Pilot study to explore girls' lacrosse players' attitudes toward headgear.

Headgear adoption is a controversial issue in girls' lacrosse due to concerns that headgear use will facilitate greater risk-taking by players and contribute to more aggressive game play behaviours. The purpose of this pilot study was to evaluate high school girls' lacrosse players' attitudes towards headgear before and after a season of use. Twenty-five high school girls' lacrosse athletes wore headgear for one competitive season and completed a pre- and post-season survey. The survey evaluated players' attitudes towards headgear use, with Aggressiveness, and Anger scales. Wilcoxon ranked tests were conducted to compare scores pre- and post-season. Players' attitude towards headgear largely remained unchanged and "neutral" after a season of wearing headgear. Players endorsed slightly greater agreement for three Headgear survey items post-season compared to pre-season: " … headgear allows me to be more aggressive … " (p = .01), " … players should wear more protective equipment " (p = .04) and " … wearing headgear increases how often I am hit in the head … " (p = .04). However, Aggressiveness and Anger scale scores were not changed following headgear use. Our findings suggest the perception of headgear use in high school girls' lacrosse is complex and could be associated with minor perceived changes in game play behaviours.

Firearm Background Checks in States With and Without Background Check Laws.

INTRODUCTION: A total of 21 states have enacted laws that extend the types of firearm transfers that require the prospective purchaser to undergo a background check, often referred to as comprehensive background check laws. Utilizing a national representative survey of gun owners, this study estimates the proportion of firearm transfers that occur without background checks in states with and without these laws. METHODS: Data came from the 2019 National Firearms Survey, a nationally representative survey of 2,950 firearm owners in the U.S. RESULTS: A smaller proportion of gun owners in states with comprehensive background check laws did not undergo a background check when they acquired their most recent firearm compared with gun owners in states without comprehensive background check laws (12%, 95% CI=9, 16 vs 24%, 95% CI=21, 28). In states with comprehensive background check laws, 40% (95% CI=23, 60) of purchasers who bought their firearm from a friend, family member, or acquaintance did not undergo a background check compared with 74% (95% CI=58, 85) in states without comprehensive background check laws. Differences in background check frequency by comprehensive background check law status was largely due to differences for 2 types of transactions: (1) private sales between friends/family members/acquaintances and (2) nonpurchase transfers. CONCLUSIONS: Fewer gun owners acquired their most recent firearm without a background check when the transfer occurred in a state with, relative to without, comprehensive background check laws. Private firearm sales that do not occur at traditional retail locations continue to be the type of sale least likely to have a background check.

Rule Modifications to Reduce Checking-Related Injuries in High School Boys' Lacrosse.

CONTEXT: The National Federation of State High School Associations previously implemented 2 lacrosse rule modifications: Rule 5.4 in the 2012-2013 academic year to heighten the penalty for a head or neck hit to the head, face, or neck (HFN) and Rule 5.3.5 in the 2013-2014 academic year to minimize body checking. OBJECTIVE: To determine if the rates of overall injury, HFN injuries, and concussions due to intentional contact (checking) differed for boys' high school lacrosse players after Rule 5.4 and 5.3.5 modifications were enacted. DESIGN: Descriptive epidemiology study. SETTING: Web-based online surveillance system. PATIENTS OR OTHER PARTICIPANTS: Boys' high school lacrosse players during the 2008-2009 to 2016-2017 seasons whose teams involved athletic trainers participating in the High School Reporting Information Online sports injury-surveillance system. INTERVENTION(S): Rule 5.4 in the 2012-2013 academic year increased the penalty for any intentional hits to the HFN, and Rule 5.3.5 in the 2013-2014 year eliminated body checking to a player in a defenseless position. MAIN OUTCOME MEASURE(S): Overall, HFN, and concussion injury rate ratios (IRRs) by checking mechanism; overall and checking-related injury ratios by competitions and practices. RESULTS: A decrease was shown in checking-related HFN injuries (IRR = 0.29, 95% CI = 0.13, 0.65) and checking-related concussions (IRR = 0.29, 95% CI = 0.12, 0.70) during practices in the seasons after both rule modifications were imposed, but no decreases occurred in any checking-related injuries during competitions. By injury mechanism, no decreases were evident after the Rule 5.4 modification. When both rule modifications (Rules 5.4 and 5.3.5) were enacted together, concussion rates due to delivering body checks (IRR = 0.51, 95% CI = 0.29, 0.91) and overall injury risk due to being body checked (IRR = 0.72, 95% CI = 0.53, 0.97) decreased. CONCLUSIONS: When both Rule 5.4 and 5.3.5 modifications were in effect, concussion and overall injury risks decreased for the body checker and the player being body checked, respectively.

The Effects of Headgear in High School Girls' Lacrosse.

BACKGROUND: Girls' lacrosse headgear that met the ASTM International performance standard (ASTM F3137) became available in 2017. However, the effects of headgear use on impact forces during game play are unknown. PURPOSE: To evaluate potential differences in rates, magnitudes, and game-play characteristics associated with verified impacts among players with and without headgear during competition. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 49 female high school participants (mean age, 16.2 ± 1.2 years; mean height, 1.66 ± 0.05 m; mean weight, 61.2 ± 6.4 kg) volunteered for this study, which took place during the 2016 (no headgear; 18 games) and 2017 (headgear; 15 games) seasons. Wearable sensors synchronized with video verification were used. Descriptive statistics, impact rates, and chi-square analyses described impacts and game-play characteristics among players with and without headgear. Differences in mean peak linear acceleration (PLA) and peak rotational velocity (PRV) between the no headgear and headgear conditions were evaluated using a linear generalized estimating equation regression model to control for repeated within-player measurements. RESULTS: Overall, 649 sensor-instrumented player-games were recorded. A total of 204 impacts ≥20g recorded by the wearable sensors were verified with video analysis (102 no headgear; 102 headgear). Most impacts were imparted to the player's body (n = 152; 74.5%) rather than to the player's head (n = 52; 25.5%). Impact rates per player-game did not vary between the no headgear and headgear conditions (0.30 vs 0.34, respectively; impact rate ratio, 0.88 [95% CI, 0.37-2.08]). There was no association between impact frequency by mechanism or penalties administered between the no headgear and headgear conditions for overall or direct head impacts. The generalized estimating equation model estimated a significant reduction in mean impact magnitudes overall (PLA: -7.9g [95% CI, -13.3 to -2.5]; PRV: -212 deg/s [95% CI, -359 to -64]) with headgear relative to no headgear. No game-related concussions were reported during this study. CONCLUSION: Lacrosse headgear use was associated with a reduction in the magnitude of overall impacts but not a significant change in the rate of impacts, how they occur, or how penalties were administered for impacts sustained during competition. Further research is needed with a larger sample and different levels of play to evaluate the consequences of headgear use in girls' lacrosse.

Game-Related Impacts in High School Boys' Lacrosse.

BACKGROUND: The rate of concussions in boys' lacrosse is reported to be the third highest among high school sports in the United States, but no studies have described game-related impacts among boys' lacrosse players. PURPOSE: To characterize verified game-related impacts, both overall and those directly to the head, in boys' varsity high school lacrosse. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 77 male participants (mean age, 16.6 ± 1.2 years; mean height, 1.77 ± 0.05 m; mean weight, 73.4 ± 12.2 kg) were instrumented with sensors and were videotaped during 39 games. All verified game-related impacts ≥20g were summarized in terms of frequency, peak linear acceleration (PLA), and peak rotational velocity (PRV). Descriptive statistics and impact rates per player-game (PG) with corresponding 95% CIs were calculated. RESULTS: Overall, 1100 verified game-related impacts were recorded (PLA: median, 33.5g [interquartile range (IQR), 25.7-51.2]; PRV: median, 1135.5 deg/s [IQR, 790.0-1613.8]) during 795 PGs. The rate for all verified game-related impacts was 1.38 impacts per PG (95% CI, 1.30-1.47). Of these, 680 (61.8%) impacts (PLA: median, 35.9g [IQR, 26.7-55.5]; PRV: 1170.5 deg/s [IQR, 803.2-1672.8]) were directly to the head (impact rate, 0.86 impacts/PG [95% CI, 0.79-0.92]). Overall, midfielders (n = 514; 46.7%) sustained the most impacts, followed by attackers (n = 332; 30.2%), defenders (n = 233; 21.2%), and goalies (n = 21; 1.9%). The most common mechanisms for overall impacts and direct head impacts were contact with player (overall: n = 706 [64.2%]; head: n = 397 [58.4%]) and stick (overall: n = 303 [27.5%]; head: n = 239 [35.1%]), followed by ground (overall: n = 73 [6.6%]; head: n = 26 [3.8%]) and ball (overall: n = 15 [1.4%]; head: n = 15 [2.2%]). Direct head impacts were associated with a helmet-to-helmet collision 31.2% of the time, and they were frequently (53.7%) sustained by the players delivering the impact. Nearly half (48.8%) of players delivering contact used their helmets to initiate contact that resulted in a helmet-to-helmet impact. Players receiving a head impact from player contact were most often unprepared (75.9%) for the collision. CONCLUSION: The helmet is commonly used to initiate contact in boys' high school lacrosse, often targeting defenseless opponents. Interventions to reduce head impacts should address rules and coaching messages to discourage intentional use of the helmet and encourage protection of defenseless opponents.

Characterizing Verified Head Impacts in High School Girls' Lacrosse.

BACKGROUND: Girls' high school lacrosse players have higher rates of head and facial injuries than boys. Research indicates that these injuries are caused by stick, player, and ball contacts. Yet, no studies have characterized head impacts in girls' high school lacrosse. PURPOSE: To characterize girls' high school lacrosse game-related impacts by frequency, magnitude, mechanism, player position, and game situation. STUDY DESIGN: Descriptive epidemiology study. METHODS: Thirty-five female participants (mean age, 16.2 ± 1.2 years; mean height, 1.66 ± 0.05 m; mean weight, 61.2 ± 6.4 kg) volunteered during 28 games in the 2014 and 2015 lacrosse seasons. Participants wore impact sensors affixed to the right mastoid process before each game. All game-related impacts recorded by the sensors were verified using game video. Data were summarized for all verified impacts in terms of frequency, peak linear acceleration (PLA), and peak rotational acceleration (PRA). Descriptive statistics and impact rates were calculated. RESULTS: Fifty-eight verified game-related impacts ≥20 g were recorded (median PLA, 33.8 g; median PRA, 6151.1 rad/s2) during 467 player-games. The impact rate for all game-related verified impacts was 0.12 per athlete-exposure (AE) (95% CI, 0.09-0.16), equivalent to 2.1 impacts per team game, indicating that each athlete suffered fewer than 2 head impacts per season ≥20 g. Of these impacts, 28 (48.3%) were confirmed to directly strike the head, corresponding with an impact rate of 0.05 per AE (95% CI, 0.00-0.10). Overall, midfielders (n = 28, 48.3%) sustained the most impacts, followed by defenders (n = 12, 20.7%), attackers (n = 11, 19.0%), and goalies (n = 7, 12.1%). Goalies demonstrated the highest median PLA and PRA (38.8 g and 8535.0 rad/s2, respectively). The most common impact mechanisms were contact with a stick (n = 25, 43.1%) and a player (n = 17, 29.3%), followed by the ball (n = 7, 12.1%) and the ground (n = 7, 12.1%). One hundred percent of ball impacts occurred to goalies. Most impacts occurred to field players within the attack area of the field (n = 32, 55.2%) or the midfield (n = 18, 31.0%). Most (95%) impacts did not result in a penalty. CONCLUSION: The incidence of verified head impacts in girls' high school lacrosse was quite low. Ball to head impacts were associated with the highest impact magnitudes. While stick and body contacts are illegal in girls' high school lacrosse, rarely did such impacts to the head result in a penalty. The verification of impact mechanisms using video review is critical to collect impact sensor data.

Video Analysis Verification of Head Impact Events Measured by Wearable Sensors.

BACKGROUND: Wearable sensors are increasingly used to quantify the frequency and magnitude of head impact events in multiple sports. There is a paucity of evidence that verifies head impact events recorded by wearable sensors. PURPOSE: To utilize video analysis to verify head impact events recorded by wearable sensors and describe the respective frequency and magnitude. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Thirty male (mean age, 16.6 ± 1.2 years; mean height, 1.77 ± 0.06 m; mean weight, 73.4 ± 12.2 kg) and 35 female (mean age, 16.2 ± 1.3 years; mean height, 1.66 ± 0.05 m; mean weight, 61.2 ± 6.4 kg) players volunteered to participate in this study during the 2014 and 2015 lacrosse seasons. Participants were instrumented with GForceTracker (GFT; boys) and X-Patch sensors (girls). Simultaneous game video was recorded by a trained videographer using a single camera located at the highest midfield location. One-third of the field was framed and panned to follow the ball during games. Videographic and accelerometer data were time synchronized. Head impact counts were compared with video recordings and were deemed valid if (1) the linear acceleration was ≥20 g, (2) the player was identified on the field, (3) the player was in camera view, and (4) the head impact mechanism could be clearly identified. Descriptive statistics of peak linear acceleration (PLA) and peak rotational velocity (PRV) for all verified head impacts ≥20 g were calculated. RESULTS: For the boys, a total recorded 1063 impacts (2014: n = 545; 2015: n = 518) were logged by the GFT between game start and end times (mean PLA, 46 ± 31 g; mean PRV, 1093 ± 661 deg/s) during 368 player-games. Of these impacts, 690 were verified via video analysis (65%; mean PLA, 48 ± 34 g; mean PRV, 1242 ± 617 deg/s). The X-Patch sensors, worn by the girls, recorded a total 180 impacts during the course of the games, and 58 (2014: n = 33; 2015: n = 25) were verified via video analysis (32%; mean PLA, 39 ± 21 g; mean PRV, 1664 ± 619 rad/s). CONCLUSION: The current data indicate that existing wearable sensor technologies may substantially overestimate head impact events. Further, while the wearable sensors always estimated a head impact location, only 48% of the impacts were a result of direct contact to the head as characterized on video. Using wearable sensors and video to verify head impacts may decrease the inclusion of false-positive impacts during game activity in the analysis.

Firearm Acquisition Without Background Checks: Results of a National Survey.

BACKGROUND: In 1994, 40% of U.S. gun owners who had recently acquired a firearm did so without a background check. No contemporary estimates exist. OBJECTIVE: To estimate the proportion of current U.S. gun owners who acquired their most recent firearm without a background check, by time since and manner of acquisition, for the nation as a whole and separately in states with and without legislation regulating private sales. DESIGN: Probability-based online survey. SETTING: United States, 2015. PARTICIPANTS: 1613 adult gun owners. MEASUREMENTS: Current gun owners were asked where and when they acquired their last firearm; if they purchased the firearm; and whether, as part of that acquisition, they had a background check (or were asked to show a firearm license or permit). RESULTS: 22% (95% CI, 16% to 27%) of gun owners who reported obtaining their most recent firearm within the previous 2 years reported doing so without a background check. For firearms purchased privately within the previous 2 years (that is, other than from a store or pawnshop, including sales between individuals in person, online, or at gun shows), 50% (CI, 35% to 65%) were obtained without a background check. This percentage was 26% (CI, 5% to 47%) for owners residing in states regulating private firearm sales and 57% (CI, 40% to 75%) for those living in states without regulations on private firearm sales. LIMITATION: Potential inaccuracies due to recall and social desirability bias. CONCLUSION: 22% of current U.S. gun owners who acquired a firearm within the past 2 years did so without a background check. Although this represents a smaller proportion of gun owners obtaining firearms without background checks than in the past, millions of U.S. adults continue to acquire guns without background checks, especially in states that do not regulate private firearm sales. PRIMARY FUNDING SOURCE: Fund for a Safer Future and the Joyce Foundation.

Rate of injury among youth lacrosse players.

OBJECTIVE: This study describes the rate of injury and the types and mechanisms of injuries incurred by girls and boys during youth recreational lacrosse. DESIGN: Prospective cohort study. SETTING: Games were played at a large turf community athletic complex. PARTICIPANTS: Participants included male and female lacrosse players aged 9-15 years. A total of 143 games were played, resulting in 4603 athlete-exposures (AEs). ASSESSMENT OF RISK FACTORS: Youth players were grouped based on sex and 3 age categories: under 11 (U11; 9-10 years), under 13 (U13; 11-12 years), and under 15 (U15; 13-14 years). MAIN OUTCOME MEASURES: Certified athletic trainers collected data on type of injury and injury mechanism. RESULTS: There were 6.3 injuries per 1000 AEs for boys and girls combined. Girls had 7 injuries (3.4 per 1000 AEs) and boys had 22 injuries (8.7 per 1000 AEs). Contusions and lacerations were the most frequent injury (n = 13), and body-to-body contact (n = 10) was the most common injury mechanism. There were 4 concussions among boys (U13 and U15) and none among girls. CONCLUSIONS: Most injuries evaluated in youth lacrosse were contusions/lacerations; however, serious injuries were observed, including concussions in boys in the age group where body contact is allowed.

Bullying and suicidal behaviors among urban high school youth.

PURPOSE: To determine whether involvement in bullying as a perpetrator, victim, or both victim and perpetrator (victim-perpetrator) was associated with a higher risk of suicidal ideation or suicide attempts among a multiethnic urban high school population in the United States. METHODS: In 2008, a total of 1,838 youth in 9th-12th grades attending public high school in Boston, MA, completed an in-school, self-reported survey of health-related behaviors. Logistic regression was used to evaluate the relationship between bullying behaviors and self-reported suicidal ideation and suicide attempts within the 12 months preceding the survey. RESULTS: Students who reported having been involved in bullying as a perpetrator, victim, or victim-perpetrator were more likely than those who had not been involved in bullying to report having seriously considered or attempted suicide within the past year. When age, race/ethnicity, and gender were controlled, students who were victim-perpetrators of bullying were at highest risk for both suicidal ideation and suicide attempt. CONCLUSIONS: Urban youth who have been bullied as well as those who have bullied others are at increased risk of suicidal ideation and suicide attempts.

The effect of child access prevention laws on unintentional child firearm fatalities, 1979-2000.

OBJECTIVE: Unintentional firearm deaths among children have been declining steadily in the United States. This study investigates whether Child Access Prevention (CAP) laws are associated with this decline. METHODS: Pooled cross-sectional time- series data (1979-2000) for 50 states and negative binomial regression methods were used to estimate the effect of Child Access Prevention laws on unintentional firearm deaths among children. RESULTS: Most states that enacted CAP laws experienced greater subsequent declines in the rate of unintentional firearm deaths for children age 0 to 14 compared with states not enacting the laws; however when adjusted for firearm prevalence and state and national effects the laws were associated with statistically significant declines only in Florida and California. In a comparison group of adults age 55 to 74, a group less likely to have young children in the home and thus less likely to be influenced by CAP laws, there was no indication that CAP laws affected unintentional firearm death rates. CONCLUSIONS: Unintentional firearm deaths are declining in the United States, with the rate for children under age 15 declining faster than adults. States that allowed felony prosecution of offenders experienced a greater effect of CAP laws than states that did not. CAP laws may have had some influence on the continued reduction in national death rates.

Differences in treatment outcome for hepatitis C among ethnic groups.

BACKGROUND: Studies of interferon-based therapies for hepatitis C virus (HCV)-infected patients have documented variable response rates according to ethnicity. However, these studies enrolled low numbers of ethnic minorities. METHODS: Data from two multicenter trials of combination therapy for hepatitis C were analyzed to determine predictors of treatment success. The first trial was a randomized study comparing interferon administered three times weekly with daily administration. Patients in both interferon groups received weight-based ribavirin. The second trial was an observational study of daily interferon and ribavirin. Only treatment-naïve patients were included in the analysis. Ethnicity (used as a nonspecific term to include race) was determined by patient self-report. Sustained virologic response was defined as negative HCV RNA by polymerase chain reaction at 24 weeks after completion of therapy. RESULTS: A total of 661 patients (390 from the randomized trial and 271 from the observational trial) were available for analysis. Sustained virologic response was highest among Asians (61% [22/36]), followed by whites (39% [193/496]), Hispanics (23% [18/79]), and African Americans (14% [7/50]). In a multiple logistic regression model that adjusted for other factors known to affect treatment outcome, including hepatitis C genotype, Asians continued to be more likely to respond to treatment, whereas Hispanics and African Americans were less likely, as compared with whites. CONCLUSION: Sustained response rates to interferon and ribavirin therapy differ among ethnic groups. Ethnicity appears to be associated with treatment outcomes, even in a model that adjusts for other factors that influence response to therapy.

The effect of nondiscretionary concealed weapon carrying laws on homicide.

BACKGROUND: Historically, the carrying of concealed firearms has been either substantially restricted or prohibited outright. Over the past two decades, laws making it easier for civilians to obtain permits allowing them to carry concealed weapons legally have proliferated throughout the United States. This study investigates the effect of such changes in state laws on state homicide rates. METHODS: Pooled cross-sectional time-series data (1979-1998) for 50 states and Poisson regression methods were used to estimate the effect of changes in state laws on homicide rates. RESULTS: No statistically significant association exists between changes in concealed weapon laws and state homicide rates. This finding is consistent across all models. CONCLUSIONS: The current findings are consistent with those of other published studies indicating that nondiscretionary concealed weapon laws are not associated with significant increases or decreases in homicide.

Low serum vitamin B12 levels in an outpatient HIV-infected population.

A retrospective review was conducted on serum vitamin B12 levels in an HIV-infected outpatient cohort, many of whom received antiretroviral therapy. B12 levels were obtained at most staging visits (every six months) and when clinically indicated. For each serum B12 level, laboratory values and clinical symptoms were recorded. Thirty-two patients (32/251 or 13%) had at least one low B12 level (<211pg/mL) during the course of their HIV infection. Within two years of their initial HIV presentation, 6/57 patients had a low serum B12. Using multiple linear regression analysis, a higher serum B12 level was significantly associated with higher folate levels, African-American race, and lower mean corpuscular volume. B12 levels increased significantly after initiating antiretroviral therapy (416 vs 535 pg/mL, P=0.04). In conclusion, low serum B12 levels occur commonly among HIV-infected patients, even at early stages without overt symptoms of B12 deficiency. Antiretroviral therapy may increase serum B12 levels.

Effects of Maryland's law banning "Saturday night special" handguns on homicides.

Small, inexpensive, often poorly made handguns known as "Saturday night specials" are disproportionately involved in crime. Maryland banned the sale of Saturday night specials effective January 1, 1990. During the 2 years between the law's passage in 1988 and its effective date, legal handgun sales in Maryland were 34% higher than expected (p = 0.09). Interrupted time-series analysis of age-adjusted homicide rates for 1975-1998 with statistical controls for trends in two neighboring states, social and economic variables, and temporal patterns in Maryland's homicide rates was used to assess the effect of the law. Estimates of the Saturday night special ban effects depended on the assumption made about the timing of the law's effects. Models that assumed a delayed or gradual effect of the Saturday night special ban produced estimates indicating that firearm homicide rates were 6.8-11.5% lower than would have been expected without the Saturday night special ban (p < or =0.05). The model that assumed an immediate, constant change in response to the law showed no law effect, unless an outlier was excluded from the analysis. Excluding this outlier, the model estimated a 15% increase in firearm homicides associated with the Saturday night special ban. None of the models revealed significant law effects on nonfirearm homicides.