide at the individual, patient group, and population level.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado Anschutz School of Medicine, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora
| | | | - Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Veterans Health Administration, Aurora, Colorado
- Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora
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Boggs JM, Quintana LM, Beck A, Clinch S, Richardson L, Conley A, Richards JE, Betz ME. “Lock to Live” for firearm and medication safety: Feasibility and acceptability of a suicide prevention tool in a learning healthcare system. Front Digit Health 2022; 4:974153. [PMID: 36148209 PMCID: PMC9485577 DOI: 10.3389/fdgth.2022.974153] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveFew patients with suicide risk are counseled on lethal means safety by health providers. This study tested the feasibility of different delivery methods for Lock to Live (L2L), a web-based decision aid of safe storage options for firearms and medications.MethodsPatients reporting suicide ideation on the PHQ9 depression screener during outpatient health visits were included. Invitation messages to visit L2L were sent via combinations of email, text, Electronic Health Record (EHR) message, mailed letter, or provider referral, followed by a survey about storage behavior and acceptability. Provider interviews evaluated logistical considerations and acceptability.ResultsThe population-based method reached 2,729 patients and the best method (EHR message plus 2 email reminders) had 11% uptake (L2L visitation rate). Provider referral had small reach (14 patients) and 100% uptake (all visited). Provider interviews identified several strategies to promote uptake including: EHR reminders, provider training, quality metrics with accountability, a clearly communicated lethal means screening/counseling policy, and strong organizational leadership support.ConclusionDespite the low uptake for population-based (11%), far more patients with suicide risk were engaged in the L2L tool through population-based outreach than provider-referral over the same time frame.
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Affiliation(s)
- Jennifer M. Boggs
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, United States
- Correspondence: Jennifer M. Boggs
| | - LeeAnn M. Quintana
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, United States
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, United States
| | - Samuel Clinch
- Kaiser Permanente Colorado Behavioral Health Department, Denver, CO, United States
| | - Laura Richardson
- Kaiser Permanente Colorado Behavioral Health Department, Denver, CO, United States
| | - Amy Conley
- Kaiser Permanente Colorado Behavioral Health Department, Denver, CO, United States
| | - Julie E. Richards
- Kaiser Permanente Washington Heath Research Institute, Seattle, WA, United States
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Betz ME, Rooney LA, Barnard LM, Siry‐Bove BJ, Brandspigel S, McCarthy M, Simeon K, Meador L, Rivara FP, Rowhani‐Rahbar A, Knoepke CE. Voluntary, temporary, out-of-home firearm storage: A qualitative study of stakeholder views. Suicide Life Threat Behav 2022; 52:655-667. [PMID: 35224749 PMCID: PMC9378345 DOI: 10.1111/sltb.12850] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/16/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reducing firearm access during times of risk is a key component of suicide prevention, including the person at risk voluntarily, temporarily storing firearms outside the home. However, this approach relies on the participation of storage providers (ranges/retailers and law enforcement agencies (LEAs)). Our objective was to describe stakeholders' views and experiences surrounding voluntary, temporary out-of-home firearm storage for suicide prevention. METHOD We conducted individual interviews with (1) firearm ranges/retailers; (2) LEAs (in Colorado or Washington State); and (3) state/national organizations involved in policy development or enactment; public health; or firearm rights. Transcripts were analyzed using a team-based mixed inductive-deductive approach. RESULTS Across 100 interviews (October-May 2021), potential storage providers were supportive of voluntary storage programs, often reporting a desire to help their customers and community. However, potential storage suppliers cited civil liability, regulatory, and legal concerns associated with storing and/or returning firearms (to people who had previously expressed suicide risk). Stakeholders offered suggested strategies meant to address liability and increase storage accessibility. CONCLUSIONS Understanding stakeholder views supports the development of acceptable, feasible programs for out-of-home firearm storage during times of suicide risk. Clarification of existing regulations or creation of new policies is necessary to address potential providers' concerns.
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Affiliation(s)
- Marian E. Betz
- Department of Emergency MedicineSchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA,Injury and Violence Prevention CenterColorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA,VA Eastern Colorado Geriatric Research Education and Clinical CenterDenverColoradoUSA
| | - Lauren A. Rooney
- Firearm Injury Policy and Research ProgramHarborview Injury Prevention and Research CenterUniversity of WashingtonSeattleWashingtonUSA
| | - Leslie M. Barnard
- Department of Emergency MedicineSchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA,Department of EpidemiologyColorado School of Public HealthAuroraColoradoUSA
| | - Bonnie J. Siry‐Bove
- Department of Emergency MedicineSchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Sara Brandspigel
- Injury and Violence Prevention CenterColorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Megan McCarthy
- Department of Emergency MedicineSchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Kate Simeon
- Denver Health Emergency Medicine ResidencyDenver Health and Hospital AuthorityDenverColoradoUSA
| | - Lauren Meador
- Department of Emergency MedicineSchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Frederick P. Rivara
- Firearm Injury Policy and Research ProgramHarborview Injury Prevention and Research CenterUniversity of WashingtonSeattleWashingtonUSA
| | - Ali Rowhani‐Rahbar
- Firearm Injury Policy and Research ProgramHarborview Injury Prevention and Research CenterUniversity of WashingtonSeattleWashingtonUSA,Department of EpidemiologySchool of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Christopher E. Knoepke
- Division of CardiologySchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA,Adult & Child Consortium for Outcomes Research & Delivery ScienceSchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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Betz ME, Brandspigel S, Barnard LM, Johnson RL, Knoepke CE, Peterson RA, Rivara FP, Rowhani-Rahbar A. Voluntary, temporary out-of-home firearm storage: a survey of law enforcement agencies in two states. Inj Epidemiol 2022; 9:24. [PMID: 35864502 PMCID: PMC9302866 DOI: 10.1186/s40621-022-00389-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Temporary, voluntary storage of firearms away from the home during times of risk is a recommended strategy for suicide prevention. Law enforcement agencies (LEAs) are often suggested as storage sites, and online maps in Colorado and Washington display LEAs willing to consider storage. Questions remain about the experiences and views of LEAs, including barriers to providing storage. Methods LEAs in Colorado and Washington were invited to complete a survey via mail or online from June to July 2021; invitations were sent by email and mail, with telephone calls to non-responders. Survey data were analyzed using descriptive statistics, with testing between states and other subgroups using Fisher’s exact tests. Results Overall, 168 LEAs in Colorado (n = 91) or Washington (n = 77) participated (40% participation rate). Of those, 53% provided temporary, voluntary storage upon request by community members at the time of the survey. More LEAs said they had ever provided storage when the requester was under a court order (74% overall). Over half (60%) of responding LEAs had received at least one storage request in the prior 12 months. Many (41%) said they had declined to return a firearm after temporary storage due to safety concerns. Most LEAs supported engagement in suicide prevention (89%) and provision of community services (77%), but they simultaneously preferred being a storage option of last resort (73%). Factors negatively influencing storage provision included liability and funding concerns. Conclusions In Colorado and Washington, half of LEAs currently offer temporary, voluntary firearm storage upon request. While LEAs support suicide prevention and community engagement, broader provision of storage and participation in online maps may be limited by logistic, liability, and financial concerns. Addressing these barriers may facilitate broader suicide prevention efforts. Supplementary Information The online version contains supplementary material available at 10.1186/s40621-022-00389-3.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA.
| | - Sara Brandspigel
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Leslie M Barnard
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Rachel L Johnson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Christopher E Knoepke
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ryan A Peterson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Frederick P Rivara
- Firearm Injury Policy and Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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Betz ME, Boggs JM, Goss FR. Predicting Firearm Suicide-Small Steps Forward With Big Data. JAMA Netw Open 2022; 5:e2223758. [PMID: 35816308 DOI: 10.1001/jamanetworkopen.2022.23758] [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)
- Marian E Betz
- School of Medicine, Department of Emergency Medicine, University of Colorado, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora
| | - Jennifer M Boggs
- Kaiser Permanente Colorado, Institute for Health Research, Aurora
| | - Foster R Goss
- School of Medicine, Department of Emergency Medicine, University of Colorado, Aurora
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Betz ME, Fowler NR, Han SD, Hill LL, Johnson RL, Meador L, Omeragic F, Peterson RA, DiGuiseppi C. Impact of the COVID-19 Pandemic on Older Adult Driving in the United States. J Appl Gerontol 2022; 41:1821-1830. [PMID: 35583182 DOI: 10.1177/07334648221091556] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To examine how the COVID-19 pandemic affected driving and health outcomes in older adults. METHODS We compared Advancing Understanding of Transportation Options (AUTO) study participants enrolled before (December 2019 to March 2020) versus during the pandemic (May 2020 to June 2021). Participants were English-speaking, licensed drivers (≥70 years) who drove weekly and had a primary care provider at a study site and ≥1 medical condition potentially associated with driving cessation. We used baseline self-reported measures on mobility and health. RESULTS Compared to those enrolled pre-COVID-19 (n = 61), more participants enrolled during COVID-19 (n = 240) reported driving reductions (26% vs. 70%, p < .001) and more often for personal preference (vs. medical/emotional reasons). While mean social isolation was higher during than pre-COVID-19, self-reported depression, stress, and overall health PROMIS scores did not differ significantly. DISCUSSION Our findings highlight the resiliency of some older adults and have implications for mitigating the negative effects of driving cessation.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Nicole R Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana University Center for Aging Research, Indiana University Center for Aging Research, Indianapolis, IN, USA
| | - S Duke Han
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Linda L Hill
- School of Public Health, University of California San Diego, San Diego, CA, USA
| | - Rachel L Johnson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Lauren Meador
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Faris Omeragic
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Ryan A Peterson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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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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Betz ME, Hill LL, Fowler NR, DiGuiseppi C, Han SD, Johnson RL, Meador L, Omeragic F, Peterson RA, Matlock DD. "Is it time to stop driving?": A randomized clinical trial of an online decision aid for older drivers. J Am Geriatr Soc 2022; 70:1987-1996. [PMID: 35441700 DOI: 10.1111/jgs.17791] [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] [Revised: 02/24/2022] [Accepted: 03/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many older adults face the difficult decision of when to stop driving. We sought to test whether an online driving decision aid (DDA) would improve decision quality. METHODS This prospective two-arm randomized trial enrolled English-speaking licensed drivers (age ≥70 years) without significant cognitive impairment but with ≥1 diagnosis associated with increased likelihood of driving cessation; all participants received primary care in clinics associated with study sites in three states. The intervention was the online Healthwise® DDA for older adults addressing "Is it time to stop driving?"; control was web-based information for older drivers only. The primary outcome was decision conflict as estimated by the Decisional Conflict Scale (DCS; lower scores indicate higher quality). Secondary outcomes were knowledge and decision self-efficacy about driving decisions. We examined postrandomization differences in primary and secondary outcomes by study arm using generalized linear mixed-effects models with adjustment for site and prerandomization scores. RESULTS Among 301 participants (mean age: 77.1 years), 51.2% identified as female and the majority as non-Hispanic (99.0%) and white (95.3%); 98.0% lived in an urban area. Participant characteristics were similar by study arm but differed across sites. Intervention participants had a lower mean DCS score (12.3 DDA vs 15.2 control; adjusted mean ratio [AMR] 0.76, 95%CI 0.61-0.95; p = 0.017). Intervention participants had higher mean knowledge scores (88.9 DDA vs. 79.9 control; OR 1.13, 95%CI 1.01-1.27, p = 0.038); there was no difference between groups in self-efficacy scores. The DDA had high acceptability; 86.9% of those who viewed it said they would recommend it to others in similar situations. CONCLUSIONS The online Healthwise® DDA decreased decision conflict and increased knowledge in this sample of English-speaking, older adults without significant cognitive impairment, although most chose to continue driving. Use of such resources in clinical or community settings may support older adults as they transition from driving to other forms of mobility. TRIAL REGISTRATION ClinicalTrials.gov identifier "Advancing Understanding of Transportation Options (AUTO)" NCT04141891.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA.,Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Linda L Hill
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Nicole R Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indiana University Center for Aging Research, Indianapolis, Indiana, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - S Duke Han
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Rachel L Johnson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Lauren Meador
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Faris Omeragic
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Ryan A Peterson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Daniel D Matlock
- Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.,Division of Geriatric Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA
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Polzer ER, Nearing KA, Knoepke CE, Matlock DD, Betz ME. Firearm access and dementia: A qualitative study of reported behavioral disturbances and responses. J Am Geriatr Soc 2022; 70:439-448. [PMID: 34590304 PMCID: PMC8821127 DOI: 10.1111/jgs.17496] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cognitive impairment and behavioral changes associated with Alzheimer's disease and related dementias (ADRDs) can impair safe firearm handling ability, an issue that can be challenging for ADRD caregivers to address. In this qualitative analysis, we sought to explore behavioral disruptions that raise concerns about firearm access in dementia and how caregivers react and respond. METHODS Secondary qualitative analysis using data from semi-structured, one-on-one interviews originally conducted as part of a study to develop firearm safety educational materials for ADRD caregivers. Interviewees were English-speaking adults (≥18 years) from three stakeholder groups: ADRD caregivers (professional or informal), medical professionals (geriatricians, neurologists), and firearm professionals (retailers, range employees, instructors). For secondary analysis, transcripts of interviews were recoded and analyzed after an inductive-deductive thematic analysis process. RESULTS Among 24 participants, 17 (70%) were female and 20 (83%) white; 13 (54%) had personal or professional experience with ADRD caregiving; and 5 (21%) had a firearm affiliation. Major themes were: (1) behavioral disturbances that make caregivers concerned about firearm access; (2) caregiver emotional responses to and difficulties associated with these disturbances; and (3) caregiver actions (planned or actual) to limit firearms access. CONCLUSION Various behavioral disturbances and emotional burdens can trigger ADRD caregiver concern about firearms access, but strategies exist for restricting or safeguarding firearms in the home. Study findings suggest a need for caregiver support on this topic, including counseling by healthcare providers, advance planning for older firearm owners, and development of community resources.
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Affiliation(s)
- Evan R. Polzer
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, 80045
| | - Kathryn A. Nearing
- Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado, School of Medicine, Aurora, CO, 80045,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, 80045
| | - Christopher E. Knoepke
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, CO, 80045, Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO, 80045
| | - Daniel D. Matlock
- Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado, School of Medicine, Aurora, CO, 80045, Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO, 80045,Division of Geriatric Medicine, University of Colorado, School of Medicine, Aurora, CO, 80045
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, 80045,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, 80045
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Prater LC, Mills B, Bowen AG, Rooney L, Cheung A, Betz ME, Rowhani-Rahbar A. Firearm Suicide Among Persons With Terminal Illness. J Pain Symptom Manage 2022; 63:e260-e263. [PMID: 34774987 DOI: 10.1016/j.jpainsymman.2021.10.017] [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: 10/19/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Laura C Prater
- Department of Psychiatry and Behavioral Sciences (L.C.P.), School of Medicine, University of Washington, Seattle, Washington, USA; Firearm Injury & Policy Research Program (L.C.P., B.M., A.G.B., L.R., A.R.R.), Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Department of Global Health, School of Public Health (A.C.), University of Washington, Seattle, Washington, USA; Department of Biochemistry (A.C.), University of Washington, Seattle, Washington, USA; Department of Emergency Medicine (M.E.B.), University of Colorado School of Medicine, Denver, Colorado, USA; Department of Epidemiology, School of Public Health (A.R.R.), University of Washington, Seattle, Washington, USA.
| | - Brianna Mills
- Department of Psychiatry and Behavioral Sciences (L.C.P.), School of Medicine, University of Washington, Seattle, Washington, USA; Firearm Injury & Policy Research Program (L.C.P., B.M., A.G.B., L.R., A.R.R.), Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Department of Global Health, School of Public Health (A.C.), University of Washington, Seattle, Washington, USA; Department of Biochemistry (A.C.), University of Washington, Seattle, Washington, USA; Department of Emergency Medicine (M.E.B.), University of Colorado School of Medicine, Denver, Colorado, USA; Department of Epidemiology, School of Public Health (A.R.R.), University of Washington, Seattle, Washington, USA
| | - Andrew G Bowen
- Department of Psychiatry and Behavioral Sciences (L.C.P.), School of Medicine, University of Washington, Seattle, Washington, USA; Firearm Injury & Policy Research Program (L.C.P., B.M., A.G.B., L.R., A.R.R.), Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Department of Global Health, School of Public Health (A.C.), University of Washington, Seattle, Washington, USA; Department of Biochemistry (A.C.), University of Washington, Seattle, Washington, USA; Department of Emergency Medicine (M.E.B.), University of Colorado School of Medicine, Denver, Colorado, USA; Department of Epidemiology, School of Public Health (A.R.R.), University of Washington, Seattle, Washington, USA
| | - Lauren Rooney
- Department of Psychiatry and Behavioral Sciences (L.C.P.), School of Medicine, University of Washington, Seattle, Washington, USA; Firearm Injury & Policy Research Program (L.C.P., B.M., A.G.B., L.R., A.R.R.), Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Department of Global Health, School of Public Health (A.C.), University of Washington, Seattle, Washington, USA; Department of Biochemistry (A.C.), University of Washington, Seattle, Washington, USA; Department of Emergency Medicine (M.E.B.), University of Colorado School of Medicine, Denver, Colorado, USA; Department of Epidemiology, School of Public Health (A.R.R.), University of Washington, Seattle, Washington, USA
| | - Angel Cheung
- Department of Psychiatry and Behavioral Sciences (L.C.P.), School of Medicine, University of Washington, Seattle, Washington, USA; Firearm Injury & Policy Research Program (L.C.P., B.M., A.G.B., L.R., A.R.R.), Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Department of Global Health, School of Public Health (A.C.), University of Washington, Seattle, Washington, USA; Department of Biochemistry (A.C.), University of Washington, Seattle, Washington, USA; Department of Emergency Medicine (M.E.B.), University of Colorado School of Medicine, Denver, Colorado, USA; Department of Epidemiology, School of Public Health (A.R.R.), University of Washington, Seattle, Washington, USA
| | - Marian E Betz
- Department of Psychiatry and Behavioral Sciences (L.C.P.), School of Medicine, University of Washington, Seattle, Washington, USA; Firearm Injury & Policy Research Program (L.C.P., B.M., A.G.B., L.R., A.R.R.), Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Department of Global Health, School of Public Health (A.C.), University of Washington, Seattle, Washington, USA; Department of Biochemistry (A.C.), University of Washington, Seattle, Washington, USA; Department of Emergency Medicine (M.E.B.), University of Colorado School of Medicine, Denver, Colorado, USA; Department of Epidemiology, School of Public Health (A.R.R.), University of Washington, Seattle, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Psychiatry and Behavioral Sciences (L.C.P.), School of Medicine, University of Washington, Seattle, Washington, USA; Firearm Injury & Policy Research Program (L.C.P., B.M., A.G.B., L.R., A.R.R.), Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Department of Global Health, School of Public Health (A.C.), University of Washington, Seattle, Washington, USA; Department of Biochemistry (A.C.), University of Washington, Seattle, Washington, USA; Department of Emergency Medicine (M.E.B.), University of Colorado School of Medicine, Denver, Colorado, USA; Department of Epidemiology, School of Public Health (A.R.R.), University of Washington, Seattle, Washington, USA
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Richards JE, Boggs JM, Rowhani-Rahbar A, Kuo E, Betz ME, Bobb JF, Simon GE. Patient-Reported Firearm Access Prior to Suicide Death. JAMA Netw Open 2022; 5:e2142204. [PMID: 35006250 PMCID: PMC8749466 DOI: 10.1001/jamanetworkopen.2021.42204] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Julie E. Richards
- Kaiser Permanente Washington Heath Research Institute, Seattle, Washington
- Department of Health Services, University of Washington, Seattle
| | | | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
- Firearm Injury and Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington
| | - Elena Kuo
- Kaiser Permanente Washington Heath Research Institute, Seattle, Washington
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Jennifer F. Bobb
- Kaiser Permanente Washington Heath Research Institute, Seattle, Washington
| | - Gregory E. Simon
- Kaiser Permanente Washington Heath Research Institute, Seattle, Washington
- Psychiatry and Behavioral Sciences, University of Washington, Seattle
- Kaiser Permanente Washington Department of Mental Health & Wellness, Seattle, Washington
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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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Lynch L, Mielenz TJ, Li G, Eby DW, Molnar LJ, Betz ME, DiGuiseppi C, Hill LL, Jones V, Strogatz D. Rate of Social Isolation by Geographic Location Among Older Adults: AAA LongROAD Study. Front Public Health 2021; 9:791683. [PMID: 34957037 PMCID: PMC8702723 DOI: 10.3389/fpubh.2021.791683] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction: Social isolation is a modifiable risk factor for negative health outcomes among older adults. This work assessed the relationship between geography (i.e., urban vs. non-urban residence) and social isolation in a cohort of older drivers. Methods: The AAA LongROAD cohort with 2,989 older adult drivers from across the country were included. Social isolation was measured at baseline and at two subsequent annual follow-ups using PROMIS v2.0 Social Isolation 4a. The effect of geographic location with social isolation was assessed through with multivariable regression using a generalized estimating equation model. Results: The rate of social isolation in urban areas was 21% lower (adjusted RR 0.79, 95% CI 0.46, 1.36) compared to non-urban areas after adjusting for covariates, though not significant. Discussion: Social isolation is a predictor of poor health outcomes and geographic considerations have been lacking in the literature. The panel data in this analysis provides more evidence for causality though the under-representation of non-urban areas potentially reduces the power for the results. Conclusions: It is important to understand the needs and risk of social isolation in various geographic settings to ensure resources and interventions are appropriately modified for a greater public health impact.
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Affiliation(s)
- Laura Lynch
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Thelma J Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States.,Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States
| | - David W Eby
- Transportation Research Institute, University of Michigan, Ann Arbor, MI, United States
| | - Lisa J Molnar
- Transportation Research Institute, University of Michigan, Ann Arbor, MI, United States
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States
| | - Linda L Hill
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Vanya Jones
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - David Strogatz
- Bassett Research Institute, Mary Imogene Bassett Hospital, Cooperstown, NY, United States
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Betz ME, Harkavy-Friedman J, Dreier FL, Pincus R, Ranney ML. Talking About "Firearm Injury" and "Gun Violence": Words Matter. Am J Public Health 2021; 111:2105-2110. [PMID: 34878863 PMCID: PMC8667825 DOI: 10.2105/ajph.2021.306525] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Marian E Betz
- Marian E. Betz is with the University of Colorado Anschutz Medical Campus and the VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora. Jill Harkavy-Friedman is with the American Foundation for Suicide Prevention, New York, NY. Fatimah Loren Dreier is with the Health Alliance for Violence Intervention, Philadelphia, PA. Rob Pincus is with the Second Amendment Organization, San Antonio, TX; Walk The Talk America, Las Vegas, NV; and the Center for Gun Rights & Responsibilities, New York, NY. Megan L. Ranney is with the Alpert Medical School, Brown University, Providence, RI
| | - Jill Harkavy-Friedman
- Marian E. Betz is with the University of Colorado Anschutz Medical Campus and the VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora. Jill Harkavy-Friedman is with the American Foundation for Suicide Prevention, New York, NY. Fatimah Loren Dreier is with the Health Alliance for Violence Intervention, Philadelphia, PA. Rob Pincus is with the Second Amendment Organization, San Antonio, TX; Walk The Talk America, Las Vegas, NV; and the Center for Gun Rights & Responsibilities, New York, NY. Megan L. Ranney is with the Alpert Medical School, Brown University, Providence, RI
| | - Fatimah Loren Dreier
- Marian E. Betz is with the University of Colorado Anschutz Medical Campus and the VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora. Jill Harkavy-Friedman is with the American Foundation for Suicide Prevention, New York, NY. Fatimah Loren Dreier is with the Health Alliance for Violence Intervention, Philadelphia, PA. Rob Pincus is with the Second Amendment Organization, San Antonio, TX; Walk The Talk America, Las Vegas, NV; and the Center for Gun Rights & Responsibilities, New York, NY. Megan L. Ranney is with the Alpert Medical School, Brown University, Providence, RI
| | - Rob Pincus
- Marian E. Betz is with the University of Colorado Anschutz Medical Campus and the VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora. Jill Harkavy-Friedman is with the American Foundation for Suicide Prevention, New York, NY. Fatimah Loren Dreier is with the Health Alliance for Violence Intervention, Philadelphia, PA. Rob Pincus is with the Second Amendment Organization, San Antonio, TX; Walk The Talk America, Las Vegas, NV; and the Center for Gun Rights & Responsibilities, New York, NY. Megan L. Ranney is with the Alpert Medical School, Brown University, Providence, RI
| | - Megan L Ranney
- Marian E. Betz is with the University of Colorado Anschutz Medical Campus and the VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora. Jill Harkavy-Friedman is with the American Foundation for Suicide Prevention, New York, NY. Fatimah Loren Dreier is with the Health Alliance for Violence Intervention, Philadelphia, PA. Rob Pincus is with the Second Amendment Organization, San Antonio, TX; Walk The Talk America, Las Vegas, NV; and the Center for Gun Rights & Responsibilities, New York, NY. Megan L. Ranney is with the Alpert Medical School, Brown University, Providence, RI
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Polzer E, Nearing K, Knoepke CE, Matlock DD, McCourt A, Betz ME. "Firearm access in dementia: legal and logistic challenges for caregivers". Int Rev Psychiatry 2021; 33:653-661. [PMID: 33792478 PMCID: PMC8484338 DOI: 10.1080/09540261.2021.1887098] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
The prevalence of Alzheimer's disease and related dementias (ADRD) is increasing. In the United States, older adults are among those most likely to have firearms in the home. Addressing firearm access among persons with ADRD can be confusing and stressful for family caregivers, healthcare providers, firearm industry representatives and law enforcement. This study sought to examine key stakeholder perspectives concerning legal and logistic considerations for temporary firearm transfers when a person with ADRD owned firearms. A secondary analysis of 24 qualitative interviews conducted to inform the development of a firearm safety tool for ADRD caregivers revealed four types of barriers. These barriers were each associated with logistical challenges and legal ambiguities that hampered ADRD-related firearm transfers: (1) legal questions on firearm ownership and permitted transferees; (2) transfer logistics and duration; (3) issues of engaging law enforcement or retailers for transfers; and, (4) lack of information resources and guidance. Siloes between stakeholder groups persist and limit information sharing. Broad initiatives engaging caregivers, older adults, clinicians, aging service providers, law enforcement, and firearm outlets could inform the development of policies, programs, and practices to enhance the safety and well-being of people with ADRD and their caregivers.
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Affiliation(s)
- Evan Polzer
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Kathryn Nearing
- Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado, School of Medicine, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Christopher E. Knoepke
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, CO
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Daniel D. Matlock
- Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado, School of Medicine, Aurora, CO, USA
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, CO
- Division of Geriatric Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Alexander McCourt
- Johns Hopkins Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
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Barnard LM, McCarthy M, Knoepke CE, Kaplan S, Engeln J, Betz ME. Colorado's first year of extreme risk protection orders. Inj Epidemiol 2021; 8:59. [PMID: 34670617 PMCID: PMC8527814 DOI: 10.1186/s40621-021-00353-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Extreme Risk Protection Orders (ERPOs) are a relatively new type of law that are being considered or implemented in many states in the United States. Colorado’s law went into effect on January 1, 2020, after significant controversy and concern over potential misuse of the law to confiscate weapons; many (n = 37 of 64) counties declared themselves “2nd Amendment (2A) sanctuaries” and said they would not enforce the law. Here, reviewed the patterns of use of the law during its first year. Methods We obtained all court records for ERPO petitions filed between January 1 and December 31, 2020. Data elements were abstracted by trained staff using a standardized guide. We calculated the proportion of petitions that were approved or denied/dismissed, identified cases of obvious misuse, and examined patterns by 2A county status. Finding and results In 2020, 109 ERPO petitions were filed in Colorado; of these, 61 were granted for a temporary ERPO and 49 for a full (year-long) ERPO. Most petitions filed by law enforcement officers were granted (85%), compared to only 15% of petitions filed by family or household members. Of the 37 2A sanctuary counties, 24% had at least one petition filed, versus 48% of non-2A sanctuary counties. Across the 2A counties, there were 1.52 ERPOs filed per 100,000 population, compared to 2.05 ERPOs filed per 100,000 in non-2A counties. There were 4 cases of obvious law misuse; none of those petitions resulted in an ERPO or firearm confiscation. Conclusion State-level studies suggest ERPOs may prevent firearm injuries. Robust implementation, however, is critical for maximal effect. Understanding ERPO experiences and challenges can inform policy creation and enaction in other states, including identifying how best to address concerns and facilitate evaluation.
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Affiliation(s)
- Leslie M Barnard
- Department of Epidemiology, Colorado School of Public Health, Leslie Barnard, 3438 N Gilpin Street, Denver, CO, 80205, USA. .,Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Megan McCarthy
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christopher E Knoepke
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sabrina Kaplan
- Denver Health Emergency Medicine Residency, Denver Health Medical Center, Denver, CO, USA
| | - James Engeln
- Denver Health Emergency Medicine Residency, Denver Health Medical Center, Denver, CO, USA
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
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50
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Asarnow JR, Zullo L, Ernestus SM, Venables CW, Goldston DB, Tunno AM, Betz ME. "Lock and Protect": Development of a Digital Decision Aid to Support Lethal Means Counseling in Parents of Suicidal Youth. Front Psychiatry 2021; 12:736236. [PMID: 34690841 PMCID: PMC8528190 DOI: 10.3389/fpsyt.2021.736236] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/27/2021] [Indexed: 12/31/2022] Open
Abstract
Objective: Reducing access to lethal methods is an effective suicide prevention strategy that is often neglected in routine care. Digital interventions have shown promise for addressing such gaps in care; and decision aids have proven useful for supporting complicated health-related decisions, like those involving lethal means restriction. This article describes a parent/caregiver-facing web-based decision aid, the development process, and user testing. Method: A user-centered, participatory, mixed methods development design was employed. Beginning with an adult-focused decision aid developed by members of our team, we assessed ten iterations of the parent/caregiver decision aid with stakeholders (N = 85) using qualitative interviews and quantitative surveys. Stakeholders included: parents/caregivers whose children had histories of suicidal episodes before age 25, young adults with histories of suicidal thoughts/behaviors, firearm owners/representatives from firearm stores/ranges/groups, mental and medical health care providers, and emergency responders. Results: The final "Lock and Protect" decision aid was viewed as "useful for changing access to lethal means" by 100% of participants. Ninety-four percent of participants rated the information on reducing access to lethal means as good to excellent, and 91% rated the information on storage options as good to excellent. Qualitative feedback underscored a preference for offering this digital tool with a "human touch," as part of safety and discharge planning. Conclusions: "Lock and Protect" is a user-friendly web-based tool with potential for improving rates of lethal means counseling for parents/caregivers of suicidal youth and ultimately reducing pre-mature deaths by suicide.
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Affiliation(s)
- Joan R Asarnow
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lucas Zullo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Chase W Venables
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Angela M Tunno
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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