Evaluating the Feasibility of a Novel Firearm Injury Prevention Program for Pre-adolescent Children Through Health Care and Community-Based Partnerships: The Future Healers Program Pilot Study

BACKGROUND

Firearm violence is an American public health crisis that negatively impacts children and disproportionately affects Black youth. Few firearm injury prevention programs have been described in pre-adolescent children. The Future Healers Program is a novel collaboration constructed via partnership between the medical school, trauma center, academic surgery department, and local non-profit community organization. Our study sought to evaluate if (1) partnering with community organizations facilitated recruitment of children with prior exposure to firearm violence and (2) the health care community was a potential trusted partner appropriate for program delivery.

METHODS

Children aged 4-13 were recruited to join the program via news outlets and social media and in partnership with a local non-profit organization. Of the children and parents participating in the program, 48% (44/92) and 59% (38/64), respectively, completed an IRB-approved survey study. Pearson's chi-square, percentages, and 95% confidence intervals evaluated differences between children and caregivers on sociodemographic characteristics, firearm exposure (FE), firearm violence exposure (FVE), and perception of health care. Participant's residence was geocoded in relationship to incidents of firearm injury (2008-2021) in the same region.

RESULTS

Caregivers (95%) and children (84%) reported substantial exposure to firearm violence and resided in areas with frequent firearm injury incidents. Notably, 82% of caregivers and 66% of children reported having a family member injured by gunfire. A high percentage of caregivers (79%) and children (91%) self-reported trust in the health care system.

CONCLUSION

Partnerships between community organizations and health care systems can develop prevention programs that effectively recruit and engage pre-adolescent children impacted by firearm violence.

The impact of historical racism on modern gun violence: Redlining in the city of Louisville, KY

BACKGROUND

The Home Owner's Loan Corporation (HOLC) was created in 1933 to provide government backing of troubled mortgages during the Great Depression. Residential security maps were created to guide investment in over 200 US cities. Neighborhoods were assigned grades of 'A' through 'D' (with corresponding color coding of green, blue, yellow and red) to indicate desirability for investment. Neighborhoods with a high percentage of African Americans or other minorities were frequently assigned grades of 'C' or 'D'. These maps are now most associated with redlining, or the process of denial of credit for real estate investment based on race. Resulting economic disparities endure in areas of many US cities today. We hypothesized that there would be a correlation between redlined areas on the 1937 map of Louisville, KY to the prevalence of gun violence today.

METHODS

Gunshot victims (GSV) and their residential addresses within the city of Louisville were examined between 2012 and 2018. GSVs were aggregated within census block groups to approximate neighborhoods. The spatial distribution of GSVs was analyzed against the original HOLC neighborhood grade. Additional control variables adapted from the 2013-2017 American Community Survey were included to account for other possible explanations for the spatial distribution of GSVs. A zero-inflated negative binomial regression with a spatial component was used to determine incidence rate ratios (IRR) for the relative likelihood of GSVs within neighborhoods.

RESULTS

Relative to green-graded neighborhoods, red-graded neighborhoods had five times as many GSVs. This difference remained statistically significant after accounting for differences in demographic, racial, and housing characteristics of the neighborhoods.

CONCLUSION

Redlined neighborhoods within Louisville, KY in 1937 had significantly more GSVs today. The impact of historical and institutional racism on modern gun violence merits acknowledgement and further study.

Employment and residential characteristics in relation to automated external defibrillator locations

BACKGROUND

Survival from out-of-hospital cardiac arrest (OHCA) is generally poor and varies by geography. Variability in automated external defibrillator (AED) locations may be a contributing factor. To inform optimal placement of AEDs, we investigated AED access in a major US city relative to demographic and employment characteristics.

METHODS AND RESULTS

This was a retrospective analysis of a Philadelphia AED registry (2,559 total AEDs). The 2010 US Census and the Local Employment Dynamics database by ZIP code was used. Automated external defibrillator access was calculated as the weighted areal percentage of each ZIP code covered by a 400-m radius around each AED. Of 47 ZIP codes, only 9% (4) were high-AED-service areas. In 26% (12) of ZIP codes, less than 35% of the area was covered by AED service areas. Higher-AED-access ZIP codes were more likely to have a moderately populated residential area (P = .032), higher median household income (P = .006), and higher paying jobs (P =. 008).

CONCLUSIONS

The locations of AEDs vary across specific ZIP codes; select residential and employment characteristics explain some variation. Further work on evaluating OHCA locations, AED use and availability, and OHCA outcomes could inform AED placement policies. Optimizing the placement of AEDs through this work may help to increase survival.

Has the NFL's Rooney Rule Efforts "Leveled the Field" for African American Head Coach Candidates?

Madden (2004) and Madden and Ruther (2009) provide evidence that African American National Football League (NFL) head coaches significantly out-performed their white counterparts between 1990 and 2002. They conclude that this evidence is consistent with the hypothesis that African Americans had to be better coaches than whites in order to be hired as a head coach in the NFL. In 2002, the NFL promulgated the Rooney Rule requiring NFL teams to interview a minority candidate when appointing new head coaches, as well as other affirmative efforts. This paper analyzes whether the performance advantage of African American head coaches has been eliminated in the time since the Rooney Rule's affirmative efforts have been in effect. The paper also examines racial differentials in performance in other NFL coaching positions that were less affected by Rooney Rule affirmative efforts, finding no similar time trends in performance differentials by race.

Strong optical activity from twisted-cross photonic metamaterials

Following a recent theoretical suggestion and microwave experiments, we fabricate photonic metamaterials composed of pairs of twisted gold crosses using two successive electron-beam-lithography steps and intermediate planarization via a spin-on dielectric. The resulting two effective resonances of the coupled system lie in the 1-2 microm wavelength regime and exhibit pronounced circular dichroism, while the circular polarization conversion is very small. In between the two resonances, we find a fairly broad spectral regime with strong optical activity, i.e., with a pure rotation of incident linear polarization. The measured optical transmittance spectra agree well with theory.

Access to hospital care for California and Michigan Medicaid recipients

This article is a comparison of the characteristics of hospitals serving the general population and Medicaid recipients in California and Michigan, using data from Medicaid uniform claims files and the American Hospital Association Annual Survey for 1984. A greater concentration of discharges in a small number of "high Medicaid volume" urban and rural hospitals in each State was observed for Medicaid recipients compared with the general population. In addition, discharge data suggest that Supplemental Security Income crossovers (individuals covered by both Medicaid and Medicare) and other recipients (mostly children not enrolled in the Aid to Families with Dependent Children program) receive inpatient care in different hospitals from the general population as well as from other Medicaid eligibility groups. Medicaid cost-containment policies and differential access to hospital care are discussed.

Use and cost of home health agency services under Medicare

Presented are 1986 data and trend data (1974-86) on the use and cost of home health agency services rendered to aged and disabled Medicare beneficiaries. Since 1974, reimbursements for these services have grown more rapidly than overall Medicare expenditures. From 1974 to 1986, Medicare expenditures for these services increased from $141 million to $1.8 billion, an average annual rate of 24 percent. HHA reimbursements, however, continue to represent only a small proportion (3.6 percent in 1986) of all Medicare expenditures.

Medicaid expenditures for the disabled under a work incentive program

Congress enacted Section 1619 of the Social Security Act to enable the disabled receiving Supplemental Security Income (SSI) to obtain jobs and still retain Medicaid health benefits. Congress intended this work incentive to remove the fear of the severely disabled that by obtaining employment they would lose Medicaid benefits. Based on data from 11 States, our analysis found that Medicaid expenditures for Section 1619 enrollees were relatively small and only one-half the average Medicaid expenditure for the disabled. Retaining Medicaid appears to provide a significant work incentive because Medicaid expenditures represent 13 percent of Section 1619 enrollees' earnings.

Medicaid Tape-to-Tape findings: California, New York, and Michigan, 1981

Presented in this report is an overview of Medicaid enrollment, utilization, and expenditures in California during 1981. The California Medicaid program, called Medi-Cal, is the largest in the Nation in terms of program beneficiaries. During 1981, California had one of the most generous Medicaid programs in the country in terms of eligibility and covered services. At the same time, there were benefit limitations and reimbursement restrictions in place that were designed to restrict program expenditures. The data in this report were provided by the State to the Health Care Financing Administration as part of the Medicaid Tape-to-Tape Project. Data from Michigan and New York are also included for comparison purposes.

Medicare use and cost of short-stay hospital services by enrollees with cataract, 1984

In this article, we present data on aged and disabled Medicare hospital insurance enrollees discharged with the principal diagnosis of cataract from short-stay hospitals. Medical technology has reduced the risk of cataract surgery and the time needed to perform the surgery. As a result, the number of enrollees undergoing cataract surgery has increased. Also, such surgery has been shifted from inpatient hospitals to outpatient facilities. However, outpatient reimbursement for cataract surgery often equals or exceeds inpatient payments. To address this inequity, Congress legislated payment limits for cataract surgery.

Equal treatment and unequal benefits: a re-examination of the use of Medicare services by race, 1967-1976

In the early years of the Medicare program, proportionally more whites than non-whites among the aged used Medicare services. This article examines the use and reimbursement of Medicare services by the aged between 1967 and 1976 to determine if racial differences still exist. To do so, three measures are studied. The first, the number of persons reimbursed for Medicare service per 1,000 enrollees, measures access to Medicare's reimbursement system. The second, reimbursement per person using reimbursed services, measures the amount of reimbursement received after persons exceed Medicare deductibles. The third, reimbursement per enrollee, indicates the combined effect of access and reimbursement and represents a measure of equity for the population at risk. Analysis of the three measures by type of Medicare service found that the disparities in use and reimbursement of services by race decreased considerably between 1967 and 1976. This trend was found both at the national and at the regional level. Overall, the decreases in the disparity measured are note-worthy. By type of service, proportionally more whites than non-whites still receive reimbursement. However, once non-whites exceed deductibles, the reimbursements per person using reimbursed services are generally comparable or higher than reimbursement to whites.