Unintentional Firearm Injury Deaths Among Children and Adolescents Aged 0-17 Years - National Violent Death Reporting System, United States, 2003-2021.

In the United States, unintentional injury is the fourth leading cause of death among infants (i.e., children aged <1 year) and is the top cause of death among children and adolescents aged 1-17 years; firearms are a leading injury method. Unsecured firearms (e.g., unlocked and loaded) are associated with risk for unintentional childhood firearm injury death. Data recorded during 2003-2021 by the National Violent Death Reporting System (NVDRS) from 49 states, the District of Columbia, and Puerto Rico were used to characterize unintentional firearm injury deaths of U.S. infants, children, and adolescents aged 0-17 years (referred to as children in this report). NVDRS identified 1,262 unintentional firearm injury deaths among children aged 0-17 years: the largest percentage (33%) of these deaths were among children aged 11-15 years, followed by 29% among those aged 0-5 years, 24% among those aged 16-17 years, and 14% among persons aged 6-10 years. Overall, 83% of unintentional firearm injury deaths occurred among boys. The majority (85%) of victims were fatally injured at a house or apartment, including 56% in their own home. Approximately one half (53%) of fatal unintentional firearm injuries to children were inflicted by others; 38% were self-inflicted. In 9% of incidents, it was unknown whether the injury was self- or other-inflicted. Approximately two thirds (67%) of shooters were playing with or showing the firearm to others when it discharged. Overall, firearms used in unintentional injury deaths were often stored loaded (74%) and unlocked (76%) and were most commonly accessed from nightstands and other sleeping areas (30%). Unintentional firearm injury deaths of children are preventable. Secured firearm storage practices (e.g., storing firearms locked, unloaded, and separate from ammunition) have been identified as protective factors against child firearm injuries and deaths, underscoring the importance of policymakers, health care professionals (e.g., pediatricians), and others partnering with parents, caregivers, and firearm owners to promote secure firearm storage.

Longitudinal Associations Between Sexual Victimization and Substance Misuse Among High School Youth in Colorado.

There are consistently high rates of sexual victimization and substance misuse among youth in the United States. Although there is a known relation between sexual victimization and substance use, there is a gap in the research regarding the magnitude and temporality of these associations. This study examined whether latent classes of sexual victimization and help-seeking attitudes longitudinally predict intentions of future substance misuse 7-10 months later. Students from nine Colorado high schools (N = 533; M = age 16 years) completed surveys across two consecutive school semesters. Latent class analysis was used to identify classes of students who experienced at least one form of sexual victimization (e.g., sexual harassment, unwanted sexual contact) according to 13 sexual victimization items, and level of positive attitudes regarding help-seeking for sexual victimization. Classes were compared on demographic characteristics and for distal outcomes of likelihood of future substance misuse (cigarettes, alcohol, cannabis, prescription drugs, and electronic vaping products) using latent class regression, controlling for previous intentions to use. At Time 1, four classes of sexual victimization were identified with two main classes for comparison: low odds of experiencing sexual victimization (60.1% of sample) and high odds of endorsing all forms of sexual victimization (7.7% of sample). The high sexual victimization class had higher proportions of male and transgender students, compared to other classes. At Time 2 (7-10 months later), students in the high sexual victimization class reported a significantly greater likelihood of future cigarette (p = .017) and prescription drug misuse (p = .007) when compared to the low sexual victimization class. There was no evidence that having higher positive attitudes towards help-seeking resulted in lower intentions to use substances in the future. These findings highlight that addressing sexual violence in prevention programming may have crossover effects of reducing substance misuse and other forms of violence among youth.

Supporting Sexual Minority Youth: Protective Factors of Adverse Health Outcomes and Implications for Public Health.

PURPOSE: Sexual and gender minority (SGM) youth (e.g., gay, lesbian, bisexual, questioning, transgender) are systemically impacted by victimization and poor mental health because of discrimination in society. To prevent adverse outcomes, we must understand factors that help communities support and protect SGM youth. This study examined to what extent protective factors longitudinally predict outcomes 2 years later in an effort to inform more sensitive prevention efforts. METHODS: Students from nine Colorado high schools (N = 2,744) completed surveys across four consecutive school semesters (T1 to T4). Structural equation modeling was conducted to determine the longitudinal associations between baseline protective factors (access to medical and counseling services, help-seeking beliefs, trusted adults, family support, peer support, spirituality) and distal adverse outcomes (substance use, depression, suicidal ideation, peer victimization, bullying perpetration, sexual violence victimization and perpetration, homophobic name-calling victimization, and perpetration), by sexual orientation. RESULTS: All protective factors examined, except for access to medical services, were associated with lower likelihood of adverse outcomes. Associations differed across sexual orientations. For students identified as questioning or something other than heterosexual, lesbian, gay, or bisexual, family support is a notable protective factor of depression, peer victimization, bullying perpetration, and sexual violence perpetration. Family support was not significantly protective for these outcomes among heterosexual, lesbian, gay, and bisexual students. CONCLUSIONS: There is no singular protective factor or universally impactful intervention for public health. Public health initiatives should recognize intersectional identities of young people and build strategies that are relevant to specific identities to create more comprehensive and effective programing.

Suicide Among Health Care Practitioners and Technicians in Colorado: An Epidemiological Study.

Suicide is a public health concern with risks that vary between occupation groups. Many suicide victims with a health care occupation die by poisoning, but few studies have epidemiologically studied this association. The objective of this study was to quantify the increased risk of suicide death by poisoning among health care professionals in Colorado. Eleven years (2004-2014, N = 8,753) of suicide deaths in Colorado were compiled from the Colorado Violent Death Reporting System. A retrospective cohort study using multivariate logistic regression was conducted to examine the risk associated with having a health care occupation and eventual suicide death by poisoning, compared independently to firearm and hanging methods. Suicide victims with a health care occupation were more likely to die by poisoning rather than by hanging (RR 1.54, 95% CI: 1.41-1.68) or firearm (RR 1.79, 95% CI: 1.60-2.01), when compared to suicide victims without a health care occupation. The association between health care occupation and suicide method was significantly (p = .032) modified by gender. The results show that health care workers who die by suicide have an increased risk of eventual suicide death by poisoning rather than by firearm or hanging. These results can be used to inform tailored suicide prevention efforts in health care professionals.

Analysis of the Effects on Time Between Divorce Decree and Suicide.

Background: Divorced individuals carry unique suicide risks, from both acute and chronic exposure to stressors from divorce. Aims: Several statewide data sets were linked to assess the relationship between divorce and suicide. Method: Divorced suicide decedents in the Colorado Violent Death Reporting System, 2004-2015, were matched with divorce decree, using multiple identifiers. Statistically significant differences between the linked cohort and all divorced suicide decedents were assessed using chi-square statistics. Kaplan-Meier survival analyses were conducted assessing which demographics and circumstances had a significant effect on the time between divorce and death. Results: The linkage resulted in 381 divorced suicide decedents linked to a divorce decree. Time between divorce and death ranged from less than 1 year to more than 10 years. Age and intimate partner problems both had significant effects on reducing the survival probability at 1 year and beyond. Limitations: Only 14% of divorced suicide decedents were linked to a Colorado divorce decree. There were noted significant differences between the linked cohort and the total divorced suicide population. Conclusion: Better understanding the relationship between divorce and suicide is imperative to design effective prevention programs for this specific population.