Art on the skin, lifesaving within: Exploring the role of tattoo artists in suicide prevention.

Different populations experience suicide at different rates. Some studies have found an increased risk of suicide among individuals with tattoos. Studies indicate a higher prevalence of mental health disorders among individuals with one or more tattoos. These findings signal a need to explore suicide prevention in tattoo shops. The aim of this project is to determine the feasibility, acceptability, and interest of providing education on suicide prevention among tattoo artists. We conducted a cross-sectional survey with tattoo artists. Survey items assessed artists' experiences with clients expressing mental health issues or suicidal thoughts, their comfort level assisting clients, and general perceptions around suicide and stigma. Seventy-nine surveys were collected. Most artists reported that they have had at least one situation in which a client mentioned something that made them concerned about that client's mental health. Most respondents reported that a client has expressed suicidal thoughts to them at least once. Our study demonstrated that tattoo artists encounter clients who express mental health challenges as well as suicidal ideation, underscoring the potential role for tattoo artists in supporting individuals at risk for suicidal thoughts and behaviors.

Implementation of a countywide adult suicide review commission: Development, lessons learned, and recommendations.

INTRODUCTION: Fatality review is a public health approach designed to inform efforts to prevent fatalities of a certain kind (e.g., suicide, homicide) or in a specific setting or population (e.g., hospitals, youth). Despite extensive literature on fatality review generally, the literature on suicide review teams specifically is scant. The aim of this paper is to: describe the implementation of a local adult suicide review commission, detail examples of initial outcomes and recommendations developed by the commission, and provide recommendations and/or best practices for how to develop and implement an adult suicide review team. METHODS: We utilize framing questions from the American Association of Suicidology's psychological autopsy framework. By using these guiding questions in the discussion, members are invited to explore not only the stressors that may have more immediately preceded the suicide event itself, but to situate those stressors in the context of the individual's life course. RESULTS: Several recommendations proposed by our commission have resulted in tangible outcomes and are detailed using Haddon's Matrix as a guiding prevention planning tool. IMPLICATIONS: We have highlighted the need to move beyond looking at individual-level help-seeking to focus on structural/systemic issues that result in stress or create unsafe environments for at-risk individuals.

Suicide Data in Trauma Centers: Implications of Imprecision.

BACKGROUND: Trauma registries exist to provide data for evaluating the quality of care of trauma patients. These data facilitate research and can be used for outreach, planning, and improvement in trauma patient outcomes. However, the accuracy of registry data related to suicide has not been well studied. OBJECTIVE: This study sought to evaluate the accuracy of current trauma registry coding practices related to labeling injury as a suicide attempt among patients presenting to a Level I trauma center after self-inflicted injury. METHODS: We conducted a single-center, retrospective cohort analysis of a Level I trauma center trauma registry on all patients with self-inflicted injuries from 2011 to 2021. Manual chart review was used to identify cases wherein patients' injuries were categorized as suicidal despite the absence of suicidal intent. RESULTS: During this 11-year period, 537 patients were identified as having presented to the trauma center for traumatic self-inflicted injuries. Manual chart review revealed that 16% of these patients were incorrectly categorized as having attempted suicide despite their self-inflicted injury lacking suicidal intent (e.g., accidents, nonsuicidal self-harm). CONCLUSION: We found that 16% of trauma registry patients were overcategorized as having attempted suicide. Trauma registry data are an important source of information for activities related to injury prevention in trauma centers. Imprecise coding of self-inflicted injury may lead to poorly targeted programs and interventions due to incorrectly represented injury causes and patterns in trauma patient populations, including suicide prevention.

Trends in Adult Suicide Rates in Milwaukee County, Wisconsin, 2002 through 2020.

BACKGROUND: Monitoring suicide rates is an important public health strategy to inform prevention efforts. We describe rates of adult suicide in Milwaukee County, Wisconsin, over a 19-year period. METHODS: Data on all adult suicides from 2002 through 2020 (n = 981) were obtained from the Milwaukee County Medical Examiner's Office. Subpopulation rates were identified using the Wisconsin Interactive Statistics on Health System. RESULTS: Suicide rates increased significantly over the study period, with disproportionate increases among Black and Latinx residents. DISCUSSION: Expanded prevention efforts are needed to reverse this concerning trend. Further research should guide development of culturally relevant interventions, provide data for the equitable allocation of limited resources.

Linking emergency care and police department data to strengthen timely information on violence-related paediatric injuries.

BACKGROUND: Combined ED and police department (PD) data have improved violence surveillance in the UK, enabling significantly improved prevention. We sought to determine if the addition of emergency medical service (EMS) data to ED data would contribute meaningful information on violence-related paediatric injuries beyond PD record data in a US city. METHODS: Cross-sectional data on self-reported violence-related injuries of youth treated in the ED between January 2015 and September 2016 were combined with incidents classified by EMS as intentional interpersonal violence and incidents in which the PD responded to a youth injury from a simple or aggravated assault, robbery or sexual offence. Nearest neighbour hierarchical spatial clustering detected areas in which 10 or more incidents occurred during this period (hotspots), with the radii of the area being 1000, 1500, 2000 and 3000 ft. Overlap of PD incidents within ED&EMS hotspots (and vice versa) was calculated and Spearman's r tested statistical associations between the data sets, or ED&EMS contribution to PD violence information. RESULTS: There were 935 unique ED&EMS records (ED=381; EMS=554). Of these, 877 (94%) were not in PD records. In large hotspots >2000 ft, ED&EMS records identified one additional incident for every three in the PD database. ED and EMS provided significant numbers of incidents not reported to PD. Significant correlations of ED&EMS incidents in PD hotspots imply that the ED&EMS incidents are as pervasive across the city as that reported by PD. In addition, ED and EMS provided unique violence information, as ED&EMS hotspots never included a majority (>50%) of PD records. Most (676/877; 77%) incidents unique to ED&EMS records were within 1000 ft of a school or park. CONCLUSIONS: Many violence locations in ED and EMS data were not present in PD records. A combined PD, ED and EMS database resulted in new knowledge of the geospatial distribution of violence-related paediatric injuries and can be used for data-informed and targeted prevention of violence in which children are injured-especially in and around schools and parks.

Assessing the Healthcare Utilization of Youth Who Died by Suicide: A Case-Control Study.

OBJECTIVE: Suicide is the second leading cause of death in youth ten years old or older. Healthcare utilization prior to death by suicide is high in adults, but there is conflicting evidence in youth. The objective of this study was to compare healthcare utilization in youth who died by suicide to youth who died in a motor vehicle accident (MVC) to determine whether healthcare utilization is associated with death by suicide in youth. METHODS: This retrospective case-control study used death records from Coroners/Medical Examiners (C/MEs) for children 11-17 years old who died by suicide (case) and MVC (control) between October 2013 and October 2018 were obtained. Data from the electronic medical record (EMR) at a healthcare system was reviewed. The primary outcome was healthcare utilization. Secondary outcomes included mental health diagnosis. Data was analyzed using Fisher's Exact Test and considered significant if p < 0.05. RESULTS: The analysis included 60 youth who died by suicide and 14 youth who died by MVC. Most decedents were male (68%) and white (80%). Mean age at death was 16 years old. Only 25 decedents had a corresponding record in the EMR, with no significant difference based on manner of death (35% suicide vs 29% MVC, p = 0.8). Fourteen decedents had a known mental health diagnosis in their EMR with no difference based on manner of death (p = 0.5). CONCLUSIONS: There was no difference in healthcare utilization or mental health diagnosis in youth who died by suicide compared to youth who died by MVC. Strict reliance on both of these factors when considering youth who may be at risk of suicide is inadequate. Expanding universal suicide screening to other settings, including schools or primary care, can help identify youth at risk for suicide and may prevent unnecessary deaths.HIGHLIGHTSLittle is known regarding the healthcare utilization of youth who died by suicide prior to their death.This study uses a case-control design to investigation healthcare utilization of youth who died by suicide versus youth who died in a motor vehicle crash.We did not find a significant difference in healthcare utilization between cases and controls. These findings suggest that non-clinical interventions would be useful in detecting suicide risk.

Disparities in disposition from trauma centers to inpatient psychiatric treatment in a national sample of patients with self-inflicted injury.

BACKGROUND: Surgery providers are integral to the treatment of patients with self-inflicted injuries. Patient disposition (eg, home, inpatient psychiatric treatment, rehabilitation) is important to long-term outcomes, but little is known about factors influencing disposition after discharge following traumatic self-inflicted injury. We tested whether patient or injury characteristics were associated with disposition after treatment for self-inflicted injury. METHODS: National Trauma Data Bank query for self-inflicted injuries from 2010 to 2018. RESULTS: There were 77,731 patients treated for self-inflicted injuries during the study period. Discharge home was the most common disposition (45%), and those without insurance were less likely to discharge to inpatient psychiatric treatment than those with insurance. Racial minority patients were less likely to discharge to inpatient psychiatric treatment (18.9%) than nonminority patients (23.8%, P < .001). Additionally, patients discharged to inpatient psychiatric treatment had significantly lower injury severity score (7.24 ± 7.5) than those who did not (8.69 ± 9.1, P < .001). CONCLUSION: Racial/ethnic minority patients and those without insurance were significantly less likely to discharge to an inpatient psychiatric facility after treatment at a trauma center for self-inflicted injury. Future research is needed to evaluate the internal factors (eg, trauma center practices) and external factors (eg, inpatient psychiatric facilities not accepting patients with wound care needs) driving disposition variability.

"I've given up": Biopsychosocial factors preceding farmer suicide in Wisconsin.

Recent studies have suggested that individuals working in certain occupations may be at increased risk for suicide. While occupation is an individual-level factor, one's work is situated in organizations, communities, and societies that are impacted by policies and systems. Analysis of existing data has identified that farmers are among those with elevated rates of suicide. This qualitative study reports themes that capture the experience of farmers prior to their death by suicide in Wisconsin. This retrospective qualitative study analyzed data from the Wisconsin Violent Death Reporting System. Data on farmer suicides that occurred in Wisconsin between 2004 and 2018 were accessed. Qualitative analyses followed an inductive thematic analysis approach. All study activities were approved by the institutional review board at the Medical College of Wisconsin. Between 2004 and 2018, 190 farmers died by suicide in Wisconsin. Five themes were identified in the qualitative analysis: "rugged individualism" clashes with a need to rely on others, interpersonal loss causes intense emotional pain and suffering, financial stress and strain overwhelm Wisconsin farmers, farmers are providers for families and communities, and alcohol and firearms are a lethal combination. Farmers who died by suicide in Wisconsin were facing significant stressors at the time of their death, many of which were not directly related to verifiable diagnosed mental illness. These circumstances varied, from physical health issues to financial stressors, to emotional pain from interpersonal conflict, and to access to lethal means. This study provides evidence calling for a public health solution to this issue, through changes at the policy, systems, and cultural levels. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Intersectionality in pandemic youth suicide attempt trends.

INTRODUCTION: The COVID-19 pandemic has resulted in increased distress at a societal level, with youth and young people bearing a disproportionate burden. A series of recent Morbidity and Mortality Weekly Reports has highlighted emergency department (ED) visit rates for suicide attempts among youth ages 12-25 during the COVID-19 pandemic. This study expands those analyses by adding race and ethnicity to the examination of suspected suicide attempts among youth. METHODS: This study uses National Syndromic Surveillance Program (NSSP) data for Wisconsin from hospitals that consistently reported ED visits between the study period of January 1, 2019 and September 30, 2021. Suspected suicide attempt visits were identified using the CDC-developed suicide attempt query. RESULTS: During the study period, there were 8915 ED visits for suicide attempts by children and youth ages 12-25 in Wisconsin's NSSP system. We confirm gendered patterns of ED visit rates for suspected suicide attempts among youth that were first noted in studies using a non-representative national dataset. Large and significant 2019 vs. 2021 increases were noted for Black females ages 12-17 (79% increase) and White non-Hispanic females ages 12-17 (58%), but no significant change for Hispanic females ages 12-17. Black females ages 18-25 had high and relatively stable rates throughout this period.

Implementation and initial analysis of Cardiff Model data collection procedures in a level I trauma adult emergency department.

OBJECTIVES: Our understanding of community violence is limited by incomplete information, which can potentially be resolved by collecting violence-related injury information through healthcare systems in tandem with prior data streams. This study assessed the feasibility of implementing Cardiff Model data collection procedures in the emergency department (ED) setting to improve multisystem data sharing capabilities and create more representative datasets. DESIGN: Information collection fields were incorporated into the ED electronic health record (EHR), which gathered additional information from patients reporting assaultive injuries. ED nurses were surveyed to evaluate implementation and feasibility of information collection. Logistic regression was performed to determine associations between missing location information and patient demographic data. SETTING: 60-bed academic level I trauma adult ED in a large Midwestern city. PARTICIPANTS: 2648 patients screened positive for assault injuries between 2017 and 2020. 198 patients were omitted due to age outside the range served by this ED. Unselected inclusion of 150 ED nurses was surveyed. MAIN OUTCOME MEASURES: Main outcomes include nursing staff survey responses and ORs for providing complete injury information across various patient demographics. RESULTS: Most ED nurses believed that information collection aligned with the hospital's mission (92%), wanted information collection to continue (88%), did not believe that information collection impacted their workflow (88%), and reported taking under 1 min to screen and document violence information (77%). 825 patients (31.2%) provided sufficient information for geospatial mapping. Likelihood of providing complete location information was significantly associated with patient gender, race, arrival means, accompaniment, trauma type and year. CONCLUSIONS: It is feasible to implement information collection procedures about location-based, assault-related injuries through the EHR in the adult ED setting. Nurses reported being receptive to collecting information. Analyses suggest patient-level and time variables impact information collection completeness. The geospatial information collected can greatly improve preexisting law enforcement and emergency medical systems datasets.

The Association Between Repealing the 48-Hour Mandatory Waiting Period on Handgun Purchases and Suicide Rates in Wisconsin.

IMPORTANCE: Suicide is a significant public health burden in the United States. There is little understanding how policies regarding gun purchasing affects suicide rates. Wisconsin state legislature rescinded a 48-hour waiting period for handgun purchases, which took effect in June 2015. OBJECTIVE: To determine whether firearm-related suicide increased with the repeal of the 48-hour waiting period for handgun purchases in 2015. METHOD: We obtained data through the Wisconsin Department of Health Services via the Wisconsin Interactive Statistics on Health Query System. Suicide rates were compared by Comparative Mortality Figures (CMF). RESULTS: We reviewed all suicides in Wisconsin between 2012-2014 and 2016-2018. The rate ratios (R) and second generation P values (pδ) comparing deaths between 2012-2014 and 2016-2018 indicate significant increases in firearm-related suicide among people of color (R = 1.927; pδ = 0.0) and among Wisconsinites residing in urban counties (R = 1.379, pδ = 0.0). There was no significant increase in non-firearm-related suicide (R = 1.117, pδ = 0.092), nor in firearm-related suicide among White non-Hispanics (R = 1.107, pδ = 0.164) or Wisconsinites residing in rural counties (R = 1.085, pδ = 0.500). CONCLUSION: Our findings suggest that the repeal of the 48-hour waiting period on handgun purchases in 2015 is correlated with the increase of firearm-related suicides among Wisconsin residents of color and Wisconsinites residing in urban counties.Key Messages:Firearm policies are associated with changes in suicide rates.

Implementing the Cardiff Model for violence prevention: using the diffusion of innovation theory to understand facilitators and barriers to implementation.

OBJECTIVE: Interpersonal violence is an ongoing, vexing public health issue. Communities require comprehensive timely data on violence to plan and implement effective violence prevention strategies. Emergency departments (EDs) can play an important role in violence prevention. EDs treat injuries associated with violent crime, and they are well-positioned to systematically collect information about these injuries, including the location where the injury occurred. The Cardiff Model for Violence Prevention (The Cardiff Model) provides a framework for interdisciplinary data collection and sharing. METHODS: This paper uses the Diffusion of Innovation Theory as a framework to present our experiences of implementing the Cardiff Model in several EDs that serve the Milwaukee area, and to detail the processes of data collection, linking and presentation across four different hospital systems. RESULTS: Implementing a city-wide data collection effort that involves multiple hospital systems is challenging. Viewing our findings through the lens of the Diffusion of Innovations theory provides a way to anticipate facilitators and challenges to Cardiff Model implementation in a hospital setting. CONCLUSIONS: Facilitators and barriers to Cardiff Model adoption in the ED setting can be understood using the Diffusion of Innovation theory, and barriers can be interrupted through careful planning and continuous communication between partners.

Farmer Suicide in Wisconsin: A Qualitative Analysis.

PURPOSE: There is a need to address suicide among farmers in the United States and understand what contributes to suicide among American farmers. The purpose of this qualitative study is to analyze narrative data to uncover circumstances that were present in the lives of farmers who died by suicide. METHODS: This study leverages data available in the National Violent Death Reporting System. For this study, we examined all suicides that occurred in Wisconsin between the years 2012 and 2016 and were extracted from the Wisconsin Violent Death Reporting System. Decedents were manually sorted by the "usual occupation" variable in order to identify farmers. FINDINGS: During the study period, 73 farmers died, most of whom were White, non-Hispanic males. Four themes were identified in the thematic analysis: stymied by physical health issues, grief from loss of relationships, ready access to firearms in rural Wisconsin, and the burden of farming and the farm. CONCLUSIONS: The findings from this study demonstrate how unique contextual factors lead to suicide among farmers. This study has implications for suicide prevention among farmers. Primarily, there is a need to address the accessibility of firearms, as their availability in a time of crisis has lethal consequences. However, suicide prevention programming that addresses access to lethal means must take the sociocultural context of rural America into consideration. These findings should also be considered as applied to health care providers that serve rural communities. Suicide risk assessment and management should consider stressors unique to farmers.

Homicide: A Leading Cause of Death for Black Non-Hispanics in Wisconsin.

IMPORTANCE: Wisconsin has the second-highest Black homicide rate in the country, reporting a rate of 37.57 deaths per 100,000 Black non-Hispanic Wisconsinites. Meanwhile, White non-Hispanics experience a homicide rate of 2.0 deaths per 100,000. OBJECTIVE: This data identifies a public health disparity that deserves further investigation. This study seeks to detail the mortality rate of all-cause homicide, firearm-related homicide, non-firearm-related homicide, and legal intervention firearm-related homicide; leading causes of death; average age of death; and years of potential life lost (YPLL) between White non-Hispanics and Black non-Hispanics in Wisconsin during 2000-2017. DESIGN: Wisconsin homicide rates, ranked leading causes of death, and average age of death were obtained through the Wisconsin Department of Health Services via the Wisconsin Interactive Statistics on Health (WISH) Query System. National data were obtained through the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System (WISQARS). Homicide rates, ranked leading causes of death, average age of death, and YPLL were compared by mechanism of injury, county of residence, and race and ethnicity. PARTICIPANTS AND EXPOSURES: The entire population of Black non-Hispanic Americans and White non-Hispanic Americans during 2000-2017 was included. For comparison, this was narrowed to the population of Black non-Hispanic Wisconsinites and White non-Hispanic Wisconsinites during 2000-2017. Exposure groups include all homicide victims during 2000-2017. MAIN OUTCOMES AND MEASURES: We hypothesized that Black non-Hispanic Wisconsinites would have a significantly worse burden of disease compared to White non-Hispanic Wisconsinites, as well as Black non-Hispanic Americans. RESULTS: This study found that firearm-related homicide rates for Black non-Hispanics compared to White non-Hispanics were 14.6 times greater in Milwaukee, 29.9 times greater in Wisconsin, and 13.0 times greater in urban counties of the United States. Firearm-related homicide is the second-leading cause of death for Black non-Hispanics in Milwaukee and the fourth-leading cause of death in Wisconsin. YPLL per person for Black non-Hispanic victims of firearm-related homicide are 36.83 years in Milwaukee and 37.04 years in Wisconsin. CONCLUSION AND RELEVANCE: Our findings strongly suggest that Black non-Hispanic Wisconsinites endure a significantly worse burden of firearm-related homicide compared to White non-Hispanic Wisconsinites and Black non-Hispanic Americans. This study demonstrates a significant disparity in firearm-related homicide that should inspire policy discussion.

Medical student education for injury prevention: closing the gap.

INTRODUCTION: Injury is a major public health issue in the USA. In 2017, unintentional injury was the leading cause of death for ages 1 through 44. Unfortunately, there is evidence that the sciences of injury prevention and control may not fully and widely integrated into medical school curriculum. This paper describes a novel injury prevention and control summer programme that was implemented in 2002 and is ongoing. METHODS: The main component of the Series includes at least seven injury-related lectures and discussions designed to provoke students' interest and understanding of injury as a biopsychosocial disease. These lectures are organised in a seminar fashion and are 2-4 hours in duration. Kirkpatrick's four-part model guides evaluation specific to our four programme objectives. Trainee satisfaction with the programme, knowledge and outcome (specific to career goals) is evaluated using several mixed-methods tools. RESULTS: A total of 318 students have participated in the Series. Evaluation findings show an increase in knowledge of injury-related concepts as well as an increase in interest in pursuing injury-related research topics in the future. IMPLICATIONS: The Series is a novel and innovative programme that provides training in injury and injury prevention and control-related topics to medical students, as well as undergraduate, graduate and pharmacy students. We hope that by increasing students' knowledge and understanding of injury prevention and control we are contributing to a physician workforce that understands the importance of a public health approach to injury prevention, that implements public health principles in practice and that advocates for policies and practices that positively impact injury prevention and control to help make our communities healthier and safer.

Systems change for suicide prevention among adolescents: a rural Wisconsin county approach.

BACKGROUND: Suicide is the tenth leading cause of death in Wisconsin. Between the years 2012 and 2016, rural counties in Wisconsin had statistically significantly higher rates of suicide than urban counties. Counties in northern and western Wisconsin have some of the highest rates of suicide, with several counties having rates nearly double the state suicide rate for the same time period. STUDY AIM: This study investigates the utility of a systems-level, primary prevention suicide prevention strategy in reducing suicide in a rural Wisconsin county. This project focuses upstream to promote behavioural health resiliency and decrease risk factors for suicide. RESULTS: County-level suicide rates decreased over time. Youth Risk Behaviour Survey results demonstrate that the percentage of students in the high school who report that they have an adult in the school to turn to for support increased by 11%. In addition, the number of students reporting a suicide attempt over the past 12 months decreased from 8.4% to 7.2%. Trust among project partners remained above 75% across the three survey timepoints, and the results demonstrated that power became more equally dispersed over time. There was an increase in community knowledge in where to go for help in an emotional crisis. DISCUSSION: Systems change to prevent suicide is a complex undertaking but can affect change at the county level. In our study county, we learnt that a strong implementation body (our Partnership Council) and buy-in from key partners is essential in creating change at the systems level.

Gun Violence: A Biopsychosocial Disease.

Gun violence is a complex biopsychosocial disease and as such, requires a multidisciplinary approach to understanding and treatment. Framing gun violence as a disease places it firmly within medical and public health practice. By applying the disease model to gun violence, it is possible to explore the host, agent, and environment in which gun violence occurs, and to identify risk factors to target for prevention. This approach also provides an opportunity to address scientifically inaccurate assumptions about gun violence. In addition, there are many opportunities for medical communities to treat gun violence as a disease by considering and treating the biologic, behavioral, and social aspects of this disease. The medical community must answer recent calls to engage in gun violence prevention, and employing this model of gun violence as a biopsychosocial disease provides a framework for engagement.

Integrating Population Health Data on Violence Into the Emergency Department: A Feasibility and Implementation Study.

Geocoded emergency department (ED) data have allowed for the development and evaluation of novel interventions for the prevention of violence in cities outside of the United States. First implemented in Cardiff, United Kingdom, collection of these data provides public health agencies, community organizations, and law enforcement with place-based information on assaults. The purpose of this study was to assess the feasibility of translating this model within the electronic medical record (EMR) in the United States. A new EMR module based on the Cardiff Model was developed and integrated into the existing ED EMR. Data were collected for all patients reporting an assaultive injury upon arrival to the ED. Emergency department nurses were subsequently recruited to participate in 2 surveys and a focus group to evaluate the implementation and to provide qualitative feedback to enhance integration. Nurses completed EMR questions in 98.2% of patients reporting to the ED over the study period. More than 90% of survey respondents were satisfied with their participation, and most felt that the questions were useful for clinical care (79/70%), were integrated well into workflow (89/90%), and were congruent with the ED and hospital goals and mission (93/98%). Focus group themes centered on ED culture, external factors, and internal workflow. It is feasible to implement place-based, assault-related injury-specific questions into the EMR with minimal disruption of workflow and triage times. Nurses, as key members of the ED team, are receptive to participating in the collection of population health data that may inform community violence prevention activities.

Shift in Drug vs Alcohol Prevalence in Milwaukee County Motor Vehicle Decedents, 2010-2016.

OBJECTIVE: The purpose of this study is to examine the prevalence of alcohol and nonalcohol drugs in motor vehicle crash (MVC) decedents in Milwaukee County, Wisconsin. METHODS: A retrospective review of MVC decedents in Milwaukee County from 2010 to 2016 was performed. Substances were divided into 5 categories based on chemical composition and clinical effects: alcohol, cocaine and its metabolite benzoylecgonine, opioids, cannabinoids, amphetamines and methamphetamines. Decedents were determined to be positive if any of these substances were detected on blood toxicology analysis. RESULTS: Sixty-five percent (n = 113) of MVC decedents tested positive for 1 substance, while polysubstance use (≥ 2 substances) was seen in 27% (n = 47). Alcohol was the most prevalent substance (n = 77, 44%), while cannabinoids were the second most prevalent (n = 50, 29%), and opioids were third most prevalent (n = 24, 14%). There was a statistically significant increase in the number of MVC decedents who tested positive for opioids from 2010 to 2016 (slope = 3.9, P < 0.01). The number of decedents who tested positive for alcohol only from 2010 to 2016 decreased significantly (slope = -3.9, P < 0.05), and 2016 was the first year in which the number of drug-positive decedents exceeded the number of alcohol-positive decedents. CONCLUSION: The prevalence of drugs exceeded that of alcohol in decedents for the first time in 2016 in Milwaukee County. While continued efforts to reduce alcohol-positive driving are encouraged, increased attention to drugged driving is needed to prevent further drug-positive fatalities.

A Multistep Approach to Address Clinican Knowledge, Attitudes, and Behavior Around Opioid Prescribing.

INTRODUCTION: The Wisconsin Prescription Drug Monitoring Program (PDMP) was implemented in 2013 to reduce the misuse, abuse, and diversion of controlled substance prescriptions. OBJECTIVE: To evaluate provider knowledge, attitudes, and behaviors regarding the Wisconsin PDMP before and after study interventions. METHODS: An initial survey of clinicians, a focus group, pre- and posttests for an educational session, and a 3-month follow-up survey were utilized. RESULTS: Initial survey participants described PDMP use. Focus group themes included system, hospital, clinician, and patient factors. Educational session pre- and posttests showed an increase in provider knowledge. Follow-up surveys demonstrated practice change among providers. CONCLUSION: This study can be useful for health care organizations, state PDMPs, and prevention organizations in tailoring messaging to clinicians around safe prescribing and PDMP use.