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Kafka JM, Moracco KE, Pence BW, Trangenstein PJ, Fliss MD, McNaughton Reyes L. Intimate partner violence and suicide mortality: a cross-sectional study using machine learning and natural language processing of suicide data from 43 states. Inj Prev 2024; 30:125-131. [PMID: 37907260 DOI: 10.1136/ip-2023-044976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Intimate partner violence (IPV) is associated with suicidal ideation, yet it remains unclear how often IPV precipitates suicide mortality. To overcome limitations with national data, we applied novel methods to: (1) document the prevalence of IPV-related suicide in the USA and (2) identify correlates for IPV-related suicide. METHODS Using National Violent Death Reporting System data (NVDRS, 2015-2019, n=1 30 550), we recorded IPV circumstances (yes/no) by leveraging prior textual reviews of death narratives and applying a validated natural language processing tool. We could not systematically differentiate IPV perpetration versus victimisation given limited details in NVDRS. Logistic regression compared IPV-related suicides with referent group suicides (no evidence of IPV), stratified by sex. RESULTS 7.1% of suicides were IPV related (n=9210), most were isolated suicide events (82.8%, n=7625; ie, not homicide suicide). There were higher odds of IPV circumstances when the decedent had civil legal problems (aOR for men: 3.6 (3.3 to 3.9), aOR for women: 2.6 (2.2 to 3.2)), criminal legal problems (aOR men: 2.3 (2.2 to 2.5), aOR for women: 1.7 (1.4 to 2.1)), or used a firearm (aOR men: 1.9 (1.8 to 2.0), aOR for women: 1.9 (1.7 to 2.1)). There were lower odds of IPV circumstances when the decedent had a current mental health problem (aOR men: 0.7 (0.7 to 0.8), aOR for women: 0.7 (0.6 to 0.8)). CONCLUSIONS IPV circumstances contribute to a notable proportion of suicides. IPV-related suicides are distinct from other suicide deaths. Targeted suicide screening and intervention in IPV settings may be beneficial for prevention.
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Affiliation(s)
- Julie M Kafka
- Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, Washington, USA
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathryn Elizabeth Moracco
- Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian W Pence
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Pamela J Trangenstein
- Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Alcohol Research Group, Public Health Institute, Oakland, California, USA
| | - Mike Dolan Fliss
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Luz McNaughton Reyes
- Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Bond AE, Stanley I, Bandel SL, Anestis M. Law enforcement and firearms: understanding firearm ownership and storage habits. Inj Prev 2024; 30:132-137. [PMID: 37875335 DOI: 10.1136/ip-2023-044919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE This study seeks to better understand firearm ownership among law enforcement officers (LEO), with the goal of informing future firearm injury and suicide prevention efforts. We describe the frequency and sociodemographic correlates of firearm ownership and storage practices among, and examine the association between suicidal ideation and current firearm storage practices. METHODS The present study used data from a large online study (n=6410) and included data from individuals who were currently or previously being employed as an LEO (n=369; M (SD) age=39.2 y (15.8 y), 75.2% male, 66.7% white). Self-report measures were used to assess for firearm ownership, storage habits and suicidal ideation. Descriptive statistics were used to describe the frequency of firearm ownership and logistic regressions were used to examine the extent to which demographic characteristics and suicidal ideation were associated with firearm ownership. RESULTS Overall, 70.5% (n=261) of the sample reported firearm ownership. LEO who were older had significantly lower odds of reporting firearm ownership. Those who were married and those who reported lifetime suicidal ideation had significantly greater odds of reporting firearm ownership. Whereas firearm-owning LEO who reporting storing a firearm locked had significantly lower odds of reporting lifetime suicidal ideation, those who reported storing a firearm unloaded had significantly greater odds of reporting lifetime suicidal ideation. CONCLUSION Findings have important public health implications and can be used to increase adherence with secure storage recommendations. Increasing secure storage may help reduce suicide risk among LEO, a sample at heightened risk for suicide.
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Affiliation(s)
- Allison E Bond
- Psychology, Rutgers University, Piscataway, New Jersey, USA
- New Jersey Gun Violence Research Center, Rutgers University, New Brunswick, New Jersey, USA
| | - Ian Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shelby L Bandel
- New Jersey Gun Violence Research Center, Rutgers University, New Brunswick, New Jersey, USA
- Department of Psychology, The State University of NJ, Piscataway, New Jersey, USA
| | - Michael Anestis
- New Jersey Gun Violence Research Center, Rutgers University, New Brunswick, New Jersey, USA
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Mournet AM, Kellerman JK, Kleiman EM. Associations between feelings of safety, concerns about firearms on campus and suicidal thoughts and behaviours among college students. Inj Prev 2024; 30:171-175. [PMID: 38050010 DOI: 10.1136/ip-2023-045060] [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] [Indexed: 12/06/2023]
Abstract
BACKGROUND Perceptions of safety on campus may be related to a variety of factors such as concerns about campus violence, especially firearm violence, and mental health, particularly suicidal thoughts and behaviours (STBs). The present analyses aim to describe associations between feelings of safety, concerns about firearms on campus and STBs among college students. METHODS This study uses data from the American College Health Association-National College Health Assessment wave III (n=24 682 participants across k=29 schools). Multilevel logistic regressions and cumulative link mixed models examine the associations between feelings of safety, concerns about firearm violence on campus and presence of STBs in the past year. RESULTS Participants who reported being concerned about firearm violence felt significantly less safe. Feeling unsafe at night was significantly associated with suicidal ideation and suicide attempts. Individuals with concerns about firearm safety on campus were up to 42% more likely to report suicidal ideation compared with those reporting they were not at all concerned about campus firearm violence. DISCUSSION With associations highlighting increased risk of STBs among those with reduced safety feelings and heightened concerns about firearms, there is a need for college campuses to intervene and promote campus safety, with particular consideration for the presence of firearms on campus and the implications of allowing such weapons to be present in environments with increasing instances of firearm violence.
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Affiliation(s)
| | - John K Kellerman
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Evan M Kleiman
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Warner TD. Locked and loaded: correlates of in-home firearm storage beliefs and behaviours. Inj Prev 2024:ip-2023-045096. [PMID: 38302283 DOI: 10.1136/ip-2023-045096] [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: 09/04/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES To understand how crime and victimisation fears and risks operate alongside social status threats and motivations to shape unsafe in-home firearm storage practices and beliefs. METHODS Using data from firearm owners identified in a nationwide sample surveyed in 2023, this study examined how in-home loaded firearm accessibility, firearm storage practice and firearm safety beliefs are associated with: fear of crime and victimisation; perceived and personal victimisation; racial resentment; cultural and status threats; and masculinity threats. Regression models also accounted for the role of gender, race, marital status, political affiliation, geographic region and protective motivation for firearm ownership. RESULTS Over 40% of firearm owners reported having a loaded firearm 'always accessible' at home, and almost half think homes with firearms are safer than those without. About one-third of owners reported storing firearms locked but still loaded. Crime and victimisation fears and threats were unrelated to firearm storage behaviours and beliefs; however, firearm owners who experience higher levels of sociocultural anxiety are more likely to always have a loaded firearm accessible at home, store firearms locked and loaded, and believe that firearms make homes safer. CONCLUSIONS Identifying the barriers to safer storage beliefs and behaviours is essential for refining and enhancing effective firearm injury prevention strategies. Sociocultural anxieties may not reflect concrete threats to physical safety, but they can be experienced as feelings of insecurity, instability and distress that-for some Americans-may be managed by knowing they have a (loaded) firearm within reach.
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Affiliation(s)
- Tara D Warner
- Criminal Justice, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Apata J, Pennap D, Ma Y, Mosholder A. Suicide poisoning mortality: a comparison of the national poison data system and centers for disease control national dataset. Inj Prev 2024; 30:81-83. [PMID: 37923357 DOI: 10.1136/ip-2023-044940] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The America's Poison Centres National Poison Data System (NPDS) is set up for the active surveillance of voluntarily reported poisoning cases in near real-time. The Centres for Disease Control and Prevention (CDC)'s Wide-ranging Online Data for Epidemiologic Research (WONDER) database is final national mortality data from state registries. We compared suicide poisoning deaths in both datasets from 2000 to 2020 and tested their relationship using a simple linear regression model. Mean annual suicide poisoning deaths during the review period were 699 (SD 145) in NPDS, and 6150 (SD 577) in WONDER. NPDS annual cases averaged 11% of cases recorded in WONDER (SD 2%; Range 8%-16%). The regression coefficient for the linear relationship between annual deaths recorded in both datasets was 0.18 (p-value<0.001, R2=0.51). The rapidly available NPDS data on fatal self-poisoning may provide sentinel surveillance regarding self-poisonings, but do not reliably predict final national data on suicide poisoning.
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Affiliation(s)
- Jummai Apata
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Silver Spring, MD, USA
| | - Dinci Pennap
- Formerly U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Division of Epidemiology 1, Silver Spring, Maryland, USA
| | - Yong Ma
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Division of Biometrics 7, Silver Spring, Maryland, USA
| | - Andrew Mosholder
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Division of Epidemiology 1, Silver Spring, Maryland, USA
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Anestis M, Bond AE, Baker N, Semenza DC. Regional differences in firearm ownership, storage and use: results from a representative survey of five US states. Inj Prev 2024; 30:53-59. [PMID: 37798091 DOI: 10.1136/ip-2023-044878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Firearm access and storage practices influence risk for injury and death; however, prior research has considered only national and regional differences on these variables, overlooking state-level differences. OBJECTIVES To analyse and describe statewide differences in firearm ownership, storage and use in a representative sample of five US states. DESIGN Variables were assessed via an online self-report survey administered between 29 April 2022 and 15 May 2022. SETTING Surveys were completed online. PARTICIPANTS Participants (n=3510) were members of knowledge panel, a probability-based sample recruited to be representative of US adults. All participants were aged 18+ and resided in one of five states: Colorado, Minnesota, Mississippi, New Jersey or Texas. MEASUREMENTS We used χ2 tests to examine state differences in firearm ownership, childhood firearm experiences and purchasing. A series of analyses of covariance were then used to assess differences in firearm storage, firearms owned and carrying behaviours while adjusting for pertinent demographic characteristics. RESULTS We found significant differences in firearm ownership across states. There were significantly more first-time firearm purchasers during the firearm purchasing surge in New Jersey. Both Mississippi and Texas have elevated rates of unsecure storage practices and firearm carrying outside of the home. LIMITATIONS Results are cross-sectional and self-report. Findings may not generalise beyond the five states assessed in this survey. CONCLUSIONS Public health messaging around firearm safety should account for differences in key firearm behaviours related to ownership, storage and use to ensure effective communication and reduce the risk of gun injury and death across states.
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Affiliation(s)
- Michael Anestis
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- Department of Urban-Global Public Health, Rutgers The State University of New Jersey, Piscataway, New Jersey, USA
| | - Allison E Bond
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Nazsa Baker
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
| | - Daniel C Semenza
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- Department of Urban-Global Public Health, Rutgers The State University of New Jersey, Piscataway, New Jersey, USA
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Austin AE, Naumann RB, DiPrete BL, Geary S, Proescholdbell SK, Jones-Vessey K. Pregnancy-associated homicide, suicide and unintentional opioid-involved overdose deaths, North Carolina 2018-2019. Inj Prev 2024:ip-2023-045112. [PMID: 38195655 DOI: 10.1136/ip-2023-045112] [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: 09/17/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Rates of death due to homicide, suicide and overdose during pregnancy and the first year postpartum have increased substantially in the USA in recent years. The aims of this study were to use 2018-2019 data on deaths identified for review by the North Carolina Maternal Mortality Review Committee (NC-MMRC), data from the North Carolina Violent Death Reporting System (NC-VDRS) and data from the Statewide Unintentional Drug Overdose Reporting System (NC-SUDORS) to examine homicide, suicide and unintentional opioid-involved overdose deaths during pregnancy and the first year postpartum. METHODS We linked data from the 2018-2019 NC-MMRC to suicide and homicide deaths among women ages 10-50 years from the 2018-2019 NC-VDRS and to unintentional opioid-involved overdose deaths among women ages 10-50 years from the 2018-2019 NC-SUDORS. We conducted descriptive analyses to examine the prevalence of demographic characteristics and the circumstances surrounding each cause of death. RESULTS From 2018 to 2019 in North Carolina, there were 23 homicides, nine suicides and 36 unintentional opioid-involved overdose deaths (9.7, 3.8 and 15.1 per 100 000 live births, respectively) during pregnancy and the first year postpartum. Most homicide deaths (87.0%) were by firearm, and more than half (52.5%) were related to intimate partner violence. More than two-thirds of women who died by suicide had a current mental health problem (77.8%). Less than one-fourth (22.2%) of those who died by unintentional opioid-involved overdose had a known history of substance use disorder treatment. CONCLUSION Our approach to quantifying and describing these causes of pregnancy-associated death can serve as a framework for other states to inform data-driven prevention.
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Affiliation(s)
- Anna E Austin
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca B Naumann
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bethany L DiPrete
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shana Geary
- Injury and Violence Prevention Branch, North Carolina Division of Public Health, Raleigh, North Carolina, USA
| | - Scott K Proescholdbell
- Injury and Violence Prevention Branch, North Carolina Division of Public Health, Raleigh, North Carolina, USA
| | - Kathleen Jones-Vessey
- North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
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Wyman P, Cero I, Brown CH, Espelage D, Pisani A, Kuehl T, Schmeelk-Cone K. Impact of Sources of Strength on adolescent suicide deaths across three randomized trials. Inj Prev 2023; 29:442-445. [PMID: 37507212 PMCID: PMC10579464 DOI: 10.1136/ip-2023-044944] [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: 07/30/2023]
Abstract
Universal interventions are key to reducing youth suicide rates, yet no universal intervention has demonstrated reduction in suicide mortality through an RCT. This study pooled three cluster-RCTs of Sources of Strength (n=78 high schools), a universal social network-informed intervention. In each trial, matched pairs of schools were assigned to immediate intervention or wait-list. Six schools were assigned without a pair due to logistical constraints. During the study period, no suicides occurred in intervention schools vs four in control schools, that is, suicide rates of 0 vs. 20.86/100,000, respectively. Results varied across statistical tests of impact. A state-level exact test pooling all available schools showed fewer suicides in intervention vs. control schools (p=0.047); whereas a stricter test involving only schools with a randomised pair found no difference (p=0.150). Results suggest that identifying mortality-reducing interventions will require commitment to new public-health designs optimised for population-level interventions, including adaptive roll-out trials.
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Affiliation(s)
- Peter Wyman
- Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ian Cero
- Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Charles Hendricks Brown
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dorothy Espelage
- Education, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anthony Pisani
- Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Tomei Kuehl
- Consulting Within Your Context LLC, Denver, Colorado, USA
| | - Karen Schmeelk-Cone
- Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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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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Cullen P, Mőller H, Baffsky R, Martiniuk A, Senserrick T, Rogers K, Woodward M, Stevenson MR, McLean R, Sawyer S, Patton G, Ivers RQ. Self-harm in adolescence and risk of crash: a 13-year cohort study of novice drivers in New South Wales, Australia. Inj Prev 2023; 29:302-308. [PMID: 36813554 PMCID: PMC10423516 DOI: 10.1136/ip-2022-044807] [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: 11/23/2022] [Accepted: 01/20/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Self-harm and suicide are leading causes of morbidity and death for young people, worldwide. Previous research has identified self-harm is a risk factor for vehicle crashes, however, there is a lack of long-term crash data post licensing that investigates this relationship. We aimed to determine whether adolescent self-harm persists as crash risk factor in adulthood. METHODS We followed 20 806 newly licensed adolescent and young adult drivers in the DRIVE prospective cohort for 13 years to examine whether self-harm was a risk factor for vehicle crashes. The association between self-harm and crash was analysed using cumulative incidence curves investigating time to first crash and quantified using negative binominal regression models adjusted for driver demographics and conventional crash risk factors. RESULTS Adolescents who reported self-harm at baseline were at increased risk of crashes 13 years later than those reporting no self-harm (relative risk (RR) 1.29: 95% CI 1.14 to 1.47). This risk remained after controlling for driver experience, demographic characteristics and known risk factors for crashes, including alcohol use and risk taking behaviour (RR 1.23: 95% CI 1.08 to 1.39). Sensation seeking had an additive effect on the association between self-harm and single-vehicle crashes (relative excess risk due to interaction 0.87: 95% CI 0.07 to 1.67), but not for other types of crashes. DISCUSSION Our findings add to the growing body of evidence that self-harm during adolescence predicts a range of poorer health outcomes, including motor vehicle crash risks that warrant further investigation and consideration in road safety interventions. Complex interventions addressing self-harm in adolescence, as well as road safety and substance use, are critical for preventing health harming behaviours across the life course.
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Affiliation(s)
- Patricia Cullen
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Ngarruwan Ngadju: First Peoples Health and Wellbeing Research Centre, University of Wollongong, Wollongong, New South Wales, Australia
| | - Holger Mőller
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rachel Baffsky
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alexandra Martiniuk
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Teresa Senserrick
- Centre for Accident Research and Road Safety - Queensland (CARRS-Q), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Kris Rogers
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, Sydney, New South Wales, Australia
- The George Institute for Global Health, Imperial College London, London, UK
| | - Mark R Stevenson
- Transport Health and Urban Design Research Hub, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca McLean
- Department of Population Health, University of Otago Christchurch, Christchurch, New Zealand
| | - Susan Sawyer
- Department of Pediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - George Patton
- Department of Pediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rebecca Q Ivers
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
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11
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Kafka JM, Fliss MD, Trangenstein PJ, McNaughton Reyes L, Pence BW, Moracco KE. Detecting intimate partner violence circumstance for suicide: development and validation of a tool using natural language processing and supervised machine learning in the National Violent Death Reporting System. Inj Prev 2023; 29:134-141. [PMID: 36600568 DOI: 10.1136/ip-2022-044662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/19/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) victims and perpetrators often report suicidal ideation, yet there is no comprehensive national dataset that allows for an assessment of the connection between IPV and suicide. The National Violent Death Reporting System (NVDRS) captures IPV circumstances for homicide-suicides (<2% of suicides), but not single suicides (suicide unconnected to other violent deaths; >98% of suicides). OBJECTIVE To facilitate a more comprehensive understanding of the co-occurrence of IPV and suicide, we developed and validated a tool that detects mentions of IPV circumstances (yes/no) for single suicides in NVDRS death narratives. METHODS We used 10 000 hand-labelled single suicide cases from NVDRS (2010-2018) to train (n=8500) and validate (n=1500) a classification model using supervised machine learning. We used natural language processing to extract relevant information from the death narratives within a concept normalisation framework. We tested numerous models and present performance metrics for the best approach. RESULTS Our final model had robust sensitivity (0.70), specificity (0.98), precision (0.72) and kappa values (0.69). False positives mostly described other family violence. False negatives used vague and heterogeneous language to describe IPV, and often included abusive suicide threats. IMPLICATIONS It is possible to detect IPV circumstances among singles suicides in NVDRS, although vague language in death narratives limited our tool's sensitivity. More attention to the role of IPV in suicide is merited both during the initial death investigation processes and subsequent NVDRS reporting. This tool can support future research to inform targeted prevention.
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Affiliation(s)
- Julie M Kafka
- Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- The University of North Carolina Injury Prevention Research Center, Chapel Hill, North Carolina, USA
- Firearm Injury & Policy Research Program, The University of Washington, Seattle, WA, USA
| | - Mike D Fliss
- The University of North Carolina Injury Prevention Research Center, Chapel Hill, North Carolina, USA
- Epidemiology, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Pamela J Trangenstein
- Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Alcohol Research Group, Emeryville, California, USA
| | - Luz McNaughton Reyes
- Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- The University of North Carolina Injury Prevention Research Center, Chapel Hill, North Carolina, USA
| | - Brian W Pence
- The University of North Carolina Injury Prevention Research Center, Chapel Hill, North Carolina, USA
- Epidemiology, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Kathryn E Moracco
- Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- The University of North Carolina Injury Prevention Research Center, Chapel Hill, North Carolina, USA
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Ranapurwala SI, Miller VE, Carey TS, Gaynes BN, Keil AP, Fitch CV, Swilley-Martinez ME, Kavee AL, Cooper T, Dorris S, Goldston DB, Peiper LJ, Pence BW. Innovations in suicide prevention research (INSPIRE): a protocol for a population-based case-control study. Inj Prev 2022; 28:injuryprev-2022-044609. [PMID: 35701110 PMCID: PMC10213808 DOI: 10.1136/injuryprev-2022-044609] [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: 04/11/2022] [Accepted: 05/28/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Suicide deaths have been increasing for the past 20 years in the USA resulting in 45 979 deaths in 2020, a 29% increase since 1999. Lack of data linkage between entities with potential to implement large suicide prevention initiatives (health insurers, health institutions and corrections) is a barrier to developing an integrated framework for suicide prevention. OBJECTIVES Data linkage between death records and several large administrative datasets to (1) estimate associations between risk factors and suicide outcomes, (2) develop predictive algorithms and (3) establish long-term data linkage workflow to ensure ongoing suicide surveillance. METHODS We will combine six data sources from North Carolina, the 10th most populous state in the USA, from 2006 onward, including death certificate records, violent deaths reporting system, large private health insurance claims data, Medicaid claims data, University of North Carolina electronic health records and data on justice involved individuals released from incarceration. We will determine the incidence of death from suicide, suicide attempts and ideation in the four subpopulations to establish benchmarks. We will use a nested case-control design with incidence density-matched population-based controls to (1) identify short-term and long-term risk factors associated with suicide attempts and mortality and (2) develop machine learning-based predictive algorithms to identify individuals at risk of suicide deaths. DISCUSSION We will address gaps from prior studies by establishing an in-depth linked suicide surveillance system integrating multiple large, comprehensive databases that permit establishment of benchmarks, identification of predictors, evaluation of prevention efforts and establishment of long-term surveillance workflow protocols.
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Affiliation(s)
- Shabbar I Ranapurwala
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Vanessa E Miller
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Timothy S Carey
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alexander P Keil
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catherine Vinita Fitch
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Monica E Swilley-Martinez
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrew L Kavee
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Toska Cooper
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Samantha Dorris
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lewis J Peiper
- Division of Adult Correction - Prisons, North Carolina Department of Public Safety, Raleigh, North Carolina, USA
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
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13
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Villaveces A, Shankar V, Palomeque F, Padilla M, Kress H. Association between violence and mental distress, self-harm and suicidal ideation and attempts among young people in Malawi. Inj Prev 2022; 28:injuryprev-2021-044510. [PMID: 35523567 PMCID: PMC10895876 DOI: 10.1136/injuryprev-2021-044510] [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: 12/17/2021] [Accepted: 04/01/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mental health problems ranging from depression to more severe acts such as self-harm or suicidal behaviours are a serious problem among adolescents and young adults. Exposure to violence during the life of young people can increase mental health issues for youth. This study examines the relationship between exposure to violence and mental health issues among youth using a nationally representative study in Malawi. METHODS We analysed data from the nationally representative Violence Against Children Survey from Malawi (2013) to quantify the association between exposures to violence (physical, sexual and emotional) and their relationship with mental distress, self-harm behaviours and suicidal ideation and attempts among youth aged 13-24 years. We evaluated the association of exposures to violence against children with reported mental health conditions among women and men. We used ordinal logistic regression models with appropriate survey weights to assess exposures to violence and the three outcomes of interest. RESULTS Children and youth aged 13-24 years exposed to violence in childhood reported higher levels of adverse mental health effects, including mental distress, self-harm behaviours and suicidal ideation and attempts. The odds of reporting these outcomes increased as the number of violence types increased. CONCLUSIONS Understanding the risks based on different combinations of exposures to violence in Malawi can help identify populations at higher risk and optimise violence prevention strategies.
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Affiliation(s)
- Andrés Villaveces
- Division of Violence Prevention, NCIPC, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Viswanathan Shankar
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Francisco Palomeque
- State, Tribal, Local, and Territorial Task Support Force, COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mabel Padilla
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Howard Kress
- Division of Violence Prevention, NCIPC, Centers for Disease Control and Prevention, Atlanta, GA, USA
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14
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Rockett IRH, Caine ED, Connery HS, Nolte KB, Nestadt PS, Nelson LS, Jia H. Unrecognised self-injury mortality (SIM) trends among racial/ethnic minorities and women in the USA. Inj Prev 2019; 26:439-447. [PMID: 31551367 PMCID: PMC7513258 DOI: 10.1136/injuryprev-2019-043371] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/26/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 01/09/2023]
Abstract
AIM To assess whether an enhanced category combining suicides with nonsuicide drug self-intoxication fatalities more effectively captures the burden of self-injury mortality (SIM) in the USA among US non-Hispanic black and Hispanic populations and women irrespective of race/ethnicity. METHODS This observational study used deidentified national mortality data for 2008-2017 from the CDC's Web-based Injury Statistics Query and Reporting System. SIM comprised suicides by any method and age at death plus estimated nonsuicide drug self-intoxication deaths at age ≥15 years. Measures were crude SIM and suicide rates; SIM-to-suicide rate ratios; and indices of premature mortality. RESULTS While the suicide rate increased by 29% for blacks, 36% for Hispanics and 25% for non-Hispanic whites between 2008 and 2017, corresponding SIM rate increases were larger at 109%, 69% and 55% (p<0.0001). SIM:suicide rate ratio gaps were widest among blacks but similar for the other two groups. Gaps were wider for females than males, especially black females whose ratios measured ≥3.71 across the observation period versus <3.00 for white and Hispanic counterparts. Total lost years of life for Hispanic, white and black SIM decedents in 2017 were projected to be 42.6, 37.1 and 32.4, respectively. CONCLUSION Application of SIM exposed substantial excess burdens from substance poisoning relative to suicide for minorities, particularly non-Hispanic blacks and for women generally. Results underscored the need to define, develop, implement and evaluate comprehensive strategies to address common antecedents of self-injurious behaviours.
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Affiliation(s)
- Ian R H Rockett
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA .,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Injury Control Research Center for Suicide Prevention, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric D Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Hilary S Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kurt B Nolte
- Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Paul S Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Haomiao Jia
- Department of Biostatistics, Columbia University, New York, New York, USA.,School of Nursing, Columbia University, New York, New York, USA
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15
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Allchin A, Chaplin V, Horwitz J. Limiting access to lethal means: applying the social ecological model for firearm suicide prevention. Inj Prev 2018; 25:i44-i48. [PMID: 29941633 DOI: 10.1136/injuryprev-2018-042809] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 03/16/2018] [Accepted: 05/16/2018] [Indexed: 11/04/2022]
Abstract
This paper outlines a novel application of the social ecological model (SEM) for firearm suicide prevention. It focuses on four levels of intervention (societal, relationship, community and individual) to reduce access to firearms, a practical contributor to the capacity to attempt suicide, from individuals when they are at an elevated risk for suicide. There is substantive research linking easy access to firearms with an increased risk of firearm suicide, and suicide prevention interventions that address access to lethal means are critical components of a comprehensive suicide prevention strategy. Potential interventions using the SEM framework include: at the policy level-extreme risk laws, voluntary self-prohibition policies and policies that reduce the availability of firearms; at the community level-gun shop projects; at the relationship level-lethal means safety counselling; and at the individual level-safer storage. Taken together with upstream interventions, such as increased access to mental health services and substance use treatment, a multilevel approach for suicide prevention that addresses access to firearms can save lives.
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Affiliation(s)
- Adelyn Allchin
- Educational Fund to Stop Gun Violence, Washington, DC, USA
| | - Vicka Chaplin
- Educational Fund to Stop Gun Violence, Washington, DC, USA
| | - Joshua Horwitz
- Educational Fund to Stop Gun Violence, Washington, DC, USA
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Rowhani-Rahbar A, Lyons VH, Simonetti JA, Azrael D, Miller M. Formal firearm training among adults in the USA: results of a national survey. Inj Prev 2017; 24:161-165. [PMID: 28698176 DOI: 10.1136/injuryprev-2017-042352] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 11/03/2022]
Abstract
Despite broad support for policies requiring that prospective firearm owners receive training before acquiring a firearm, little is known about the scope and content of firearm training in the USA. Nationally representative surveys conducted in 1994 estimated that 56%-58% of the US firearm owners had received formal firearm training. We conducted a nationally representative survey in 2015 (n=3932; completion proportion=55%) to update those estimates and characterise training contents. 61% of firearm owners and 14% of non-owners living with a firearm owner reported having received formal firearm training. The most commonly reported combination of training topics was safe handling, safe storage and preventing accidents. 15% of firearm owners reported that their training included information about suicide prevention. The proportion of the US firearm owners with formal firearm training has not meaningfully changed since two decades ago. Training programme contents vary widely. Efforts to standardise and evaluate the effectiveness of firearm training are warranted.
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Affiliation(s)
- Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
| | - Vivian H Lyons
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
| | - Joseph A Simonetti
- Division of General Internal Medicine, University of Colorado, Denver, Colorado, USA
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Veterans Affairs Eastern Colorado Healthcare System, Denver, Colorado, USA
| | - Deborah Azrael
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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