Injury Epidemiology最新文献

Background: Recent publications on Child Access Prevention (CAP) laws suggest substantial protective effects on adolescent firearm suicide. However, these studies have also found comparable protective effect estimates on adolescent non-firearm suicide and adult firearm suicide, which may indicate residual confounding. Here we apply bias analysis techniques to assess the effects of CAP laws while accounting for potential unmeasured sources of bias using a negative control approach.

Method: Using established bias formulas, we bias-adjust previously published point estimates and their 95% confidence intervals (CI) assuming that an arbitrary confounder biases all suicide-related effect estimates and that adolescent non-firearm suicide and adult firearm suicide are negative controls. Negative controls are outcomes or populations that prior subject matter suggests should not be meaningfully affected by the exposure and can be used to better understand and sometimes account for bias in the primary exposure-outcome relationship.

Results: After bias adjustments, effect estimates were attenuated, with many of the confidence intervals including the null. Assuming that adolescent non-firearm suicide is a negative control outcome and taking a published point estimate as the bias parameter, the bias-adjusted effect estimate for adolescent firearm suicide decreased from an incidence rate ratio of 0.87 (95% CI: 0.78, 0.97) to 0.95 (95% CI: 0.85, 1.07). When adult firearm suicide was used as the negative control, the bias-adjusted estimate was 0.92 (95% CI: 0.82, 1.03).

Conclusion: Our findings suggest that CAP laws may have had a smaller public health impact on adolescent suicide than previously estimated. Given the strong evidence that reducing access to firearms can prevent suicide deaths, and that secure storage helps reduce access for many children, our findings underscore the need to continue to identify and promote effective ways to motivate adults to make household firearms inaccessible to children.

Background: Increased concerns of political violence in the US have drawn attention to sociopolitical movements across the political spectrum. The 2023 National Survey of Gun Policy sought to characterize approval of these movements and whether gun ownership was associated with this approval.

Methods: The National Survey of Gun Policy was fielded from 1/4/23 - 2/6/23 among a nationally representative sample of US adults (N = 3,096), including gun owners (n = 1,002). Respondents rated their level of approval for the militia, antifascist (Antifa), white supremacy, Christian nationalist, boogaloo, and anarchist movements. Logistic regression was used to compare differences in movement approval by gun ownership.

Results: Approval of each movement was relatively low, ranging from 4% for the boogaloo movement to 13% for the Christian nationalist movement. Proportions of respondents that reported lacking knowledge was highest for the boogaloo movement (64%) and lowest for the white supremacy movement (17%); these two movements had similar proportions of approval (4% and 5%, respectively). Significantly larger proportions of gun owners reported both knowledge and approval of any of the six movements compared to non-gun owners, but differences in approval by gun ownership were no longer significant when only comparing those with knowledge of the movements.

Conclusions: Results indicate low probabilities of knowledge and approval. Moreover, greater knowledge was not accompanied by greater approval (e.g., white supremacy). Gun ownership was associated with movement knowledge, but not with movement approval among those with knowledge. These findings suggest opportunities for more proactive public health messaging to appeal to majority groups to resist movements that may sow division.

Background: Firearms became the leading cause of death in the United States pediatric population in 2019 and have persisted as the leading cause through 2021, with widening racial and ethnic disparities. We aimed to examine recent trends in U.S pediatric firearm mortality, how they differ by intent, and identify which ages, and racial and ethnic groups have been most impacted over time.

Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was queried for mortalities in children aged 0-19 years from 2014-2023, and crude death rate was reported as number of deaths per 100,000 persons per year.

Results: Firearms continued to be the leading cause of death in patients aged 0-19 years from 2021 to 2023, firearm crude death rate decreased from 5.8 to 5.5. In patients aged 14-19, firearms became the leading cause of death in 2016. In patients aged 0-13 years, firearms continue to be the fourth leading cause of death. Firearm death rates for Black children decreased from 18.6 in 2022 to 17.6 in 2023 yet remained far higher than other races, and highest in all census regions. Crude firearm death rates for American Indian and Alaskan Native (AIAN) children remained the second highest. The firearm suicide rate in Black children (1.8) surpassed that of White children (1.6) in 2022 and was the highest of any ethnicity in 2023. NonCore (rural) regions had the highest firearm crude death rates in 2018-19, and AIAN children were disproportionately affected in these areas, while Large Central Metro areas surpassed this in 2020-2021.

Conclusions: Firearms remain the leading cause of death among children aged 14-19, and the fourth leading cause of death among children 13 and younger. Racial and ethnic disparities remain prominent, as Black and American Indian and Alaskan Native children continue to be disproportionately affected, particularly by firearm suicide. Prevention strategies should target these vulnerable populations and children at highest risk to prevent future firearm deaths.

Background: It is a "law" of criminology that urban crime chronically recurs at the same microplaces (i.e., street segments and intersections). An influential study found high concentrations of firearm violence at microplaces in Boston, MA, from 1980 to 2008. The current study assessed whether this strong spatial concentration has persisted.

Approach: Fatal and nonfatal shooting incidents with one or more victims from January 2007 through September 2021 were included, obtained from the Boston Police Department. We matched shootings to the closest microplaces, i.e., intersections and street segments in Boston (n = 32,267). We operationalized spatial concentration as the probability of shootings occurring at the same microplace. We employed a case-only design, with shootings as the units of analysis; the outcome of interest was a binary indicator for whether another shooting in the dataset occurred at the same microplace in the past or future. We used log-linear regression to estimate this outcome as a function of study year.

Results: Annual shootings decreased over the study period, except for a spike in 2020. Spatial concentration of shootings declined from 62% in 2007 to 55% in 2021. We estimated that spatial concentration declined by an average of 1.8% per year [95% CI (-1.1, -3.4), p < 0.001].

Implications: This declining trend in the spatial concentration of firearm violence has important implications for place-based interventions and underscores the need to monitor this trend over time. Social media, which reshapes social interactions and is linked to community violence, warrants further study as a potential cause.

Background: Extreme Risk Protection Orders (ERPOs) are a legislative tool that temporarily restrict firearm access and purchasing ability in patients at risk for harm. Data from four states with ERPO legislation, including Connecticut, estimates 17 to 23 filed ERPOs can prevent 1 suicide. Connecticut medical providers are permitted to independently file an ERPO directly to the courthouse. This survey assesses provider knowledge and attitudes towards use of ERPOs.

Methods: This study electronically surveyed providers from six hospitals regarding their current knowledge of the Connecticut ERPO law, perceived barriers to the use of the law and procedures that might make use more likely.

Results: 114 providers completed the survey in 2022. 66 (57.8%) providers encountered at least 1 patient per year at risk for suicide with firearm access. Only 2 (1.7%) providers had ever initiated an ERPO, but both found it extremely helpful. Only 1 provider was extremely familiar with ERPO while 91 (78.9%) were not familiar. Barriers to using ERPO include negatively impacting the patient relationship, and not enough time to call and follow up. ERPO specific training, and trained on-site coordinators to help file and follow through were ways to encourage to ERPO utilization.

Conclusion: The majority of providers encounter at least one patient annually who may benefit from ERPO utilization. However, providers are largely unfamiliar with ERPO and the filing process. Time cost is the greatest barrier to its utilization. Provider training and trained coordinators to process ERPO were the two most requested supports to encourage providers to initiate ERPOs.

Background: Suicide prevention strategies are targeted at three levels: the general population (Universal), persons at risk (Selected), and persons who have attempted suicide or have suicidal ideation (Indicated). This study describes the implementation of an innovative indicated suicide prevention service that prioritizes peer and psychosocial support at one of Australia's largest mental health services. The purpose of this paper is threefold. (1) To describe the process of designing and implementing an innovative indicated suicide prevention service in Melbourne (2) To compare the implementation framework developed around it with other relevant frameworks and (3) To describe its stages of care.

Results: Based on the activities undertaken by the 'project champion' in designing and implementing Clayton HOPE, a pragmatic framework of implementation (PFI) was developed. The PFI included six steps. 1: Determine client needs; 2: Plan the model of care; 3: Determine the workforce and other resource requirements to achieve client needs; 4: Establish the workforce and finalize the team; 5: Facilitate stakeholder buy-in and 6: Regular monitoring and evaluation. The steps of the PFI, fit within the Quality Implementation Framework, albeit in a different sequence, owing to variations in settings, organizational circumstances, and readiness for change. The PFI also enhances the Levels of Change model by including additional requirements. A five-stage model of care was developed and implemented. They are 1: Early engagement and empathetic support (within 24 h of referral); 2: Assessment of psychosocial needs and suicidal risk (within 72 h of referral) 3: Construction of a personal safety plan (within 7 days of referral) 4: Implementation of the personal safety plan and risk management (week 2 - week12) and 5: Discharge and handover to ongoing supports (12 weeks from enrollment).

Conclusions: The main implications of this work are twofold: (1) The implementation of innovative models of care can be achieved by a 'project champion' with the relevant experience, authority and determination when funding is available and (2) Indicated suicide prevention models of care can strike a balance between clinical and non-clinical interventions that are tailored to client needs.

Background: Firearm violence is a major public health problem and the leading cause of death among children and youth aged one to nineteen in the United States (US). School shootings, though a relatively rare form of firearm violence in the US, have been occurring with increasing frequency, exposing more than 380,000 students to such events since 1999. This study engaged school shooting survivors to identify key research areas regarding their mental health, aiming to enhance the relevance and impact of future research for this community.

Methods: Participants for individual and group interviews were recruited from survivor support groups and through snowball sampling between May and August 2024. The interview guide, based on a recent scoping review highlighting gaps in research on the mental health impacts of school shootings, facilitated discussions on participants' experiences, needs, and research priorities. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Thirteen individuals participated (median age: 40 years; range: 18-47), including 11 former student survivors, one parent of a survivor, and one sibling of a victim. These participants represented ten school shootings from 1997 to 2022 across eight US states including Colorado, Florida, Kentucky, Maryland, Michigan, Oregon, Tennessee, and Washington. Eight participants experienced a mass school shooting (four or more fatalities excluding the perpetrator).

Results: The study identified three key research priorities: (1) understanding the long-term mental health impacts of school shootings across the life course, (2) expanding research to include broader outcomes beyond traditional mental health metrics, and (3) diversifying research approaches, study designs, and study populations to better capture the varied experiences of survivors.

Conclusion: There is a need for researchers to explore a wider range of outcomes, communities, and timeframes when studying the mental health impacts of school shootings. Such investigations are essential for understanding the complex and unique aspects of recovery and resilience among survivors. Centering survivor perspectives enhances our understanding of ongoing challenges facing survivors of school shootings, which should be prioritized in designing and evaluating interventions and policies.

Background: Following the Supreme Court's decision in New York State Rifle & Pistol Association, Inc. v. Bruen, which ruled a New York concealed-carry permitting requirement unconstitutional, laws restricting the public carrying of firearms in "sensitive places," like college campuses, have received increasing attention. However, there is little evidence for whether permissive campus carry policies increase firearm violence or, via deterrence, reduce general crime on campus. We estimated the effect of implementing state laws allowing the carry of firearms on public college and university campuses on rates of violent crime and burglary.

Methods: Arkansas, Georgia, and Texas, containing 106 public institutions, implemented permissive campus carry laws in 2017, 2017, and 2016, respectively. Control institutions were all those in states that did not allow the carry of firearms on college campuses for the entire study period (2006-2019) (n = 324 institutions, 21 states). The rates of major violence and burglary per 1,000 enrolled students was obtained from the Office of Postsecondary Education Campus Safety and Security Statistics website. We use two-way fixed effects difference-in-differences models to estimate state-specific effects and a modified difference-in-differences approach that accounts for variation in treatment timing to generate an overall estimate.

Results: Differences in rates of major violence and burglary were not statistically distinguishable from zero in our main models and sensitivity analyses. The overall estimated difference in the rate of major violence following policy implementation was - 0.01 (- 0.113, 0.093). For burglary, we estimated a difference of - 0.02 (- 0.147, 0.106). Violence rates trended upward in treated states in the last exposure period, but differences were not consistently distinguished from the null.

Conclusions: This study does not find significant changes in crime rates following state implementation of permissive campus carrying laws. Decision-makers might therefore consider other factors such as the opinions of students, faculty, and staff regarding campus carry policies and feelings of safety, potential impacts on instructional quality and student engagement, and potential impacts on accidental or self-directed harm.

Background: This study assesses the impact of heatwaves on road safety in five Québec cities (Montréal, Québec City, Laval, Longueuil, and Sherbrooke) from June to September 2015-2022. Using Urban Heat Island (UHI), 90th and 95th percentile thresholds for heatwaves, we analyze their effects on collisions, traffic injuries, and killed and seriously injured (KSI) cases.

Methods: Traffic data were analyzed across two heatwave definitions, utilizing a time-stratified case-crossover design. UHI was approximated using the annual maximum of mean warm-season land surface temperatures (LST) derived from Landsat 8 (30 m resolution) over three consecutive years, identifying areas that stay hotter during the day and radiate excess heat at night. Heatwaves were defined as periods of at least two consecutive days with mean temperatures exceeding the historical 90th or 95th percentile of mean temperatures. Negative Binomial regression models were used to examine associations between UHI, heatwave events and traffic incidents. Models controlled for time varying variables such as rainfall, seasonality, and COVID-19 impacts.

Results: Heatwaves, particularly at the 95th percentile threshold, significantly increased traffic incidents in Montréal and Longueuil. In Sherbrooke, the 90th percentile threshold showed significant effects on collisions and injuries, while Québec City and Laval exhibit no significant associations. UHIs show a modest overall increase in collisions (IRR: 1.07) but limited effects on traffic injuries and KSI. Differences across cities highlight Montréal's higher IRR for collisions under heatwaves and lower IRR for KSI compared to Québec and Longueuil respectively. DISCUSSION AND CONCLUSION: The results indicate that cities like Montréal and Longueuil, with slightly stronger UHI and higher susceptibility to heatwaves, face increased road safety risks. However, UHI levels in Montréal were not significantly different from those in other cities, and heatwaves at the 95th percentile showed variability across regions. These findings highlight the need for targeted climate-adaptive strategies, such as green spaces and heat-reflective materials, to mitigate risks. Integrating climate resilience into urban planning remains critical as extreme weather events grow more frequent.

Background: Around 40% of US households with children have a firearm kept in the home. This study sought to describe firearm storage practices and locking device preferences among caregivers of children presenting to a pediatric emergency department (ED).

Methods: We conducted a cross-sectional survey of caregivers of children presenting to a pediatric ED who endorsed having a firearm in the home from August 2023 to May 2024. A self-administered electronic survey inquired about current firearm storage practices and locking device preferences. Caregivers who endorsed any unsafe firearm storage practice (i.e., firearm stored unlocked, loaded, and/or with ammunition) were offered, based on their preference, a free cable gun lock, lock box, or gun safe along with safe firearm storage education materials. Caregivers given a device were surveyed 30 days later to reevaluate firearm storage behavior. McNemar's test was used to evaluate differences in reported baseline locking device use. Wilcoxon signed rank test was used to evaluate changes in storage behaviors (locked, unloaded, and stored separate from ammunition) from baseline to 30-day follow-up.

Results: Of 139 caregivers with a firearm in the home, 91% (n = 126) reported having a handgun and 41% (n = 57) reported storing firearms with triple safe storage. Safes/vaults were more frequently used (40%, n = 56) than cable gun locks (20%, n = 28) (p = 0.003). Factors involved in caregiver preference for firearm locking devices were: speed of access to firearms (47%, n = 66), strength of the device (45%, n = 63), and cost of device (42%, n = 58). Seventeen caregivers were provided a free device based on preference: 15 gun safes, 2 lock boxes, and 0 cable gun locks. At 30-day follow up, 70.6% (n = 12) of eligible caregivers responded, and the proportion of respondents who reported storing all firearms locked increased significantly from baseline (from 67 to 100%, p = 0.036).

Conclusions: Caregivers in a pediatric ED reported using safes most frequently and, when offered a device, preferred safes over other locking devices. After being provided a free device of their preference, all caregivers who completed follow-up surveys reported all firearms were locked. Healthcare and community organizations should align resources with caregiver preferences.