When public health crises collide: 5 years of pediatric firearm injury prevention opportunities.

Objectives: Prior publications on pediatric firearm-related injuries have emphasized significant social disparities. The pandemic has heightened a variety of these societal stresses. We sought to evaluate how we must now adapt our injury prevention strategies. Patients and methods: Firearm-related injuries in children 15 years old and under at five urban level 1 trauma centers between January 2016 and December 2020 were retrospectively reviewed. Age, gender, race/ethnicity, Injury Severity Score, situation, timing of injury around school/curfew, and mortality were evaluated. Medical examiner data identified additional deaths. Results: There were 615 injuries identified including 67 from the medical examiner. Overall, 80.2% were male with median age of 14 years (range 0-15; IQR 12-15). Black children comprised 77.2% of injured children while only representing 36% of local schools. Community violence (intentional interpersonal or bystander) injuries were 67.2% of the cohort; 7.8% were negligent discharges; and 2.6% suicide. Median age for intentional interpersonal injuries was 14 years (IQR 14-15) compared with 12 years (IQR 6-14, p<0.001) for negligent discharges. Far more injuries were seen in the summer after the stay-at-home order (p<0.001). Community violence and negligent discharges increased in 2020 (p=0.004 and p=0.04, respectively). Annual suicides also increased linearly (p=0.006). 5.5% of injuries were during school; 56.7% after school or during non-school days; and 34.3% were after legal curfew. Mortality rate was 21.3%. Conclusions: Pediatric firearm-related injuries have increased during the past 5 years. Prevention strategies have not been effective during this time interval. Prevention opportunities were identified specifically in the preteenage years to address interpersonal de-escalation training, safe handling/storage, and suicide mitigation. Efforts directed at those most vulnerable need to be reconsidered and examined for their utility and effectiveness. Level of evidence: Level III; epidemiological study type.

Traumatic pediatric firearm injuries during the COVID-19 pandemic

Statement of Purpose: The purpose of this study is to epidemiologically describe firearms injuries treated at a Level 1 pediatric trauma center occurring during the COVID-19 pandemic and compare them to injuries seen in the year prior.Methods: This is a retrospective chart review of patients seen by pediatric trauma surgery for a firearm injury between February 1, 2019 and March 30, 2021;the pre-pandemic time period included February 1, 2019 – March 9, 2020 and the pandemic period included March 10, 2020 – March 31, 2021. We excluded patients with firearms injuries that were not assessed by trauma surgery and patients with injuries from non-powder guns.Results: Twenty-eight patients were seen for firearm injuries in the pre-pandemic period;22 (78.5%) were male, and the mean age was 13.3 years, with 17.8% of patients < 10 years old. Sixteen (57.1%) were black, 8 (28.6%) white, and 4 (14.3%) multiracial. The pandemic period included 80 patients with firearm injuries, with 59 (74%) male, and a mean age of 12.5 years. Seventeen (21.5%) were < 10 years old. Fifty-six (70%) of patients during the pandemic period were black, 15 (20%) white, 6 (7.5%) multiracial, and 2 (2.5%) Hispanic. There was no statistically significant difference between the two groups demographically. No patients were identified as having an intentional self-inflicted firearm injury.Conclusion: While there was a nearly threefold increase in pediatric firearm injuries seen during the pandemic, the demographics of the victims have not changed compared to pre-pandemic patterns. This reflects a need for ongoing and targeted preventive measures to reduce these extremely high-risk injuries.Key Take Away Points [list] [list] [list_item] Since the World Health Organization (WHO) declared a pandemic from the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2 or COVID-19), there has been a dramatic increase in the number of pediatric firearm injuries identified when compared to the preceding year. [/list_item] [list_item] A continued pattern of racial distribution before and during the pandemic with black children being overrepresented in the population with firearm injury as compared to all injuries seen was identified, with an overwhelming majority of firearm injuries occurring in urban areas. [/list_item] [list_item] The profound escalation of firearm injury in the pediatric population during the pandemic demonstrates the critical need for intensive community intervention and prevention efforts. [/list_item] [/list]

How Life During a Pandemic May Have Contributed to Homicide in Houston, Texas

This study offers an examination of a sample of 150 homicides in Houston, Texas in 2020 as described by local news sources. The purpose was to understand dynamics that may explain what appears to be an increase in domestic disputes that led to increases in homicides. This mixed method study utilized content analysis that included quantifying the patterns of concepts in the news reports to isolate racial, gender and location factors. Data are displayed in tables and figures to illustrate patterns and regression analyses indicate predictive relations. The study is important given the recent homicide increases during the COVID-19 pandemic, and the substantial impact on families and communities. The data reveal that domestic disputes and access to firearms are evident in the increases. The study offers implications for micro and macro responses involving media coverage, interpersonal communication, community programming and messaging, law enforcement engagement, and justice system reforms.Key Take Away Points [list] [list] [list_item] increase in homicide during COVID-19 [/list_item] [list_item] decrease in police presence [/list_item] [list_item] majority of homicides are caused by guns [/list_item] [/list]

Defensive Behaviors During COVID-19 and the 2020–2021 Firearm Purchasing Surge: A Latent Class Analysis

Objective: This study examined the extent to which political beliefs and public health behaviors cluster together and define distinct groups of individuals and whether those groups differ on firearm purchasing behaviors. Methods: 6,404 US residents (Minnesota, n = 1,789;Mississippi, n = 1,418;New Jersey, n = 3,197) were recruited via Qualtrics panels. Participants were matched to 2010 census data. Results: Fit statistics determined a four-class solution fit the data best. The Liberal-Many Health Behaviors class had high probabilities of voting for President Biden, reporting more liberal political beliefs than other classes, and engaging in multiple health behaviors (e.g., mask wearing, vaccination). The Moderate-Few Health Behaviors class had high probabilities of voting for President Biden, reporting moderate political beliefs, and engaging in few health behaviors. The Conservative-Few Health Behaviors class had high probabilities of voting for former President Trump, reporting conservative political beliefs, and engaging in few health behaviors. The Conservative-Many Health Behaviors class had high probabilities of voting for former President Trump, having conservative political beliefs, and engaging in many health behaviors. Of the participants in the study who reported owning firearms, those in the Few Health Behavior classes were more likely to have purchased firearms during the purchasing surge, whereas those in the Many Health Behavior classes were likely to have become first-time firearm owners in 2020-2021. Lastly, the Few Health Behavior classes exhibited significantly less trust in the intentions of scientists. Conclusion: Different subgroups of firearm owners may evaluate and respond to risk differently, resulting in a pattern of adopting or avoiding a range of public health recommendations. Those who avoided mask wearing and COVID-19 vaccinations and who purchased firearms during the firearm purchasing surge appear to have less trust in science, highlighting the need for trusted messengers to increase the reach of behavioral interventions. [ FROM AUTHOR] Copyright of Journal of Social & Clinical Psychology is the property of Guilford Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Best way to prevent firearm violence: Limit access to firearms

The increased publicity of mass shootings and the COVID-19 pandemic have fueled American demand for firearm purchases. Firearm violence has largely been blamed on people with mental illnesses instead of firearm accessibility, despite the lack of population-level evidence associating mental illness with firearm violence perpetration. We support interventions and policies to limit firearm access in homes, schools, and by all intimate partners who have been convicted of domestic abuse. We advocate for restrictions on the civilian purchases of semi-automatic rifles and large capacity magazines. Finally, we call for research addressing firearm violence as an environmental and structural issue, not an intrapersonal one.Key Take Away Points [list] [list] [list_item] Despite worsening mental health outcomes among American youth, there is little population-based evidence supporting an association between firearm violence perpetration and mental illness. [/list_item] [list_item] Firearm accessibility increases the risk for firearm violence and injuries. [/list_item] [list_item] Preventing school shootings requires both promotion of socio-emotional learning and restrictions of firearm sales from young civilians. [/list_item] [list_item] Provisions in the Bipartisan Safer Communities Act to regulate access to firearms is an initial step to reducing firearm violence. [/list_item] [list_item] Long-term reductions in firearm violence require structural approaches to improve social determinants of health. [/list_item] [/list]

Changes in suicide in California from 2017 to 2021: a population-based study.

BACKGROUND: Suicide is a major public health problem with immediate and long-term effects on individuals, families, and communities. In 2020 and 2021, stressors wrought by the COVID-19 pandemic, stay-at-home mandates, economic turmoil, social unrest, and growing inequality likely modified risk for self-harm. The coinciding surge in firearm purchasing may have increased risk for firearm suicide. In this study, we examined changes in counts and rates of suicide in California across sociodemographic groups during the first two years of the COVID-19 pandemic relative to prior years. METHODS: We used California-wide death data to summarize suicide and firearm suicide across race/ethnicity, age, education, gender, and urbanicity. We compared case counts and rates in 2020 and 2021 with 2017-2019 averages. RESULTS: Suicide decreased overall in 2020 (4123 deaths; 10.5 per 100,000) and 2021 (4104; 10.4 per 100,000), compared to pre-pandemic (4484; 11.4 per 100,000). The decrease in counts was driven largely by males, white, and middle-aged Californians. Conversely, Black Californians and young people (age 10 to 19) experienced increased burden and rates of suicide. Firearm suicide also decreased following the onset of the pandemic, but relatively less than overall suicide; as a result, the proportion of suicides that involved a firearm increased (from 36.1% pre-pandemic to 37.6% in 2020 and 38.1% in 2021). Females, people aged 20 to 29, and Black Californians had the largest increase in the likelihood of using a firearm in suicide following the onset of the pandemic. The proportion of suicides that involved a firearm in 2020 and 2021 decreased in rural areas compared to prior years, while there were modest increases in urban areas. CONCLUSIONS: The COVID-19 pandemic and co-occurring stressors coincided with heterogeneous changes in risk of suicide across the California population. Marginalized racial groups and younger people experienced increased risk for suicide, particularly involving a firearm. Public health intervention and policy action are necessary to prevent fatal self-harm injuries and reduce related inequities.

Gun violence is a public health crisis that needs more applied criminologists

Research SummaryGun violence was declared a "public health crisis” after shootings increased in many U.S. cities during the course of the COVID‐19 pandemic. The public health approach to gun violence prevention offers many advantages such as an applied research model, the mobilization of a wider range of stakeholders, and a commitment to harm reduction. Too often, however, the public health community seems unaware of criminological research on gun violence and avoids including criminal justice interventions in their comprehensive plans.Policy ImplicationsCommunities need immediate relief from the persistent trauma of repeated shootings. Criminal justice interventions represent important responses to outbreaks of gun violence that should be included among recommended public health programs intended to address proximate and upstream causes of gun violence. Gun violence prevention policy and practice would be strengthened by more deliberate attempts to foster complementary public health and criminology research and development collaborations. More applied criminologists need to become engaged in gun violence research to meet this call.

Reversing the Decreasing Life Expectancy: A National Health Priority

The Center for Disease Control and Prevention (CDC)'s National Center for Health Statistics (NCHS) published a startling report in July 2021 documenting a decrease in the life expectancy of Americans to the lowest level since 2003.1,2 This was the largest one-year drop since World War II. The leading causes of death for 2020 were heart disease, cancer, and COVID.3 Seventy-four percent of the decline in life expectancy was attributed to COVID while accidental and unintentional injuries contributed to 11% of the decline, homicide contributed 3.1%, diabetes contributed 2.5%, and chronic liver disease and cirrhosis contributed 2.3%.1,2 The overall decline of 1.5 years would have been greater if there had not been offsetting effects of declining mortality due to cancer, chronic lower respiratory diseases, heart disease, suicide, and certain perinatal conditions.2 Across racial groups, there were differences in the decline as well as the reasons for lower life expectancy. Excess mortality due to COVID contributed to 67.9% of the decrease followed by unintentional injuries, chronic liver disease and cirrhosis, diabetes, and homicide.2 Changes in the Missouri Life Expectancy Rates The Missouri Department of Health and Senior Services published a report in August 2021 providing details on the decrease in life expectancy for Missourians.4 The overall decline was 2.1 years with male life expectancy dropping 2.3 years to 72.3 and females dropping 1.9 years to 78.4 years. Accidental and Unintentional Injuries The Substance Abuse and Mental Health Services Administration (SAMHSA) defines harm reduction as a "proactive and evidence-based approach to reduce the negative personal and public health impacts of behavior associated with alcohol and other substance use at both the individual and community levels.

Biting the Bullet: A Call for Action on Lead-Contaminated Meat in Food Banks

Even though the presence of ammunition-derived metallic lead fragments in donated firearms-hunted meat has been recognized for more than a decade, the vast majority of donated hunted meat is not inspected to discard meat containing lead fragments.1 An underlying lack of food safety standards for adulterated donated food increases risks to lowincome recipients, who are already disproportionately affected by elevated blood lead levels (BLLs).2 Primary prevention is needed for this overlooked source of lead exposure. LOW-LEVEL LEAD Primary prevention is recognized as the most effective way to address the epidemic of lead poisoning in the United States.3 The current blood lead reference level recognized by the Centers for Disease Control and Prevention is 3.5 micrograms per deciliter (mg/dL). A strong body of scientific research demonstrates that leadbased ammunition frequently contaminates hunted meat and increases BLLs of humans and animals who consume it.1,7-9 Lead-contaminated hunted meat has been identified as the most poorly acknowledged and addressed example of food lead contamination, and scientists have called for this source of lead exposure to be acknowledged and addressed with health-protective measures.8,9 A 2013 consensus statement of experts in human, environmental, and wildlife toxicology supports reducing and eventually eliminating the introduction of lead into the environment from lead-based ammunition, emphasizing that shooting lead ammunition into the environment poses significant risks of lead exposure to humans and wildlife.10 In 2016, Arnemo et al. found that more than 99% of 570 scientific articles about environmental and health consequences of lead in ammunition raised concerns about lead toxicity.7 The authors highlighted that nonlead ammunition is as effective as lead-based ammunition and is comparably priced. Despite the well-established scientific basis for regulation of lead ammunition for hunting, the topic has been politicized by misinformation campaigns portraying concerns about ingesting lead ammunition as a product of antihunting agendas.11 Lead Contamination in Donated Hunted Meat Donated hunted meat is a vital source of protein distributed by food banks at a time when food bank use remains far above pre-COVID-19 pandemic levels.12 Published evidence of leadcontaminated meat in food banks has existed for more than a decade (Figure A, available as a supplement to the online version of this article at https://www.ajph.org).13 Investigations in multiple states have confirmed the presence of lead in donated meat.

Trends in Pregnancy-Associated Homicide, United States, 2020

Objectives. To estimate the national pregnancy-associated homicide rate in 2020 and to characterize patterns of victimization. Methods. Using a retrospective analysis of the 2020 US national mortality file, I identified all homicides of women who were pregnant or within 1 year of the end of pregnancy. Descriptive statistics characterized these victims, and I calculated annual pregnancy-associated homicide rates (deaths per 100 000 live births) for comparisons with 2018 and 2019. I estimated the added risk conferred by pregnancy in 2020 by comparing the pregnancy-associated homicide rate to homicide in the nonpregnant, nonpostpartum population of females aged 10 to 44 years. Results. There were 5.23 pregnancy-associated homicides per 100 000 live births in 2020, a notable increase from previous years. Rates were highest among adolescents and non-Hispanic Black women. Eighty percent of incidents involved firearms. The risk of homicide was 35% greater for pregnant and postpartum women than for their nonpregnant, nonpostpartum counterparts, who did not experience as large an increase from previous years. Conclusions. Pregnancy-associated homicide substantially increased in 2020. Public Health Implications. Policies to address domestic and community violence against women are urgently needed. (AmJ Public Health. 2022;112(9):1333-1336. https://doi.org/10.2105/AJPH.2022.306937)

Teen firearm access during COVID: a repeated cross-sectional analysis of Pennsylvania families

Purpose: This study aims to investigate patterns in adolescent gun access and household gun storage in 2021 and 2022. Design/methodology/approach: Data were collected from two cross-sectional surveys of Pennsylvania parents with a teenage child at home. Findings: The results indicated that about 20% of gun owners in each survey stored their guns loaded;a similar percentage stored their guns unlocked. Very few gun owners reported that their children could access their guns without adult supervision. This study found no change in gun storage practices between 2021 and 2022, but higher rates of gun ownership in 2022. The factors associated with gun storage behaviors did change between the two time points. COVID-related uncertainties and transitions in the household were linked to gun ownership and less safe storage practices in 2021, but not in 2022. Originality/value: This study identified factors associated with teen gun access at distinct points during the pandemic. This study found little evidence of any association between child mental health and household firearm storage. © 2022, Emerald Publishing Limited.

Death and ill health by order of the Supreme Court

kabbasi@bmj.com 
Follow Kamran on Twitter @KamranAbbasi The US Supreme Court is a danger to public health and an example of how political manipulation of legal checks and balances can score a quick ideological victory but lead to long term harm to health and wellbeing. The UK is using legal mechanisms against asylum seekers (doi:10.1136/bmj.o1502),6 and it plans to remove itself from the jurisdiction of the European Court of Human Rights (https://www.theguardian.com/law/2022/jun/21/uks-new-bill-of-rights-will-curtail-power-of-european-human-rights-court).7 Historically, the world has looked to established democracies such as the UK and the US to take a lead on human rights. Health is not a priority when a government sidesteps the sensible recommendations of an independent review of food strategy that it itself commissioned (doi:10.1136/bmj.o1520, doi:10.1136/bmj.o1549).89 Other priorities are at play when major national drug regulators and “independent advisers” are funded extensively by the industry and make decisions that unduly favour it, as our new investigation shows (doi:10.1136/bmj.o1538).10 Which priorities drive the reluctance to accept the evidence on airborne transmission of SARS-CoV-2, to which we add a new review (doi:10.1136/bmj-2021-068743, 10.1136/bmj.o1408)?1112 Are they related to the commercial and legal missteps in protecting healthcare professionals?

Improving care for survivors of gun violence

Survivors of gun violence have significant sequelae including mental health disorders that often go undiagnosed and untreated. Survivors of gun violence are at high risk for both re-injury with a firearm as well as interaction with the criminal justice system. These poor outcomes for survivors of gun violence contribute to the cycle of gun violence that plague communities across the United States. Learning from historical public health successes, survivors of gun violence are an important population for targeted secondary prevention efforts. Despite this, the mechanisms for these outcomes among survivors of gun violence are largely unknown and there is a dearth of research on effective prevention strategies. Combining qualitative and quantitative research methods, I sought to better describe the experience of recovery for survivors of gun violence, conduct a pilot study of a mental health intervention for post-traumatic stress symptoms, and describe the effect of the COVID-19 pandemic on community violence in Connecticut (CT). In Aim 1, I used a qualitative research study design and a community-based participatory research approach to better understand how Black male gunshot wound survivors in the United States describe their experience of recovery and their perceptions of their mental, emotional and social health following the event. We conducted in-depth interviews with 20 Black male gunshot wound survivors from New Haven, CT. This study identified five themes which define the psychological recovery after intentional injury from gun violence as well as describe the various strategies used by survivors of gun violence to cope with a disrupted sense of safety when returning to their communities. In the secondary analysis of the data, I found that participants described distrust for the police and an ecology of guns that confers symbolic, social and strategic meaning to owning a gun. These findings suggest that barriers to mental health treatment may be addressed through "credible messengers" who can develop relationships of trust with this high-risk population and that interventions to decrease gun violence should address the cultural value of a gun as well as focus on improving police relations with racial/ethnic minoritized communities.In Aim 2, I designed a pilot study evaluating the feasibility of completing a randomized controlled trial to test the Screening and Tool for Awareness and Relief of Trauma (START), a targeted mental health intervention developed for patients that come from communities of color with sustained and persistent trauma. I conducted the study at Yale New Haven Hospital in New Haven, CT through the YNHH Violence Intervention Program beginning in January 2020. For a variety of reasons but most notably due to the disruption caused by the COVID-19 pandemic, only 11 patients were enrolled in the study. With this small cohort, I was able to conclude that (1) Successful recruitment hinges on enrollment in the local hospital-based violence intervention program and the effectiveness of credible messengers in the organization;(2) The START techniques would be improved by additional audiovisual resources;(3) The novel survey to measure alienation is reliable and (4) Testing the START intervention may be most successful in a stepped wedge cluster randomized controlled trial design so that all centers in the study will receive the intervention. In Aim 3, I examined the effect of the COVID-19 pandemic on community violence in the state of Connecticut (CT). Through the CT Hospital-based Violence Intervention Program Collaborative, I used the trauma registries from Yale New Haven Hospital, Bridgeport Hospital, St. Francis Hospital, and Hartford Hospital to collect data on all violence-related trauma presentations in the emergency room from January 1st, 2018 to January 1st, 2021. I compared the pattern of violence-related... (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Abstracts from International Emergency Medicine Journals

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an from each publication.

A time series projection model of online seasonal demand for American wine and potential disruption in the supply channels due to COVID-19

Purpose>This study statistically examines the shifting distribution channels in the American wine industry based on the growth trajectory of sales, seasonality and disruption due to consumers switching to online platforms. The purpose of this paper is to design a model that will have general applicability beyond the wine industry.Design/methodology/approach>The research uses regression-based additive decomposition of time series data to predict the trajectory of the market share for the digital distribution channel. The study develops a statistical prediction model using time series data between 2007 and 2020, inclusive, sourced from US Annual Wine Reports and Bureau of Alcohol, Tobacco and Firearms databases.Findings>The results show an increasing trajectory of wine sales through the online distribution channel with predictable seasonality. The disruptive effects of consumer switching behavior point to a steady increase in sales due both to increasing demand and accelerating switching. Nevertheless, the model shows that bricks and mortar purchases will remain strong and continue to account for the bulk of wine sales. COVID-19 has caused a step function increase in online sales but this should moderate after the crisis subsides and can be tested further.Originality/value>This study is original in developing a model for an industry where bricks and mortar sales are growing and are expected to remain strong while there is still identifiable switching to online sales. The wine industry presents a classic case of accelerating switching behavior where there is still a strong franchise for in-store purchases. The model should have general applicability to distribution channels beyond the wine industry where steady growth, marked seasonality and disruptive consumer switching are in evidence.

Taking crime guns seriously: A socio-material perspective

This article argues that guns, as objects used in and for crime, have received insufficient criminological attention. It proposes a socio-material perspective for taking crime guns seriously as material agents in the ways many serious crimes are planned and executed. Drawing in part upon affordance theory, the perspective links the ‘objective’ physical properties of guns to their allure and take up for the purposes of carrying out crime. Guns are powerful organising objects in the commission of crime, it is argued, capable of provoking as well as enabling a range of threatening and harmful activities. The perspective is developed drawing upon interview data from a large qualitative study of convicted gun criminals. These data enable the notion of materiality to be considered at different stages of criminal career, particularly prior to first criminal gun use through to enforced or voluntary desistance. The article concludes with a consideration of policy options suggested by the socio-material perspective. In a post-Covid 19 world in which guns have gained greater salience in many countries, it is argued that the need to ‘dematerialise’ gun attraction and use has never been greater.

Pursuing an Evidence-Informed Approach to the Prevention of Gun Violence

The book largely focuses on solutions that can be implemented right away. [...]in line with existing data and literature on prevention of gun violence, it underscores the need for a multifaceted prevention approach. The authors then identify clear gaps in existing public health surveillance (particularly as they consider different types of gun violence), and this discussion ends with a call for a coordinated data collection effort to be expanded to include nonfatal injuries from firearms. A true preventive public health approach must consider the ways in which both indirect (e.g., witnessing gun violence) and direct (e.g., being injured with a bullet) forms of exposure to gun violence affect the health and well-being of individuals and communities.4,5 Building off of this foundation, the predominant theme woven throughout the book's subsequent chapters is the notion that multiple strategies across sectors and levels are needed to reduce the harms that stem from our national gun violence crisis.