"Your son needs help and we're gonna help him": A qualitative study of the experiences of gun-owning caregivers of adolescents receiving lethal means counseling in the emergency department.

Suicide attempts in adolescents are often transient and unpredictable, making preventative approaches crucial in reducing suicide deaths. One important approach is lethal means counseling (LMC), in which clinicians counsel caregivers to reduce access to methods used in suicide, specifically firearms and medications. Research on LMC has increasingly encouraged the use of the shared decision-making (SDM) model, which emphasizes information exchange, collaborative deliberation, and joint planning between caregivers and clinicians. We examine caregivers' experiences with LMC, using the SDM model as our analytic framework. We conducted qualitative interviews with 21 firearm-owning caregivers of adolescents who came to emergency departments (EDs) in Colorado for a behavioral health complaint. The implementation of LMC at these institutions had three central components: training for clinicians, materials (e.g., lockboxes and pamphlets) to support LMC, and the protocolization of LMC at the institution. Our semi-structured, hour-long interviews examined participants' reflections on and reactions to LMC provided in the ED and how that related to changes in their understanding of their medication and gun storage practices. We analyzed interviews using a phenomenological approach, focusing on experiences with LMC and informed by the tenets of the SDM model. Our analysis revealed that caregivers were receptive to the idea of LMC in the pediatric emergency care setting. Caregivers' engagement in LMC was reinforced by experiences with clinicians who sought to understand the circumstances of their household, shared the motivation behind LMC, and facilitated conversation around a shared concern for the child's safety. In contrast, counseling delivered mechanically and without considering the household context was tied to caregivers' confusion and alienation, both for LMC and their consideration of changes to home storage practices. These findings provide insight into adolescent caregivers' experiences with LMC implemented in EDs and how LMC may best be approached.

Messaging inclusion with consequence: U.S. sanctuary cities and immigrant wellbeing.

In the United States (U.S.), sanctuary cities have increasingly garnered public attention as places dedicated to increasing immigrant safety, inclusion, and health. These cities primarily rely on limiting local police cooperation with federal immigration enforcement to deter immigrant detention and deportation. However, sanctuary policies' inability to extend immigrants' legal rights and their reliance on police as ushers of sanctuary may complicate how these spaces attend to their stated goals. In this paper, we examine how organizational workers conceptualize sanctuary, safety, and immigrant health and wellbeing within sanctuary cities. We draw on interviews with organizational workers in two sanctuary cities: Boston, Massachusetts and Seattle, Washington collected between February and August 2018. Our findings reveal that immigrants continue to face structural barriers to housing, safe employment, education, and healthcare within sanctuary cities with consequences to wellbeing. Workers' definitions of safety draw on interconnected structural exclusion that prevent immigrants from accessing basic needs and fail to account for historically rooted forms of racism and nativism. Organizational workers identified tensions between messages of sanctuary and what local sanctuary policies offer in practice, providing insight into consequences of institutionalizing a grassroots social movement. As organizational workers negotiate these tensions, they must develop everyday sanctuary practices to extend immigrant inclusion, safety, health, and wellbeing.

Selection and Use of Firearm and Medication Locking Devices in a Lethal Means Counseling Intervention.

Background: While some suicide prevention initiatives distribute locking devices for firearms and medication, little evidence exists to guide the selection of devices. Aims: This study aimed to describe safety standards for locking devices and compare parental acceptance rates for different types of devices. Method: As part of the larger SAFETY Study, behavioral health clinicians provided free locking devices to parents whose child was evaluated in the emergency department (ED) for a suicide-related or behavioral health-related problem. For logistical reasons, we changed the specific devices offered midstudy. Data on device use came from follow-up interviews with 226 parents. Results: Few effective standards exist for locking devices for home use; we could easily break into some. At follow-up, twice as many gun-owning parents were using ED-provided handgun lockboxes as cable locks (28% vs. 14%, p = .02). Overall, 55% of parents reported using an ED-provided medication lockbox, with more using the drawer-sized lockbox than the larger, steel toolbox (60% vs. 42%, p < .01). Limitations: Storage outcomes are from parents' self-report and from one state only. Conclusion: Parents appeared to prefer some devices over others. Our findings suggest the need for (a) effective safety standards, (b) affordable devices meeting these standards, and (c) further research on consumer preferences to ensure use.

You Have to Pay to Live: Somali Young Adult Experiences With the U.S. Health Care System.

There is increasing documentation that refugees face experiences of interpersonal or structural discrimination in health care and employment. This study examines how Somali refugees understand various forms of discrimination in employment and health care related to their health, utilization of, and engagement with the health care system in the United States. We draw on semistructured qualitative interviews (N = 35) with Somali young adults in three U.S. states-Minnesota, Massachusetts, and Maine. Using modified grounded theory analysis, we explore how experiences of discrimination in employment and health care settings impact health care access, utilization, and perceptions of health among Somali young adults. Discrimination was identified as a major barrier to using health services and securing employment with employer-sponsored insurance coverage. These findings highlight how interpersonal and structural discrimination in employment and health care are mutually reinforcing in their production of barriers to health care utilization among Somali refugees.

Parent and Adolescent Reports of Adolescent Access to Household Firearms in the United States.

Importance: Adolescent access to firearms increases their risk of firearm injury. Objective: To examine adolescent firearm access in homes with guns, how storage may modify access, and discordance between parent and adolescent report of access. Design, Setting, and Participants: This survey study used data on parents and their adolescent children from a nationally representative online survey of adults in gun-owning households, conducted from June 30 to August 11, 2019. Individuals who owned firearms and parents of adolescents were oversampled. All parents living with a child aged 13 to 17 years were invited to have their child participate in a separate survey. Respondents with more than 1 adolescent living with them were asked to choose the child with the most recent birthday. Analyses were conducted from June 1, 2020, to January 4, 2021. Main Outcomes and Measures: Firearm access was assessed by asking adolescents how long it would take to access a loaded gun in their home. Parents were asked whether their child could independently access a household firearm. Individuals who owned guns reported firearm storage practices. Study-specific poststratification weights adjusted for survey nonresponse and undercoverage or overcoverage resulting from the study-specific sample design and for benchmark demographic distributions. Results: Of 6721 adults invited to participate, 4030 completed the survey. Of these, 280 had a firearm in their homes and had a child aged 13 to 17 years who participated in the survey. The mean (SD) age of parents was 45.2 (7.2) years; of children, 15.0 (1.4) years. The sample included 159 male adolescents (weighted percentage, 60.8%; 95% CI, 53.8%-67.8%) and 129 male adults (weighted percentage, 48.3%; 95% CI, 40.9%-55.6%). In 33.9% (95% CI, 26.7%-41.2%) of households, an adolescent reported that they could access a loaded firearm in less than 5 minutes. In homes where all guns were locked, 23.7% (95% CI, 12.3%-35.1%) of adolescents reported that they could access a loaded firearm in less than 5 minutes. Overall, 70.4% (95% CI, 63.7%-77.1%) of parents reported that their child could not access a household firearm. In households where parents said their child could not access a firearm, 21.8% (95% CI 13.8%-29.7%) of their children indicated that they could access a firearm within 5 minutes and 14.9% (95% CI, 8.9%-20.9%) indicated that they could access a firearm in more than 5 minutes but less than 1 hour. Conclusions and Relevance: In this study, many adolescents reported having ready access to loaded guns in their homes, even when all household firearms were locked. Many adolescents who reported having access to household firearms lived with parents who knew their children had access, but others lived with parents who did not know. These finding should inform prevention efforts aimed at reducing adolescent access to household firearms.

The relationship of pre- and post-resettlement violence exposure to mental health among refugees: a multi-site panel survey of somalis in the US and Canada.

BACKGROUND: A large body of research highlights the lasting impact of pre-resettlement violence on the mental health of refugees after resettlement. However, there is limited research on violence exposure after resettlement and its association with mental health. We examine the association of pre- and post-resettlement violence with post-resettlement mental health symptoms in a survey of Somali refugees in the US and Canada. METHODS AND FINDINGS: We collected survey data from 383 Somalis across five cities in the US and Canada (Boston, MA; Minneapolis, MN; Lewiston, NC; Portland, ME; Toronto, Canada). Wave 1 data were collected between May 2013 and January 2014, while Wave 2 was collected between June 2014 and August 2015. Data from both waves were used to examine whether the association of past violence exposures persists across time and with more recent violence exposures. The War Trauma Screening Scale assessed exposure to any pre- and post-resettlement violence at Wave 1, while the My Exposure to Violence scale assessed any past-year violence exposure at Wave 2. Mental health outcomes included symptoms of depression and anxiety (Hopkins Symptom Checklist) and post-traumatic stress symptoms (Harvard Trauma Questionnaire). Separate linear regression models at Waves 1 and 2 examined the relationship of past violence exposure to standardized scores of mental health symptoms. Participants were 22 years of age, on average. Fifty-six percent of our sample had been exposed to violence after resettlement by Wave 2. At Wave 1, the associations of pre- and post-resettlement violence with mental health were comparable in magnitude across depression [ß = 0.39, 95% CI (0.21 0.57) vs. ß = 0.36, 95% CI (0.10 0.62)], anxiety [ß = 0.33, 95% CI (0.12 0.55) vs. ß = 0.38, 95% CI (0.01 0.75)], and PTSD [ß = 0.55, 95% CI (0.37 0.72) vs. ß = 0.47, 95% CI (0.21 0.74)]. At Wave 2, pre-resettlement violence was associated with depressive symptoms only [ß = 0.23, 95% CI (0.06 0.40)], while past-year exposure to violence had the largest association with all mental health outcomes [depression: ß = 0.39, 95% CI (0.17 0.62); anxiety: ß = 0.46, 95% CI (0.01 0.75); PTSD: ß = 0.67, 95% CI 0.46 0.88)]. CONCLUSIONS: Our study is the first to examine refugees' exposure to post-resettlement violence across time, finding that Somali refugees' exposure is both persistent and prevalent after resettlement. Post-resettlement violence had a larger association with mental health than pre-resettlement exposure by Wave 2. Our study highlights the urgent need to understand the role of post-resettlement violence exposure for refugees in the US and Canada.

Physical Discipline, Deprivation, and Differential Risk of Developmental Delay Across 17 Countries.

OBJECTIVE: Parenting behaviors have been studied largely in isolation with regard to child development in cross-national contexts. We examine and compare the relative strength of association between physical discipline and deprivation with risk of children's socioemotional and cognitive developmental delay in a cross-national sample. METHOD: The sample was drawn from the UNICEF Multiple Indicator Cluster Survey. Analyses used observations with data on parental physical discipline, parenting behaviors associated with deprivation, and child developmental outcomes. The present analysis included 29,792 children aged 36-59 months across 17 countries. Using the Early Child Development Index, risk for cognitive or socioemotional developmental delay was indicated if a child could not accomplish 2 or more items within that specific subdomain. Overall risk for delay was indicated if a child was at risk in either subdomain. Associations among discipline, deprivation, and delay were assessed using multivariable logistic regression. RESULTS: Five of the 7 exposures were associated with risk of overall developmental delay. Physical discipline (odds ratio [OR] = 1.49 [95% CI = 1.39, 1.59]; p < .001) had the largest association with risk for socioemotional delay. Not having books (OR = 1.62 [95% CI = 1.42, 1.84]; p < .001) and not counting with the child (OR = 1.47 [95% CI = 1.32, 1.64]; p < .001) had the largest associations with risk of cognitive delay. CONCLUSION: The exposures of physical discipline and deprivation measured here have distinct associations with risk of socioemotional and cognitive delay cross-nationally. Programmatic and clinical interventions should seek to act on adversities that are relevant to the targeted delay.

Violence Exposure and Mental Health Among Resettled Refugees: A Systematic Review.

Refugee populations are often characterized by their high exposure to violence, which are tied to various challenges upon resettlement. This systematic review synthesizes the empirical literature related to violence exposure for refugees resettled in high-income countries and the impact of that exposure on mental health symptoms. The authors reviewed quantitative studies published from 2000 to 2018 and found 12 studies met criteria for inclusion. Studies were excluded if the study did not include a measured mental health outcome, if violence exposure was not measured and reported on distinctly from nonviolent exposures, if the sample did not include a refugee population, or if the relationship between violence exposure and mental health of refugees was not empirically examined. Overall, studies found that resettled refugee populations were more likely to have higher rates of violence exposure than comparison groups. This violence exposure was significantly related to higher mental health symptoms, including symptoms of depression, anxiety, and, most commonly reported, posttraumatic stress disorder. However, there is substantial heterogeneity in measurement of violence exposure, particularly in the use of author-created scales. The vast majority of included studies examined only exposure to violence prior to resettlement. The review shows significant evidence for the effect of violence prior to resettlement on mental health after resettlement and reveals a need for improved measurement and definitions of violence exposure at different time points for resettled refugee populations. Assessing current exposure to violence is an important step for effective intervention related to mental health dilemmas for refugee populations.

Discrimination, marginalization, belonging, and mental health among Somali immigrants in North America.

In this study, we examined the relationships among discrimination and mental health for Somali young adults, a group at risk for an unfavorable context of reception, and the way in which individual- and community-level factors explain these associations. The present study drew upon data collected during the first wave of the Somali Youth Longitudinal Study, a community-based participatory research project focused on understanding and supporting the healthy development of Somali young adults in four different regions in North America: Boston, MA, Minneapolis, MN, and Portland/Lewiston, ME in the United States and Toronto, Canada. Somali men and women aged 18-30 participated in quantitative interviews that included questions about their health, their neighborhoods, and their thoughts and feelings about their resettlement communities (N = 439). Results indicate that discrimination has a direct effect on worse mental health; this effect was mediated through both individual (marginalized acculturation style) and community-level (sense of belonging) factors. These findings suggest that factors associated with a receiving society's attitudes and behaviors, in addition to its structural supports and constraints, may be particularly important in understanding immigrant mental health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Patterns of gun owner beliefs about firearm risk in relation to firearm storage: a latent class analysis using the 2019 National Firearms Survey.

BACKGROUND: Research on gun owners' risk-related beliefs has focused on how gun owners answer discrete questions about firearm risk. The current study is the first to use latent class analysis (LCA) to: (A) identify groups of gun owners who share patterns of beliefs about firearm-related risk and (B) examine whether class membership predicts household firearm storage. METHODS: We conducted LCA using the 2019 National Firearms Survey, a nationally representative survey of US adult gun-owners (n=2950). The LCA assigned gun owners to classes based on responses to four questions about firearm-related risk. Identified classes were included in logistic regression models predicting firearm storage, along with characteristics linked to storage in past research. RESULTS: Three classes emerged: (1) owners who believe that guns unconditionally make the home safer and should generally be readily accessible (47%); (2) owners who believe that whether guns make homes safer or less safe depends on context (34%); (3) owners who believe that guns do not pose a risk if stored safely (19%). In adjusted models, compared with owners in class 1, those in classes 2 and 3 were less likely to store guns loaded and unlocked (class 2: OR 0.30, 95% CI 0.23 to 0.39; class 3: OR 0.23, 95% CI 0.16 to 0.32). CONCLUSION: Our LCA is a first step towards better understanding variation in patterns of beliefs among gun owners regarding the risks and benefits of firearms. Our results suggest that messaging aimed at promoting safer firearms storage might benefit from the empirically derived typologies we identify.

Changes in Firearm and Medication Storage Practices in Homes of Youths at Risk for Suicide: Results of the SAFETY Study, a Clustered, Emergency Department-Based, Multisite, Stepped-Wedge Trial.

STUDY OBJECTIVE: We evaluate whether a counseling intervention implemented at the hospital level resulted in safer firearm and medication storage by caregivers of youths aged 10 to 17 years after their child's evaluation in the emergency department (ED) for a behavioral health concern. METHODS: We used a stepped-wedge clustered design rolled out at 4 hospital sites to assess primary preregistered outcomes (self-reported storage changes caregivers made to household firearms and medications), assessed by survey 2 weeks after the ED visit. Three logistic models provided estimates of the intervention effect: an unadjusted model, a model with hospital-level fixed effects, and a model that further adjusts for time. RESULTS: Of the 575 caregiver participants, 208 were firearm owners (123 in usual care, 85 in the intervention). Baseline (pre-ED visit) characteristics did not differ between usual care and intervention phases. During the 2-year study period, twice as many caregivers whose child visited the ED after (compared with before) a hospital adopted the intervention improved firearm storage and 3 times as many improved medication storage (odds ratio [OR]=2.1 [95% confidence interval {CI} 1.0 to ∞] and OR=3.0 [95% CI 2.2 to ∞], respectively). After adjusting for time, the intervention effect for medications persisted (OR=2.0 [95% CI 1.0 to ∞]); the effect on firearms did not (OR=0.7 [95% CI 0.1 to ∞]). CONCLUSION: To our knowledge, this study is the first controlled trial to estimate the effectiveness of an intervention on firearm and medication storage in homes of youths at elevated risk of suicide. We found evidence that caregivers' medication storage improved after their child's ED visit, with evidence suggestive of improvement for firearm storage.

A Typology of Civilians Shot and Killed by US Police: a Latent Class Analysis of Firearm Legal Intervention Homicide in the 2014-2015 National Violent Death Reporting System.

Approximately 1000 people are killed by police acting in the line of duty each year. Historically, research on these deaths, known as legal intervention homicides (LIH), has been limited by data that is either contextually rich but narrow in scope and not readily available to the public (e.g., police department reports from a single city), or detail-poor but geographically broad, large, and readily available (and maintained by federal agencies) (e.g., vital statistics and supplemental homicide reports). Over the past 5 years, however, researchers have turned to the National Violent Death Reporting System (NVDRS), which captures nearly all lethal police shootings in participating states while providing detailed incident and victim information. The current study extends prior work on police-involved lethal shootings in three important ways. First, we use latent class analysis to construct a data-driven, exhaustive, mutually exclusive typology of these events, using NVDRS data 2014-2015. Second, rather than fitting some, but not all cases into predefined sub-types, every case is assigned membership to a particular emergent class. Third, we use a validated case identification process in NVDRS to identify incidents of lethal police-involved shootings. Seven classes emerge. Classes differ across important incident and victim characteristics such as the event that brought the victim and law enforcement together, the highest level of force used by the victim against law enforcement, and the kind of weapon, if any, used by the victim during the incident. Demographic variables do not distribute uniformly across classes (e.g., the latent class in which the victim appeared to pose minimal threat to law enforcement was the only class in which the plurality of victims was a non-white race). Our approach to generating these typologies illustrates how data-driven techniques can complement subjective classification schemes and lay the groundwork for analogous analyses using police encounter data that include fatal and non-fatal outcomes.

Network structure reveals clusters of associations between childhood adversities and development outcomes.

Exposure to childhood adversity is common and associated with a host of negative developmental outcomes. The most common approach used to examine the consequences of adversity exposure is a cumulative risk model. Recently, we have proposed a novel approach, the dimensional model of adversity and psychopathology (DMAP), where different dimensions of adversity are hypothesized to impact health and well-being through different pathways. We expect deprivation to primarily disrupt cognitive processing, whereas we expect threat to primarily alter emotional reactivity and automatic regulation. Recent hypothesis-driven approaches provide support for these differential associations of deprivation and threat on developmental outcomes. However, it is not clear whether these patterns would emerge using data-driven approaches. Here we use a network analytic approach to identify clusters of related adversity exposures and outcomes in an initial study (Study 1: N = 277 adolescents aged 16-17 years; 55.1% female) and a replication (Study 2: N = 262 children aged 8-16 years; 45.4% female). We statistically compare our observed clusters with our hypothesized DMAP model and a clustering we hypothesize would be the result of a cumulative stress model. In both samples we observed a network structure consistent with the DMAP model and statistically different than the hypothesized cumulative stress model. Future work seeking to identify in the pathways through which adversity impacts development should consider multiple dimensions of adversity.

Child discipline in low- and middle-income countries: Socioeconomic disparities at the household- and country-level.

BACKGROUND: In the past month, an estimated eight of ten children worldwide have experienced violent discipline. Understanding the economic and social contexts in which parents are more likely to use particular disciplinary practices is necessary to reduce violence against children. Critical examination of disciplinary practices and beliefs in cross-country analysis of low- and middle-income countries (LMICS) has been limited. OBJECTIVE: To estimate the association of country-level stressors and household-level economic stressors with disciplinary behaviors and beliefs. PARTICIPANTS AND SETTING: Using Multiple Indicator Cluster Survey data between 2010 and 2013, 231,221 parents from 32 LMICS were included. METHODS: The prevalence of past-month nonviolent discipline, physical discipline, psychological aggression, belief in the utility of physical discipline, and incongruence of disciplinary practice and belief were estimated. Country-level prevalence was regressed on country-level stressors (economic burden, economic inequality, human security, and human development). Individual-level disciplinary practices and beliefs were regressed on household wealth. RESULTS: Country-level stressors predicted psychological and physical discipline use and belief in the utility of physical discipline. Lower household wealth was associated with increased violent disciplinary practice and belief. Lower household wealth was associated with increased likelihood of using violent discipline, even when the caregiver did not believe in its utility (OR = 1.63 [1.34, 1.98]). CONCLUSIONS: Discipline use and belief in LMICS should be understood within the context of salient societal and household stressors.Parental disciplinary beliefs and practices reflect complex interplay with broader social, political and economic contexts and should not be taken to be defined by monolithic views of culture.

Early childhood exposure to non-violent discipline and physical and psychological aggression in low- and middle-income countries: National, regional, and global prevalence estimates.

BACKGROUND: Advocates for children's rights have recommended the elimination of all forms of violent discipline given its detrimental effects on children's development. Yet, little is known about the global prevalence of various forms of discipline, including physical and psychological aggression, as well as alternative forms of non-violent discipline, especially in low- and middle-income countries (LMICs). OBJECTIVE: This study aims to obtain national, regional, and global prevalence estimates of the percentage and number of 2- to- 4-y-olds in LMICs exposed to these disciplinary practices by their caregivers. PARTICIPANTS AND SETTING: We use data collected between 2010 and 2016 from 107,063 2- to- 4-y-old children living in 49 LMICs as part of the Multiple Indicator Cluster Survey (MICS). METHODS: Using the best-fitting model based on cross-validation techniques, we performed predictive modeling to generate country-level prevalence estimates for 131 LMICs in 2013, as well as 95% confidence intervals around these estimates. RESULTS: We estimate that 296.2 million 2- to- 4-y-olds (95% CI 256.9, 300.9) were exposed to non-violent discipline in 2013, which corresponds to 83.9% of the population. Furthermore, 220.4 million (95% CI 138.1, 283.7) and 230.7 million (95% CI 128.4, 300.6) children were exposed to aggressive physical and psychological discipline, respectively, which corresponds to prevalence of 62.5% and 65.4%. We also identify a high heterogeneity in the estimates across and within regions, finding a higher prevalence of both violent disciplinary methods in South Asia and Sub-Saharan Africa. CONCLUSIONS: These results suggest the need for new policies and programs to minimize violent discipline around the world.

The relationship between cognitive enrichment and cognitive control: A systematic investigation of environmental influences on development through socioeconomic status.

We measured the impact of socioeconomic status (SES) on cognitive processes. We examined cognitive control, specifically working memory (WM), in a sample of N = 141 7- to 17-year-olds using rule-guided behavior tasks. Our hypothesis is based on computational modeling data that suggest that the development of flexible cognitive control requires variable experiences in which to implement rule-guided action. We found that not all experiences that correlated with SES in our sample impacted task performance, and not all experiential variables that impacted performance were associated with SES. Of the experiential variables associated with task performance, only cognitive enrichment opportunities worked indirectly through SES to affect WM as tested with rule-guided behavior tasks. We discuss the data in the context of necessary precision in SES research.

Urban-rural disparity and urban population growth: A multilevel analysis of under-5 mortality in 30 sub-Saharan African countries.

OBJECTIVES: To assess whether country-level urban population growth is associated with the magnitude of the urban-rural disparity in under-five mortality (U5M) using ecologic and multilevel analyses. METHODS: We used data from 2010 to 2015 Demographic and Health Surveys and World Bank data from 30 sub-Saharan African countries (n = 411,054 women). Country-level linear regressions determined associations between urban population growth and economic growth between 2005 and 2010 on U5M risk differences. Multilevel logistic regression models were used to determine the impact of urban population growth on the urban advantage in U5M, adjusting for child and maternal factors. RESULTS: Countries with greater urban population growth and low economic growth had greater disparities in U5M between urban and rural areas. After adjusting for known U5M risk factors in multilevel analyses, interactions between country-level urban population growth and urbanicity were identified. CONCLUSIONS: Continued efforts to evaluate and address disparities in child mortality outcomes in sub-Saharan Africa should acknowledge urbanicity in context, as well as socioeconomic and geographic realities of families, mothers and children. Low-resource, demographically shifting environments require novel strategies to decrease child mortality.

Firearm Storage in Gun-Owning Households with Children: Results of a 2015 National Survey.

Data from a nationally representative probability-based online survey sample of US adults conducted in 2015 (n = 3949, response rate 55%) were used to assess self-reported gun storage practices among gun owners with children. The presence of firearms and children in the home, along with other household and individual level characteristics, was ascertained from all respondents. Questions pertaining to household firearms (how guns are stored, number, type, etc.) were asked only of those respondents who reported that they personally owned a gun. We found that approximately one in three US households contains at least one firearm, regardless of whether children lived in the home (0.34 [0.29-0.39]) or not (0.35 [0.32-0.38]). Among gun-owning households with children, approximately two in ten gun owners store at least one gun in the least safe manner, i.e., loaded and unlocked (0.21 [0.17-0.26]); three in ten store all guns in the safest manner, i.e., unloaded and locked (0.29, [0.24-0.34]; and the remaining half (0.50 [0.45-0.55]) store firearms in some other way. Although firearm storage practices do not appear to vary across some demographic characteristics, including age, sex, and race, gun owners are more likely to store at least one gun loaded and unlocked if they are female (0.31 [0.23-0.41]) vs. male (0.17 [0.13-0.22]); own at least one handgun (0.27 [0.22-0.32] vs. no handguns (0.05 [0.02-0.15]); or own firearms for protection (0.29 [0.24-0.35]) vs. do not own for protection (0.03 [0.01-0.08]). Approximately 7% of US children (4.6 million) live in homes in which at least one firearm is stored loaded and unlocked, an estimate that is more than twice as high as estimates reported in 2002, the last time a nationally representative survey assessed this outcome. To the extent that the high prevalence of children exposed to unsafe storage that we observe reflects a secular change in public opinion towards the belief that having a gun in the home makes the home safer, rather than less safe, interventions that aim to make homes safer for children should address this misconception. Guidance alone, such as that offered by the American Academy of Pediatrics, has fallen short. Our findings underscore the need for more active and creative efforts to reduce children's exposure to unsafely stored firearms.

Urbanicity matters in self-reported child maltreatment prevalence: Findings from a nationally representative study.

Despite indications that there are differences in rates of child maltreatment (CM) cases in the child protection system between urban and rural areas, there are no published studies examining the differences in self-reported CM prevalence and its correlates by urbanicity. The present study aimed to: (1) identify the distribution of self-reported childhood experiences of maltreatment by urbanicity, (2) assess whether differences by urbanicity persist after adjusting for known risk factors, and (3) explore whether the associations between these risk factors and CM are modified by urban-rural designation. Using nationally representative data from waves I and III of the National Longitudinal Study of Adolescent to Adult Health, the prevalence of six maltreatment outcomes was estimated for rural, minor urban, and major urban areas (N = 14,322). Multivariable logistic models were estimated identifying if risk associated with urbanicity persisted after adjusting for other risk factors. Interactions between urbanicity and main effects were explored. Prevalence estimates of any CM, poly-victimization, supervision neglect, and physical abuse were significantly higher in major urban areas. Those from major urban areas were more likely to report any maltreatment and supervision neglect even after adjusting for child and family risk factors. The association between race/ethnicity, welfare receipt, low parental educational attainment, and disability status and CM were modified by urbanicity. Significant differences in the prevalence and correlates of CM exist between urban and rural areas. Future research and policy should use self-reported prevalence, in conjunction with official reports, to inform child maltreatment prevention and intervention.

Cognitive impacts of ambient air pollution in the National Social Health and Aging Project (NSHAP) cohort.

BACKGROUND: Pathways through which air pollution may impact cognitive function are poorly understood, particularly with regard to whether and how air pollution interacts with social and emotional factors to influence cognitive health. OBJECTIVE: To examine the association between air pollutant exposures and cognitive outcomes among older adults participating in the National Social Life, Health, and Aging Project (NSHAP) cohort study. METHODS: Measures of cognitive function, social connectedness, and physical and mental health were obtained for each NSHAP participant starting with Wave 1 of the study in 2005. Cognitive function was assessed using the Chicago Cognitive Function Measure (CCFM) for 3377 participants. Exposures to fine particles (PM2.5) were estimated for each participant using GIS-based spatio-temporal models, and exposures to nitrogen dioxide (NO2) were obtained from the nearest EPA monitors. RESULTS: In adjusted linear regression models, IQR increases in 1 to 7year PM2.5 exposures were associated with a 0.22 (95% CI: -0.44, -0.01) to a 0.25 (95% CI: -0.43, -0.06) point decrease in CCFM scores, equivalent to aging 1.6years, while exposures to NO2 were equivalent to aging 1.9years. The impacts of PM2.5 on cognition were modified by stroke, anxiety, and stress, and were mediated by depression. The impacts of NO2 were mediated by stress and effect modification by impaired activities of daily living for NO2 was found. CONCLUSIONS: Exposures to long-term PM2.5 and NO2 were associated with decreased cognitive function in our cohort of older Americans, and individuals who experienced a stroke or elevated anxiety were more susceptible to the effects of PM2.5 on cognition. Additionally, mediation results suggest that PM2.5 may impact cognition through pathways related to mood disorders.