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Chen DZ, Chen KF, Xu JS, Gao K. Analysis of influencing factors of psychological resilience in patients with traumatic fractures and its effect on posttraumatic growth. World J Psychiatry 2025; 15:100819. [DOI: 10.5498/wjp.v15.i4.100819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 12/20/2024] [Accepted: 02/05/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Traumatic fractures are mainly caused by various exogenous traumatic events, which not only damage patients’ physical health but also affect their psychological state and aggravate stress responses.
AIM To analyze the influencing factors of psychological resilience of patients with traumatic fractures and the effect of psychological resilience on posttraumatic growth (PTG).
METHODS This study included 188 patients with traumatic fractures admitted to the First People’s Hospital of Shangqiu from November 2022 to November 2023. The participants were categorized based on the patient’s psychological resilience assessed by the Connor-Davidson Resilience Scale (CD-RISC) into the better resilience group (CD-RISC score ≥ 60 points, n = 80) and the poor resilience group (CD-RISC score < 60 points, n = 108). Patients’ sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). The identification of the influencing factors of psychological resilience in patients with traumatic fractures was realized by binary Logistic regression (with factors such as sex, age, injury cause, trauma severity, fracture site, personality, and PSQI included for analysis). The determination of the PTG status of all participants used the Chinese version of the Posttraumatic Growth Inventory (C-PTGI). Furthermore, a Spearman correlation analysis was conducted to analyze the association between psychological resilience and PTG.
RESULTS The psychological resilience of patients with traumatic fractures was related to age, sex, trauma severity, and personality. The better resilience group demonstrated statistically lower PSQI scores than the poor resilience group (P < 0.05). The Logistic regression analysis revealed sex, age, trauma severity, personality, and sleep quality as influencing factors of CD-RISC scores in patients with traumatic fractures (all P < 0.05). The score of each C-PTGI dimension and the total score (relating to others, new possibilities, personal strength, spiritual change, and appreciation of life) were higher in the better resilience group than in the poor resilience group (all P < 0.05). Spearman correlation analysis indicated a positive association of the CD-RISC score in patients with traumatic fractures with the scores of all dimensions of C-PTGI and the total C-PTGI score (all P < 0.05).
CONCLUSION The factors influencing the psychological resilience of patients with traumatic fractures include age, sex, trauma severity, personality, and sleep quality, and psychological resilience is closely associated with PTG.
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Affiliation(s)
- Dao-Zhen Chen
- Department of Traumatology, The First People’s Hospital of Shangqiu, Shangqiu 476100, Henan Province, China
| | - Kun-Feng Chen
- Department of Traumatology, The First People’s Hospital of Shangqiu, Shangqiu 476100, Henan Province, China
| | - Ji-Sheng Xu
- Department of Traumatology, The First People’s Hospital of Shangqiu, Shangqiu 476100, Henan Province, China
| | - Kun Gao
- Department of Orthopedics, Henan Province People’s Hospital, Zhengzhou 462000, Henan Province, China
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Lee LK, Butler A, Andrews NC. The Urgent Need for More Federal Funding for Pediatric Firearm Injury Prevention Research. Pediatrics 2025; 155:e2024068652. [PMID: 40064314 DOI: 10.1542/peds.2024-068652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 01/23/2025] [Indexed: 04/02/2025] Open
Affiliation(s)
- Lois K Lee
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Alex Butler
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Nancy C Andrews
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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McMullen CL, Levin D, Rama A. Pediatric trauma and resuscitation: optimizing care in an evolving landscape. Curr Opin Anaesthesiol 2025:00001503-990000000-00275. [PMID: 40084494 DOI: 10.1097/aco.0000000000001484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2025]
Abstract
PURPOSE OF REVIEW Penetrating firearm-related injury has increased mortality rates in children in the USA. This article summarizes trends in pediatric injury patterns, the unique coagulation system of infants, and key components of hemostatic resuscitation in children. RECENT FINDINGS Firearm-associated penetrating trauma increased mortality and led to higher rates of pediatric massive transfusions. Patients may be the victim of previous gun violence or live with an adult who purchased a firearm for the first time during the COVID-19 pandemic. Platelet dysfunction and hypocalcemia are important considerations that may lead to higher transfusion requirements if not addressed. Pediatric massive transfusion protocols have become more standardized, and the use of whole blood has increased. Low-titer group O whole blood has shown benefit to improve coagulopathy and shock-associated indices when compared with conventional component therapy. SUMMARY Traumatic hemorrhage is potentially life-threatening in children and requires prompt hemostatic resuscitation. Massive transfusion protocols that target trauma-induced coagulopathy and account for the unique pediatric coagulation system are imperative. Ongoing and future research is important to standardize pediatric resuscitation practices.
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Affiliation(s)
- Carl L McMullen
- Division of Pediatric Anesthesiology, Department of Anesthesiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David Levin
- Department of Anesthesia, University of Toronto
- Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Asheen Rama
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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Lee LK, Tang SFS, Cull WL, Fleegler EW, Olson LM. Firearm and Motor Vehicle Pediatric Deaths-Intersections of Age, Sex, Race, and Ethnicity. JAMA Pediatr 2025; 179:310-320. [PMID: 39714814 DOI: 10.1001/jamapediatrics.2024.5089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2024]
Abstract
Importance Injuries from firearms and motor vehicle crashes (MVCs) are the leading causes of death among US children and youths aged 0 to 19 years. Examining the intersections of age group, sex, race, and ethnicity is essential to focus prevention efforts. Objective To examine firearm and motor vehicle fatality rates by population subgroups and analyze changes over time. Design, Setting, Participants This cross-sectional study of firearm and MVC fatalities among US children and youths aged 0 to 19 years from the Centers for Disease Control and Prevention Web-Based Injury Statistics and Query Reporting System from 2011 to 2021. Participants included American Indian and Alaska Native; Asian, Hawaiian Native, and Pacific Islander; Black; Hispanic; and White youths. Data analysis was conducted from July 2023 to May 2024. Exposure Firearm or MVC fatality. Main Outcome Measures Firearm and MVC fatality rates by year and over time, as measured by the Joinpoint regression annual percent change (APC). Results From 2011 to 2021 there were 35 684 firearm and 40 735 MVC fatalities among US youths aged 0 to 19 years. For firearm fatalities, there were 21 332 homicides (59.8%), 12 113 suicides (33.9%), 1359 unintentional shootings (3.8%), 277 by legal enforcement (0.8%), and 603 from unknown intents (1.6%). When considering the intersections of age group, sex, race, and ethnicity, for firearm homicides among youths aged 15 to 19 years, the APCs were similar for Black (21.8%) and Hispanic (22.2%) males from 2018 to 2021, although with different peak rates (104.22 per 100 000 individuals and 17.80 per 100 000 individuals, respectively, in 2021). Black females aged 15 to 19 years demonstrated a dramatic APC increase of 40.7% from 2019 to 2021 (peak rate, 14.07 per 100 000 individuals). For firearm suicide in youths aged 10 to 19 years by sex, Black females had the greatest APC increase of 22.0% from 2016 to 2021. For MVC fatalities, the highest APC increase of 24.9% occurred among American Indian and Alaska Native females aged 15 to 19 years from 2018 to 2021. The highest MVC fatality rates occurred in 2021 among American Indian and Alaska Native males (38.16 per 100 000 individuals) and females (29.31 per 100 000 individuals) aged 15 to 19 years. Conclusions and Relevance In this cross-sectional study, US youths aged 0 to 19 years experienced important disparities in firearm and MVC fatality rates and increases over time when considering the intersectionality by age group, sex, race, and ethnicity. These findings suggest that a multipronged strategy focused on individual, community, and policy level approaches for specific high-risk groups for each injury mechanism is necessary to address these leading causes of death in US youths.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Suk-Fong S Tang
- Department of Research, American Academy of Pediatrics, Itasca, Illinois
| | - William L Cull
- Department of Research, American Academy of Pediatrics, Itasca, Illinois
| | - Eric W Fleegler
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Gun Violence Prevention Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Lynn M Olson
- Department of Research, American Academy of Pediatrics, Itasca, Illinois
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Haasz M, Doh KF, Hanson HR, Pomerantz WJ, Agrawal N, Beckworth K, Chaudhary S, Clukies L, Fleegler EW, Formica MK, Gallardo A, Kiragu A, Laraque-Arena D, Levas MN, Levine MC, McKay S, McFadden T, Monroe K, Lee LK. Pediatric firearm injuries and socioeconomic vulnerability before and during the COVID-19 pandemic. Am J Emerg Med 2025; 88:84-90. [PMID: 39608312 DOI: 10.1016/j.ajem.2024.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 10/08/2024] [Accepted: 11/08/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND Pediatric firearm injuries disproportionately affect groups experiencing socioeconomic disadvantage. Firearm injuries increased during the COVID-19 pandemic, but the impact on communities by degree of socioeconomic disadvantage is unknown. We examined the association between socioeconomic vulnerability and change in pediatric firearm injuries before versus during the pandemic. METHODS This was a secondary analysis of a multicenter retrospective study comparing pediatric injuries pre- (March 17, 2019-December 31, 2020) versus during (March 15, 2020 - December 31, 2020) the COVID-19 pandemic. The parent study included injury-related visits to one of 40 Pediatric Emergency Departments in patients <18 years old. We examined firearm injuries as a proportion of all injuries. Deprivation Index (DI) was assigned using home zip code and divided into quartiles based on the distribution of DI in our total population, with deprivation increasing from quartile 1 (Q1, least deprivation) to quartile 4 (Q4, most deprivation). Kruskal-Wallis and Chi-square tests were used to compare variables of interest. Interrupted time series analysis was used to estimate pandemic effects on firearm injuries by DI quartile. RESULTS There were 1231 visits for firearm injuries. Mean DI was higher among firearm-injured than non-firearm-injured patients (0.43 vs. 0.35, p < 0.0001). Firearm injuries increased in proportion to all injuries pre- vs during pandemic (0.16 % vs 0.27 %, p < 0.0001). On interrupted time series analysis, the proportion of firearm injuries increased for Q2, Q3, and Q4. On subgroup analysis by intent, assault injuries as a proportion of all injuries increased from pre- to during COVID-19 for Q2 (3.32 % vs 6.94 %, ARD 3.62 %, 95 % CI 1.03, 6.20), Q3 (2.71 % vs 7.01 %, ARD 4.30, 95 % CI 1.99, 6.61), and Q4 (5.97 % vs 17.40 %; ARD 11.42, 95 % CI 0.19, 0.33). Unintentional injuries and injuries in youth 10-17 years old increased for Q2, Q3, and Q4. CONCLUSIONS The increase in pediatric firearm injuries during the COVID-19 pandemic impacted youth in all but the lowest deprivation quartile. Efforts at curbing gun violence should identify and amplify protective effects in under-resourced communities.
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Affiliation(s)
- Maya Haasz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Kiesha Fraser Doh
- Department of Pediatrics and Emergency Medicine at Emory University, Atlanta, GA, USA.
| | - Holly R Hanson
- University of Cincinnati College of Medicine, Cincinnati Children's Hospital, Division of Emergency Medicine, USA.
| | - Wendy J Pomerantz
- University of Cincinnati College of Medicine, Cincinnati Children's Hospital, Division of Emergency Medicine, USA.
| | - Nina Agrawal
- City University of New York, School of Public Health and Health Policy, USA
| | - Kristen Beckworth
- Center for Childhood Injury Prevention, Texas Children's Hospital, Houston, TX, USA.
| | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine at Emory University, Atlanta, GA, USA.
| | - Lindsay Clukies
- Washington University in St. Louis, St. Louis Children's Hospital, Division of Emergency Medicine, USA.
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Margaret K Formica
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Adrienne Gallardo
- HSU Doernbecher Children's Hospital, Doernbecher Injury Prevention Program, USA.
| | - Andrew Kiragu
- Department of Pediatrics, University of Minnesota and Children's Minnesota, Minneapolis, MN, USA.
| | - Danielle Laraque-Arena
- Clinical Epidemiology and Pediatrics, Mailman School of Public Health and Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA.
| | - Michael N Levas
- Department of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Marla C Levine
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
| | - Sandra McKay
- University of Texas Health Science Center at Houston, McGovern Medical School, Children's Memorial Hermann Hospital, USA.
| | - Terri McFadden
- Department of Pediatrics, Emory University, Atlanta, GA, USA.
| | - Kathy Monroe
- Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
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Ziminski D, Harmon-Darrow C, Westley-Henson K, Ross S. Exploring the Role of Fear, Civic Disengagement, and Economic Disenfranchisement Within Communities that Experience Gun Violence. Psychol Rep 2025; 128:305-333. [PMID: 39096345 DOI: 10.1177/00332941241269500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
Abstract
A growing body of research has documented how gun violence can affect mental and physical health outcomes among adults. Likewise, the literature is also beginning to reveal negative psychological effects related to distress and hypervigilance and sociological implications around diminished community engagement and economic opportunity. However, there remains a need to fully explore the role of fear related to the experience of gun violence. Through a qualitative inquiry consisting of community resident focus groups and community leader interviews, this study examined how participants' perceptions of fear related to their exposures to and experiences of gun violence. The findings highlight the pervasive emotional experience of existing in a fearful, distressed, and/or anxious state within certain communities, and how civic disengagement, neighborhood disconnection, and economic disenfranchisement exist in communities that disproportionately experience violence.
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Affiliation(s)
- Devon Ziminski
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
- Senator Walter Rand Institute for Public Affairs, Rutgers University - Camden, Camden, NJ, USA
- New Jersey Gun Violence Research Center, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | | | - Kiersten Westley-Henson
- Senator Walter Rand Institute for Public Affairs, Rutgers University - Cadmen, Camden, NJ, USA
- Department of Prevention Science, Rutgers University - Camden, Camden, NJ, USA
| | - Samuel Ross
- Senator Walter Rand Institute for Public Affairs, Rutgers University - Camden, Camden, NJ, USA
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7
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Osborne MC, Reidy DE, Temple JR, DeMello A, Lu Y. Examining the Relation Between Early Violence Exposure and Firearm-Related Experiences in Emerging Adulthood: A Longitudinal Cohort Study. Psychol Rep 2025; 128:78-99. [PMID: 38738909 DOI: 10.1177/00332941241254313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Firearms are a leading cause of death among adolescents and young adults in the United States. Early exposure to violence, as a victim or witness, is associated with increased risk of firearm-related experiences, including carrying and threatening others with a gun. These experiences, in turn, increase the risk of both fatal and non-fatal firearm injuries. Using an ethnically diverse sample of emerging adults, we build on prior research by examining the link between early violence exposure at multiple contexts of the social-ecological model and multiple firearm-related experiences (i.e., firearm-threatening victimization, firearm-threatening perpetration, and firearm carriage). We analyzed data from a 10-year longitudinal study of 1042 youth in the Southern United States. Experiencing childhood physical abuse was associated with both firearm-threatening victimization and perpetration in emerging adulthood. Additionally, exposure to neighborhood and interparental violence were linked to threatening others with firearms and carrying firearms, respectively. Counter to expectations, bullying victimization did not emerge as a predictor of any firearm-related experiences. Findings highlight the importance of cross-cutting violence prevention efforts to prevent high-risk firearm-related behaviors among emerging adults. Programs for children and adolescents that address these types of violence exposure should highlight coping skills and sources of positive social support to bolster protective factors against firearm-related outcomes.
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Affiliation(s)
- Melissa C Osborne
- Wellstar School of Nursing, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA
| | - Dennis E Reidy
- School of Public Health, Georgia State University, Atlanta, GA, USA;Center for Research on Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | - Jeff R Temple
- Center for Violence Prevention, UTHealth, Houston, TX, USA; School of Behavioral Health Sciences, UTHealth, Houston, TX, USA
| | - Annalyn DeMello
- School of Nursing, University of Texas Medical Branch, Galveston, TX, USA
| | - Yu Lu
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
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Haasz M. It's Time to Engage Teens in Suicide Prevention in the Emergency Department. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)02027-6. [PMID: 39615834 DOI: 10.1016/j.jaac.2024.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 08/21/2024] [Accepted: 11/21/2024] [Indexed: 12/16/2024]
Abstract
I stood at the head of the resuscitation room as the nurses hooked a boy up to monitors. "Joshua is a 14-year-old boy, history of depression," the paramedic began. "One hour ago, he ingested a handful of Tylenol and 8 Benadryl. Dad found out at 6:10 pm and called an ambulance to bring him to the emergency department (ED). He was stable on the ambulance ride. Any questions?" I performed the initial medical assessment, seeking to identify any conditions that would require urgent treatment. Minutes later, I sat next to Joshua and listened to his story.
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Affiliation(s)
- Maya Haasz
- University of Colorado, Aurora, Colorado.
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9
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Semenza DC. Addressing Data Deficiencies to Prevent Pediatric Firearm Injuries: Insights From the American College of Surgeons (ACS) Firearm Study. Am J Public Health 2024; 114:1167-1169. [PMID: 39236277 PMCID: PMC11447797 DOI: 10.2105/ajph.2024.307836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2024] [Indexed: 09/07/2024]
Affiliation(s)
- Daniel C Semenza
- Daniel Semenza is an associate professor in the Department of Sociology, Anthropology, and Criminal Justice, Rutgers University-Camden and the Department of Urban-Global Public Health in the School of Public Health, Rutgers University, New Brunswick, NJ. He is the director of Interpersonal Violence Research at the New Jersey Gun Violence Research Center, Rutgers University
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10
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Romo ND, Dawkins-Hamilton C, Confino M. The Potential Impact of Hospital Violence Intervention Programs. Hosp Pediatr 2024; 14:e497-e499. [PMID: 39444372 DOI: 10.1542/hpeds.2024-007816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/16/2024] [Accepted: 07/28/2024] [Indexed: 10/25/2024]
Affiliation(s)
- Noé D Romo
- Lewis M. Fraad Department of Pediatrics
- Department of Social Work
| | | | - Marni Confino
- The Albert Einstein College of Medicine, Bronx, New York
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Lee LK, Laraque-Arena D, Fleegler EW. The Updated Haddon Matrix for Pediatric Firearm Injuries. JAMA Surg 2024; 159:1229-1230. [PMID: 39259531 DOI: 10.1001/jamasurg.2024.2753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
This Viewpoint presents an updated scientific approach applied to the foundational framework of the Haddon Matrix for injury prevention to reduce firearm injuries and deaths to children and youth.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Danielle Laraque-Arena
- Mailman School of Public Health, Department of Epidemiology and Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
- New York Academy of Medicine, New York
| | - Eric W Fleegler
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
- MGH Gun Violence Prevention Center, Massachusetts General Hospital, Boston
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12
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Peta D, Vanairsdale-Carrasco S, Stone E. Firearm Safety and Injury Prevention. J Emerg Nurs 2024; 50:696-709. [PMID: 39537260 DOI: 10.1016/j.jen.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 11/16/2024]
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13
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McDonald CC, Rix K, Ebert JP, Aryal S, Xiong R, Wiebe DJ, Delgado MK. Handheld Cellphone Use and Risky Driving in Adolescents. JAMA Netw Open 2024; 7:e2439328. [PMID: 39418022 PMCID: PMC11581603 DOI: 10.1001/jamanetworkopen.2024.39328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/02/2024] [Indexed: 10/19/2024] Open
Abstract
Importance Handheld cellphone use while driving is associated with increased motor vehicle crash risk among adolescents. Objective To examine the association of handheld cellphone use while driving with kinematic risky driving (KRD) events-hard braking and rapid acceleration-in adolescent drivers. Design, Setting, Participants Adolescents aged 16.50 to 17.99 years licensed 365 days or less in Pennsylvania were eligible to participate in this cross-sectional study. Enrollment occurred from July 29, 2021, to June 6, 2022. Participants downloaded a smartphone telematics cellphone app to record driving data for 60 days. Exposures Trip characteristics, including frequency, length, and duration; presence of speeding; frequency and duration of handheld cellphone use; time of day; and presence of precipitation. Main Outcomes and Measures Kinematic risky driving events per 100 miles driven. Zero-inflated Poisson regression models examined whether individual characteristics and trip characteristics were associated with KRD. Incidence rate ratios were computed. Results Of 405 adolescents who responded to recruitment, 151 enrolled, 140 completed study procedures, and 119 with 12 360 trips were included in the analytic sample (60 female participants [50.4%]; mean [SD] age, 17.2 [0.4] years). Adolescents drove a mean (SD) of 103.8 (65.7) trips, 565.0 (487.3) miles, and 25.1 (19.3) hours. Adolescents had minimal night trips (1.5% [192]), and few trips with precipitation present (9.0% [1097]). Speeding occurred in 43.9% (5428) of the trips and handheld cellphone use occurred in 34.1% (4214) of the trips. Kinematic risky driving events occurred in 10.9% (1358) of the trips at a rate of 2.65 per 100 miles. In adjusted models, increased KRD events were associated with handheld cellphone use (incidence rate ratio [IRR], 2.62; 95% CI, 1.53-4.48), speeding (IRR, 2.12; 95% CI, 1.06-4.26), and minutes driving (IRR, 1.02; 95% CI, 1.01-1.02). Trips at night, precipitation presence, licensure for less than 6 months, and sex were not associated with increased KRD events. Conclusions In this cross-sectional study of adolescent drivers, trips with handheld cellphone use and speeding were associated with higher rates of KRD, while individual characteristics were not. The findings suggest that smartphone telematics apps provide an opportunity to observe behaviors as well as surveil changes due to intervention efforts.
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Affiliation(s)
- Catherine C. McDonald
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Injury Research and Prevention at the Children’s Hospital of Philadelphia, Philadelphia
| | - Kevin Rix
- Department of Health Promotion and Behavioral Science, University of Texas Health, Houston
| | - Jeffrey P. Ebert
- Penn Medicine Nudge Unit, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Subhash Aryal
- Department of Nursing Faculty, Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Ruiying Xiong
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - M. Kit Delgado
- Penn Medicine Nudge Unit, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
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14
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Katzburg JR, Bronson J, Kessel W, Degutis LC, Carson LM, Bonne S, Robbins S, Fine M, Crandall M, Thompson NA, Witt WP. How the APHA Maternal and Child Health Section Advanced the Public Health Approach to Gun Violence Prevention. Matern Child Health J 2024:10.1007/s10995-024-03969-5. [PMID: 39254820 PMCID: PMC11891080 DOI: 10.1007/s10995-024-03969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 09/11/2024]
Abstract
PURPOSE This manuscript provides a history of efforts by the American Public Health Association (APHA) Maternal and Child Health Section (MCH Section) Gun Violence Prevention Workgroup (GVP Workgroup) to promote gun violence prevention (GVP) as a key public health priority both within the MCH Section and APHA, and nationally. DESCRIPTION The MCH Section established a gun violence prevention workgroup in response to the murders of twenty first-grade children and six adults at Sandy Hook Elementary School. This article presents an overview of the accomplishments and challenges of the MCH Section GVP Workgroup in a context of ever-increasing gun violence. As of 2020, firearms became the leading cause of death for U.S. children and teens. ASSESSMENT Over the past decade, a small group of volunteers helped maintain GVP as one of the top priorities of both the MCH Section and APHA. Endorsement by the MCH Section and APHA leadership facilitated MCH Section GVP Workgroup efforts including organizing a national conference, developing scientific sessions for APHA annual meetings, establishing coalitions, and providing ongoing education and outreach to APHA members. CONCLUSION The MCH Section GVP Workgroup helped to both elevate and maintain focus on GVP as a top priority of the MCH Section and APHA, indirectly impacting national efforts to promote a public health approach to GVP. The ongoing epidemic of firearm violence highlights the importance of continuing and strengthening this work. Individuals at other national, state or local organizations might look to the efforts and accomplishment of the MCH Section GVP Workgroup in pursuing critical issues within their own organizations.
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Affiliation(s)
- Judith R Katzburg
- , Westlake Village, CA, USA.
- APHA Maternal & Child Health Section Gun Violence Prevention Workgroup, APHA Intersectional Council Gun Violence Prevention Workgroup, American Public Health Association (APHA), Westlake Village, CA, USA.
| | - Jennifer Bronson
- Criminal Justice Division, Abt Associates, 6130 Executive Blvd Rockville, Rockville, MD, 20852, USA
- APHA Maternal & Child Health Section Gun Violence Prevention Workgroup, American Public Health Association (APHA), Laurel, MD, USA
| | - Woodie Kessel
- Koop Institute, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- School of Public Health, University of Maryland, Rockville, MD, USA
| | | | - Leslie M Carson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway 8th Floor, Baltimore, MD, 21205, USA
| | - Stephanie Bonne
- Department of Surgery, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ, 07601, USA
| | - Susan Robbins
- , Philadelphia, PA, USA
- APHA Maternal & Child Health Section Gun Violence Prevention Workgroup, American Public Health Association (APHA), Philadelphia, PA, USA
| | - Mighty Fine
- Public Health Practice and Policy, American Public Health Association (APHA), 800 I Street, NW, Washington DC, 20001, USA
| | - Marie Crandall
- Case Western Reserve University MetroHealth, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Nicholas A Thompson
- Patient Access, Robert Wood Johnson Barnabas Health, Wyncote, PA, USA
- Jefferson College of Population Health, Wyncote, PA, USA
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15
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Boccio C, Jones MS, Semenza D, Jackson DB. Prevalence and correlates of handgun carrying and perceived ease of access among adolescents in Florida. Inj Prev 2024:ip-2024-045347. [PMID: 39227147 DOI: 10.1136/ip-2024-045347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/15/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE Adolescent firearm violence poses a serious public health concern. The aim of this study is to explore correlates of access to firearms and firearm carrying patterns among adolescents in 2022. While previous research has documented correlates and risk factors for firearm carrying, the majority of this research has relied on samples collected prior to the COVID-19 pandemic and recent shifts in national patterns of firearm violence. METHODS We analysed data from the 2022 Florida Youth and Substance Use Survey (FYSAS) (N=41 768). Logistic regression models were used to examine associations between demographic, familial, temperamental, and behavioural factors and both ease of perceived firearm access and patterns of firearm carrying. RESULTS The results suggest that gender, grade level, race, residential setting, having a parent in the military, delinquency, depression, bullying and substance use are associated with perceived firearm access. In addition, gender, grade level, residential setting, ease of firearm access, delinquency, substance use, and bullying are all associated with firearm carrying. CONCLUSIONS Our findings suggest a host of demographic features and behavioural factors are associated with both perceived ease of firearm access and patterns of firearm carrying. Implications of these findings for reducing access to firearms is discussed.
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Affiliation(s)
- Cashen Boccio
- Criminology and Criminal Justice, The University of Texas at San Antonio, San Antonio, Texas, USA
| | | | - Daniel Semenza
- Sociology, Anthropology, and Criminal Justice, Rutgers University Camden, Camden, New Jersey, USA
| | - Dylan B Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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16
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Magee LA, Ortiz D, Adams ZW, Raymond JL, Marriott BR, Landman MP, O'Neill J, Davis TL, Williams J, Adams K, Belchos J, Fortenberry JD, Jenkins PC, Ranney ML. Linking Data on Nonfatal Firearm Injuries in Youths to Assess Disease Burden. JAMA Netw Open 2024; 7:e2436640. [PMID: 39348121 PMCID: PMC11443348 DOI: 10.1001/jamanetworkopen.2024.36640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
This cross-sectional study estimates the incidence of nonfatal firearm injuries among children and young adults after linking patient-level police and trauma registry data.
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Affiliation(s)
- Lauren A Magee
- Paul H. O'Neill School of Public and Environmental Affairs, Indiana University Indianapolis, Indianapolis
| | - Damaris Ortiz
- Department of Surgery, Indiana University School of Medicine, Indianapolis
- Smith Level 1 Shock Trauma Center, Sidney & Lois Eskenazi Hospital, Indianapolis, Indiana
| | - Zachary W Adams
- Adolescent Behavior Health Research Program, Indiana University School of Medicine, Indianapolis
| | - Jodi L Raymond
- Riley Hospital for Children at Indiana University Health, Indianapolis
| | - Brigid R Marriott
- Adolescent Behavior Health Research Program, Indiana University School of Medicine, Indianapolis
| | - Matthew P Landman
- Department of Surgery, Indiana University School of Medicine, Indianapolis
- Riley Hospital for Children at Indiana University Health, Indianapolis
| | - Joseph O'Neill
- Riley Hospital for Children at Indiana University Health, Indianapolis
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | | | - Jamie Williams
- Ascension St Vincent Hospital-Indianapolis, Indianapolis, Indiana
| | - Kendale Adams
- Indianapolis Metropolitan Police Department, Indianapolis, Indiana
| | - Jessica Belchos
- Ascension St Vincent Hospital-Indianapolis, Indianapolis, Indiana
| | - J Dennis Fortenberry
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Peter C Jenkins
- Department of Surgery, Indiana University School of Medicine, Indianapolis
- Indiana University Health Methodist Hospital, Indianapolis
| | - Megan L Ranney
- Yale School of Public Health, Yale University, New Haven, Connecticut
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17
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Cain CM, Oluyomi AO, Levine N, Pompeii L, Rosales O, Naik-Mathuria B. Socioeconomic disparities based on shooting intent in pediatric firearm injury. J Trauma Acute Care Surg 2024; 97:440-444. [PMID: 38282248 DOI: 10.1097/ta.0000000000004269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Pediatric firearm injury is often associated with socioeconomically disadvantaged neighborhoods. Most studies only include fatal injuries and do not differentiate by shooting intent. We hypothesized that differences in neighborhood socioeconomic disadvantage would be observed among shooting intents of fatal and nonfatal cases. METHODS A linked integrated database of pediatric fatal and nonfatal firearm injuries was developed from trauma center and medical examiner records in Harris County, Texas (2018-2020). Geospatial analysis was utilized to map victim residence locations, stratified by shooting intent. Area Deprivation Index (ADI), a composite measure of neighborhood socioeconomic disadvantage at the census tract level was linked to shooting intent. Differences in high ADI (more deprived) versus low ADI among the shooting intents were assessed. Unadjusted and adjusted regression models assessed differences in ADI scores across shooting intent, adjusted models controlled for age, gender, and race/ethnicity. RESULTS Of 324 pediatric firearm injuries, 28% were fatal; 77% were classified as interpersonal violence, 15% unintentional, and 8% self-harm. Differences were noted among shooting intent across the ADI quartiles; with increases in ADI score, the odds of interpersonal violence injuries compared with self-harm injuries significantly increased by 5%; however, when adjusting for individual-level variables of age, gender, and race and ethnicity, no significant differences in ADI were noted. CONCLUSION Our results suggest that children living in disadvantaged neighborhoods are more likely to be affected by interpersonal firearm violence compared with self-harm; however, when differences in race/ethnicity are considered, the differences attributable to neighborhood-level disadvantage disappeared. Resources should be dedicated to improving structural aspects of neighborhood disadvantage, which disproportionately impact racial/ethnic minoritized populations. Furthermore, firearm self-harm injuries occurred among children living in the less disadvantaged neighborhoods. Understanding the associations among individual and neighborhood-level factors are important for developing streamlined injury prevention interventions by shooting intent. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Cary M Cain
- From the Baylor College of Medicine (C.M.C., A.O.O., O.R.); Ned Levine & Associates (N.L.), Houston, Texas, US; Cincinnati Children's Hospital (L.P.), Cincinnati, Ohio; and University of Texas Medical Branch (B.N.-M.), Galveston, Texas
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18
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Greydanus DE, Nazeer A, Qayyum Z, Patel DR, Rausch R, Hoang LN, Miller C, Chahin S, Apple RW, Saha G, Prasad Rao G, Javed A. Pediatric suicide: Review of a preventable tragedy. Dis Mon 2024; 70:101725. [PMID: 38480023 DOI: 10.1016/j.disamonth.2024.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ahsan Nazeer
- Division of Child and Adolescent Psychiatry, Sidra Medicine/Weill Cornell Medicine, Doha, Qatar
| | - Zheala Qayyum
- Harvard Medical School, Boston, Massachusetts, United States
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Rebecca Rausch
- Division of Pediatric Psychology, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Western Michigan University, Kalamazoo, MI, United States
| | - Caroline Miller
- Fielding Graduate University, Santa Barbara, CA, United States
| | - Summer Chahin
- Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States
| | - Roger W Apple
- Division of Pediatric Psychology, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Gautam Saha
- Immediate Past President of the SAARC (South Asian Association for Regional Cooperation) Psychiatric Federation (SPF), India
| | - G Prasad Rao
- President, Asian Federation of Psychiatric Association (AFPA), India
| | - Afzal Javed
- Chairman Pakistan Psychiatric Research Centre, Immediate Past President of the World Psychiatric Association (WPA), Pakistan
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19
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Sescleifer AM, Onufer EJ, Greenspon J, Keller MS. A Decade of Firearm Injuries: Children Caught in the Crossfire. J Surg Res 2024; 301:259-268. [PMID: 38972263 DOI: 10.1016/j.jss.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 05/16/2024] [Accepted: 06/16/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Firearm injuries (FIs) are the leading cause of preventable morbidity and mortality in pediatric patients. In this study, we aim to define evolving trends and avenues for prevention. METHODS Following institutional review board approval, medical records of patients presenting to our two State-Designated Level 1 Pediatric Trauma Centers for treatment of FIs from 2010 to 2019 were retrospectively reviewed. Data was analyzed with Chi-Squared and Student's t-test; P-value <0.05 was significant. RESULTS 1037 FI encounters from 1005 unique patients aged 0-21 y were included. 70.4% (n = 730) were determined to be assaults, 26.1% (n = 271) unintentional, and 1.7% (n = 18) self-inflicted injuries. Overall mortality was 4.5% (n = 45). FI victims were most commonly African American (n = 836, 80.6%), male (n = 869, 83.8%), aged 13-17 (n = 753, 72.6%), and from single-parent families (n = 647, 62.4%). The incidence of FIs increased significantly over the last 5 y of the study (2010-2014, 6.8 FIs/month), compared to 2015-2019 (averaging 10.6 FIs/month, P < 0.0001). Concurrently, FI related fatality increased from an average of 2.6 deaths/year (2010-2014) to 6.4 deaths/year (2015-2019, P = 0.064). Results were subanalyzed for pediatric patients aged 0-14 y. For the entire cohort, 12.1% (n = 116) recidivists were identified. Geographic patterns of injury were identified, with 75% of all FIs clustered in a single urban region. CONCLUSIONS Incidence of pediatric FIs is increasing in recent years, with high mortality rates. Violence and recidivism are geographically concentrated, offering an opportunity for targeted interventions.
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Affiliation(s)
- Anne M Sescleifer
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Emily J Onufer
- Division of Pediatric Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Jose Greenspon
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Martin S Keller
- Division of Pediatric Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
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Pulavarthi TS, Fabio A, Miller E, Culyba AJ. Examining Associations Between School Connectedness, Social Support, Violence, and Firearm Carrying. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:3651-3668. [PMID: 38379210 DOI: 10.1177/08862605241233267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Firearms are the leading cause of pediatric deaths. Few studies have identified protective factors that reduce the risk of firearm violence. Interpersonal factors, including school connectedness and social support, protect against multiple health-affecting risk behaviors. Therefore, this study examines associations of school connectedness and social support with firearm and weapon violence involvement. Data were gathered through an anonymous survey conducted across 13 high schools within an urban school district in 2018 (n = 2,604) modeled on the Centers for Disease Control and Prevention Youth Risk Behavior Surveillance Survey. Separate hierarchical logistic regression models examined associations between school connectedness and social support, and the outcomes of firearm carrying and engaging in violence with a weapon on school property in the past 12 months. Models were adjusted for age, race, and covariates representing basic needs, education, and mental health. The mean age was 15.7 years, and 57.5% of youth were female. 5.8% of youth had carried firearms and 5.5% engaged in violence with a weapon on school property in the past 12 months. School connectedness was significantly inversely associated with engaging in violence with a weapon on school property (odds ratio [OR] 0.225, 95% confidence interval [CI] [0.080, 0.632] and high levels of social support were significantly inversely associated with firearm carrying (OR 0.522, 95% CI [0.313, 0.870]). School connectedness and social support may be important in protecting youth from firearm and weapon-related violence. Interventions that strengthen safe and supportive interpersonal relationships within school environments and broader support systems across contexts may help reduce firearm and weapon violence involvement.
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Affiliation(s)
| | - Anthony Fabio
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alison J Culyba
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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21
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McKie KA, Bell RC, Lee LK. Variations by State in Firearm Suicide Among US Children and Young Adults, 2016-2021. JAMA Pediatr 2024; 178:722-725. [PMID: 38767910 PMCID: PMC11106711 DOI: 10.1001/jamapediatrics.2024.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/08/2024] [Indexed: 05/22/2024]
Abstract
This cross-sectional study examines variations by state in firearm suicide rates in US children and young adults from 2016 to 2021 using data from the Centers for Disease Control and Prevention.
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Affiliation(s)
- Kerri A. McKie
- Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts
| | - Rebecca C. Bell
- Department of Pediatrics, University of Vermont Children’s Hospital, Burlington
| | - Lois K. Lee
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
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22
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Novak A, Semenza D, Gutman C, Heard-Garris N, Testa A, Jackson DB. Adverse Childhood Experiences and Trajectories of Firearm Exposure in Childhood. J Pediatr 2024; 270:114008. [PMID: 38479639 PMCID: PMC11176024 DOI: 10.1016/j.jpeds.2024.114008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To examine the longitudinal relationship between exposure to adverse childhood experiences (ACEs) in early life and trajectories of firearm exposure from early to middle childhood (ages 5-9 years old). STUDY DESIGN Data from the Longitudinal Studies of Child Abuse and Neglect (LOGSCAN) study were used. The LONGSCAN study was a prospective study in the United States and contained data from 1354 children from age 4 to age 18 years old. Exposure to ACEs was measured through the wave 1 interview (age 5 years old) and trajectories of firearm exposure were created using data from waves 1 (age 5 years old) and two (age 9 years old). RESULTS Two trajectories of firearm exposure in childhood were identified: a low exposure group and a group with persistently-high firearm exposure from ages 5 to 9 years old. ACEs were associated with membership in the high exposure group and children with four or more ACEs had over twice the odds of membership in the high exposure group compared with children with zero ACEs. CONCLUSION ACEs exposure in early childhood is associated with persistently-high exposure to firearms from early to middle childhood. This finding highlights the need for pediatricians to consider screening for both ACEs and firearm exposure in routine examinations, as well as the need for future research to identify and evaluate interventions intended to address exposure to adversity and firearms.
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Affiliation(s)
- Abigail Novak
- Department of Criminal Justice & Legal Studies, University of Mississippi, University, MS.
| | - Daniel Semenza
- Camden College of Arts and Sciences, Rutgers University, Camden, NJ
| | - Colleen Gutman
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Nia Heard-Garris
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Policy Research, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alexander Testa
- Department of Criminology and Criminal Justice, The University of Texas at San Antonio, San Antonio, TX
| | - Dylan B Jackson
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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23
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Bruns A, Aubel AJ, Zhang X, Buggs SA, Kravitz-Wirtz N. Community exposure to gun homicide and adolescents' educational aspirations. J Adolesc 2024; 96:1137-1152. [PMID: 38584575 DOI: 10.1002/jad.12324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Witnessing violence and violent victimization have detrimental effects on adolescents' emotional functioning and ability to envision and plan for their futures. However, research is limited on the impact of violence that occurs in adolescents' communities-whether or not it was witnessed or experienced firsthand. This paper investigated the associations between community exposure to gun homicide and adolescents' high school and college graduation aspirations. METHODS We analyzed data from the Future of Families and Child Wellbeing Study (N = 3031), a cohort study of children born 1998-2000 in 20 large US cities, merged with incident-level data on deadly gun violence from the Gun Violence Archive (2014-2017). Outcomes were reported by adolescents (girls and boys) during wave 6 (2014-2017) of the study, conducted when the children were 15 years of age. We employed ordinary least squares regression, ordered logistic regression, and multilevel stratification to examine the average and heterogeneous impacts of community exposure to gun homicide on adolescents' educational aspirations. RESULTS Community exposure to gun homicide was associated with reduced high school graduation aspirations, particularly among adolescents with the lowest risk of exposure to gun homicide. Gun homicide exposure was also associated with increased college graduation aspirations; this association was concentrated among adolescents with moderate-high risk of exposure. CONCLUSIONS Given the importance of education for job opportunities and the better health that accompanies education and occupational attainment, preventing early exposure to gun violence and providing institutional supports to help adolescents facing adversity realize their goals is essential to their long-term health and success.
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Affiliation(s)
- Angela Bruns
- Department of Sociology & Criminology, Gonzaga University, Spokane, Washington, USA
| | - Amanda J Aubel
- Department of Emergency Medicine, Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA
| | - Xiaoya Zhang
- Department of Family Youth and Community Sciences, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, Florida, USA
| | - Shani A Buggs
- Department of Emergency Medicine, Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA
| | - Nicole Kravitz-Wirtz
- Department of Emergency Medicine, Violence Prevention Research Program, University of California Davis School of Medicine, Sacramento, California, USA
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24
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Hatchimonji JS, Hatchimonji DR, Allee L, Scantling DR. Trends in youth risk behaviours and firearm injury in the USA over 20 years. Inj Prev 2024:ip-2023-045161. [PMID: 38802244 DOI: 10.1136/ip-2023-045161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Firearm injuries are the leading cause of death in children and adolescents in the USA. We hypothesised that high rates of risky behaviour in high school students are associated with firearm injury and death in this population. METHODS We obtained data from the Youth Behaviour Risk Survey of the Centers for Disease Control and Prevention (CDC) and combined it with data from the CDC Web-based Injury Statistics Query and Reporting System, CDC Wide-ranging Online Data for Epidemiologic Research and American Community Survey, 2001-2020. We examined trends over time using a non-parametric test for trends. RESULTS The percentage of high school-aged youth carrying a weapon in the preceding 30 days ranged from 13.2% in 2019 to 18.5% in 2005, without a statistically significant trend over time (p=0.051). Those carrying a weapon to school peaked at 6.5% in 2005 and steadily downtrended to 2.8% in 2019 (p=0.004). Boys consistently reported higher rates of weapon carriage, with white boys reporting higher rates than black boys. Firearm homicides among adolescents 14-18 years showed no significant change, ranging from 4.0 per 100k in 2013 to 8.3 per 100k in 2020. This varied considerably by sex and race, with black boys suffering a rate of nearly 60 per 100 000 in 2020 and white girls rarely exceeding 1/100 000 during the study period. CONCLUSION Self-reported weapon carriage among teens in the USA has steadily downtrended over time. However, shooting injuries and deaths have not. While the former suggests progress, the latter remains concerning. LEVEL OF EVIDENCE Level III; retrospective cohort study.
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Affiliation(s)
- Justin S Hatchimonji
- Division of Traumatology, Emergency Surgery, and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Danielle R Hatchimonji
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA
| | - Lisa Allee
- Division of Trauma and Acute Care Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Dane R Scantling
- Division of Trauma and Acute Care Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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25
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Dholakia A, Burdick KJ, Kreatsoulas C, Monuteaux MC, Tsai J, Subramanian SV, Fleegler EW. Historical Redlining and Present-Day Nonsuicide Firearm Fatalities. Ann Intern Med 2024; 177:592-597. [PMID: 38648643 DOI: 10.7326/m23-2496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Redlining began in the 1930s with the Home Owners' Loan Corporation (HOLC); this discriminatory practice limited mortgage availability and reinforced concentrated poverty that still exists today. It is important to understand the potential health implications of this federally sanctioned segregation. OBJECTIVE To examine the relationship between historical redlining policies and present-day nonsuicide firearm fatalities. DESIGN Maps from the HOLC were overlaid with incidence of nonsuicide firearm fatalities from 2014 to 2022. A multilevel negative binomial regression model tested the association between modern-day firearm fatalities and HOLC historical grading (A ["best"] to D ["hazardous"]), controlling for year, HOLC area-level demographics, and state-level factors as fixed effects and a random intercept for city. Incidence rates (IRs) per 100 000 persons, incidence rate ratios (IRRs), and adjusted IRRs (aIRRs) for each HOLC grade were estimated using A-rated areas as the reference. SETTING 202 cities with areas graded by the HOLC in the 1930s. PARTICIPANTS Population of the 8597 areas assessed by the HOLC. MEASUREMENTS Nonsuicide firearm fatalities. RESULTS From 2014 to 2022, a total of 41 428 nonsuicide firearm fatalities occurred in HOLC-graded areas. The firearm fatality rate increased as the HOLC grade progressed from A to D. In A-graded areas, the IR was 3.78 (95% CI, 3.52 to 4.05) per 100 000 persons per year. In B-graded areas, the IR, IRR, and aIRR relative to A areas were 7.43 (CI, 7.24 to 7.62) per 100 000 persons per year, 2.12 (CI, 1.94 to 2.32), and 1.42 (CI, 1.30 to 1.54), respectively. In C-graded areas, these values were 11.24 (CI, 11.08 to 11.40) per 100 000 persons per year, 3.78 (CI, 3.47 to 4.12), and 1.90 (CI, 1.75 to 2.07), respectively. In D-graded areas, these values were 16.26 (CI, 16.01 to 16.52) per 100 000 persons per year, 5.51 (CI, 5.05 to 6.02), and 2.07 (CI, 1.90 to 2.25), respectively. LIMITATION The Gun Violence Archive relies on media coverage and police reports. CONCLUSION Discriminatory redlining policies from 80 years ago are associated with nonsuicide firearm fatalities today. PRIMARY FUNDING SOURCE Fred Lovejoy Housestaff Research and Education Fund.
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Affiliation(s)
- Ayesha Dholakia
- Department of Pediatrics, Boston Children's Hospital, and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts (A.D., K.J.B.)
| | - Kendall J Burdick
- Department of Pediatrics, Boston Children's Hospital, and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts (A.D., K.J.B.)
| | | | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts (M.C.M.)
| | - Jennifer Tsai
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, and St. Joseph's Medical Center in Stockton, Stockton, California (J.T.)
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, and Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (S.V.S.)
| | - Eric W Fleegler
- Department of Emergency Medicine, Massachusetts General Hospital, and Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts (E.W.F.)
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26
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Rapa LJ, Katsiyannis A, Scott SN, Durham O. School Shootings in the United States: 1997-2022. Pediatrics 2024; 153:e2023064311. [PMID: 38433681 DOI: 10.1542/peds.2023-064311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES Gun violence in the United States is a public health crisis. In 2019, gun injury became the leading cause of death among children aged birth to 19 years. Moreover, the United States has had 57 times as many school shootings as all other major industrialized nations combined. The purpose of this study was to understand the frequency of school-related gun violence across a quarter century, considering both school shootings and school mass shootings. METHODS We drew on 2 publicly available datasets whose data allowed us to tabulate the frequency of school shootings and school mass shootings. The databases contain complementary data that provide a longitudinal, comprehensive view of school-related gun violence over the past quarter century. RESULTS Across the 1997-1998 to 2021-2022 school years, there were 1453 school shootings. The most recent 5 school years reflected a substantially higher number of school shootings than the prior 20 years. In contrast, US school mass shootings have not increased, although school mass shootings have become more deadly. CONCLUSIONS School shootings have risen in frequency in the recent 25 years and are now at their highest recorded levels. School mass shootings, although not necessarily increasing in frequency, have become more deadly. This leads to detrimental outcomes for all the nation's youth, not just those who experience school-related gun violence firsthand. School-based interventions can be used to address this public health crisis, and effective approaches such as Multi-Tiered Systems of Supports and services should be used in support of students' mental health and academic and behavioral needs.
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Affiliation(s)
- Luke J Rapa
- Department of Education and Human Development, College of Education, Clemson University, Clemson, South Carolina
| | - Antonis Katsiyannis
- Department of Education and Human Development, College of Education, Clemson University, Clemson, South Carolina
| | - Samantha N Scott
- Department of Education and Human Development, College of Education, Clemson University, Clemson, South Carolina
| | - Olivia Durham
- Department of Education and Human Development, College of Education, Clemson University, Clemson, South Carolina
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Chang C, Anderson MN, Shao B, Lin JC, Ranney ML, Cielo D. Letter: A Call to Action: A Neurosurgeon's Responsibility in Firearm Injury Prevention and Advocacy. Neurosurgery 2024; 94:e61-e62. [PMID: 38265204 DOI: 10.1227/neu.0000000000002844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Affiliation(s)
- Christopher Chang
- Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Matthew N Anderson
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle , Washington , USA
| | - Belinda Shao
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - John C Lin
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia , Pennsylvania , USA
| | - Megan L Ranney
- Yale School of Public Health, Yale University, New Haven , Connecticut , USA
| | - Deus Cielo
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
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28
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Bell R. Confronting School Shootings in America: The Pediatrician's Role. Pediatrics 2024; 153:e2023065281. [PMID: 38433663 DOI: 10.1542/peds.2023-065281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 03/05/2024] Open
Affiliation(s)
- Rebecca Bell
- University of Vermont Children's Hospital, Burlington, Vermont
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Kodali S, He CH, Patel S, Tao A, Szlechter M, Parsikia A, Mbekeani JN. Characteristics of ocular injuries associated with mortality in patients admitted with major trauma. BMC Ophthalmol 2024; 24:125. [PMID: 38504178 PMCID: PMC10949718 DOI: 10.1186/s12886-024-03392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Few ocular trauma studies have addressed mortality outcomes. We sought to determine characteristics of mortality-related ocular trauma admissions and compared them with non-fatal injuries. METHODS A retrospective study was conducted using de-identified data of patients admitted with major trauma from the National Trauma Data Bank (2008-2014). Patients with ocular injury were identified using ICD- 9CM codes. Demographics, intention and mechanism, types of ocular and head injuries, and injury severity were documented. Mortality was determined using post-admission disposition. Statistical analysis using student t-test, chi-square, and odds ratios (OR) calculations were performed with STATA-17 software. Significance was set at P < 0.05. RESULTS Of 316,485 patients admitted with ocular trauma, 12,233 (3.86%) were mortality related. Expired patients were older than survivors: mean (SD) of 50.1(25.5) vs. 41.5(22.8) years. White (OR = 1.32; P < 0.001), ≥ 65years old (OR = 2.25; P < 0.001), and male (OR = 1.05; P = 0.029) patients were most likely to expire than their counterparts. Common mechanisms of injury in survivors were falls (25.3%), motor vehicle traffic-occupant, MVTO (21.8%) and struck by/against (18.1%) and for fatal injuries, falls (29.7%), MVTO (21.9%) and firearms (11.5%). Traumatic brain injury (TBI) was documented in 88.2% of mortality-related admissions. Very severe injury severity scores (ISS > 24) (OR = 19.19; P < 0.001) and severe Glasgow Coma Score (GCS < 8) (OR = 19.22; P < 0.001) were most associated with mortality than survival. Firearms were most associated with very severe ISS (OR = 3.73; P < 0.001), severe GCS (OR = 4.68; P < 0.001) and mortality (OR = 5.21; P < 0.001) than other mechanisms. Patients with cut/pierce injuries had the greatest odds of survival (OR = 13.48; P < 0.001). Optic nerve/visual pathways injuries (3.1%) had the highest association with very severe ISS (OR = 2.51; P < 0.001), severe GCS (OR = 3.64; P < 0.001) and mortality (OR = 2.58; P < 0.001) than other ocular injuries. Black patients with very severe ISS (OR = 32.14; P < 0.001) and severe GCS (OR = 31.89; P < 0.001) were more likely to expire than other race/ethnicities with similar injury severity. CONCLUSIONS Mortality-related admissions were older, male, and mostly of White race than ocular trauma admissions of survivors. Firearms were the deadliest mechanism. TBI was commonly associated and patients with optic nerve/pathway injuries, very severe ISS and severe GCS had higher mortality rates. Characteristics and demographic variations identified in this study may be useful in developing focused measures aimed at preventing trauma-related deaths.
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Affiliation(s)
- Sruthi Kodali
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Catherine H He
- Department of Ophthalmology & Visual Sciences, Yale School of Medicine, New Haven, Conn, USA
| | - Sheel Patel
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Alice Tao
- Department of Ophthalmology, Jamaica Hospital Medical Center, New York Medical College, Queens, NY, USA
| | - Moshe Szlechter
- Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY, 10461, USA
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, USA
| | - Afshin Parsikia
- Department of Research Services, University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce N Mbekeani
- Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY, 10461, USA.
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, USA.
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Mulugeta MG, Bailey G, Parsons K, Gillespie S, Johnson LM, Doh KF, Reisner A, Blackwell LS. Trends in pediatric firearm-related injuries and disparities in acute outcomes. Front Public Health 2024; 12:1339394. [PMID: 38566791 PMCID: PMC10985139 DOI: 10.3389/fpubh.2024.1339394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Firearm-related injuries (FRI) are an increasing cause of death and injury in children. The etiology for this rise is multifactorial and includes socioeconomic factors. Despite its prevalence and documented increase over COVID-19, there is a paucity of research on disparities and the influence of social determinants of health (SDH) in pediatric FRI. This study aims to explore the epidemiology of this vulnerable population in Atlanta, trends over time and relevant dates such as COVID-19 and a state firearm law, and disparities in clinical outcomes. Methods Retrospective cohort of patients with FRI (0-20 years-old, x̄=9.8, Median = 11) presenting to our hospital EDs from January 2014 to April 2023 (N = 701) and eligible for the Trauma Registry. This period includes two major events, namely the COVID-19 pandemic (March 2020), and passage of state law Constitutional Carry Act (SB 319) (April 2022), allowing for permit-less concealed firearm carry. Single series interrupted time series (ITS) models were run and clinical outcome differences between race and insurance groups were calculated unadjusted and adjusted for confounders using inverse propensity treatment weights (IPTW). The primary outcome was mortality; secondary are admission and discharge. Results Majority of FRI involved patients who were male (76.7%), Black (74.9%), publicly insured (82.6%), ≤12 years-old (61.8%), and injured by unintentional shootings (45.6%) or assault (43.7%). During COVID-19, there was a sustained increase in FRI rate by 0.42 patients per 1,000 trauma visits per month (95% CI 0.02-0.82, p = 0.042); post-SB 319 it was 2.3 patients per 1,000 trauma visits per month (95% CI 0.23-4.31, p = 0.029). Publicly insured patients had 58% lower odds of mortality than privately insured patients (OR 0.42, 95% CI 0.18-0.99, p = 0.047). When controlled for race and mechanism of injury, among other confounding factors, this association was not significant (p = 0.652). Conclusion Pediatric FRI are increasing over time, with disproportionate burdens on Black patients, at our hospitals. Disparities in mortality based on insurance necessitate further study. As social and economic repercussions of COVID-19 are still present, and state firearm law SB 319 is still in effect, assessment of ongoing trends is warranted to inform preventative strategies.
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Affiliation(s)
| | | | - Kendall Parsons
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Scott Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Laura M. Johnson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Kiesha Fraser Doh
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Andrew Reisner
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Laura S. Blackwell
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
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Rossen LM, Resendez A, Behdin A, Louis MS. Trends and disparities in deaths among young persons in the US during the COVID-19 pandemic. Ann Epidemiol 2024; 91:37-43. [PMID: 38309641 PMCID: PMC10922572 DOI: 10.1016/j.annepidem.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/18/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE To examine changes in death rates by demographic group and by the leading causes of death in U.S. persons 1 to 24 years of age during the COVID-19 pandemic. METHODS A retrospective cross-sectional study using mortality data from the National Vital Statistics System from April 2017 to March 2023. Pre-pandemic death rates were compared with death rates during the pandemic overall, by race/ethnicity, age, sex, and cause group. RESULTS Age-adjusted death rates in young persons 1-24 years of age increased by 14.3% during the pandemic. Injury-related causes accounted for 78.2% of the increase, driven mainly by increases in homicides and unintentional injuries related to drug overdose, firearms, and motor-vehicle traffic crashes. Non-Hispanic Black and Hispanic teens and young adults experienced the largest increases in deaths overall and across the leading causes of death. CONCLUSIONS During the COVID-19 pandemic, injury-related causes accounted for the majority of the increases in deaths in children and young adults, driven mainly by firearms, drug overdoses, and motor vehicle traffic crashes. Findings highlight the importance of understanding the drivers of these marked increases in injury-related mortality and the need for injury prevention efforts among children even in the context of an infectious disease pandemic.
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Affiliation(s)
- Lauren M Rossen
- Division of Research and Methodology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, United States.
| | - Adriana Resendez
- Milken Institute School of Public Health, George Washington University, United States
| | - Amanda Behdin
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Michael St Louis
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
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32
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Dao KD, Gisselman AS, Siegel MB, Hegedus EJ, Wooten LC. Firearm Violence as a Public Health Crisis: A Call to Action for Physical Therapists. Phys Ther 2024; 104:pzad143. [PMID: 37839055 DOI: 10.1093/ptj/pzad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Kim D Dao
- Department of Rehabilitation Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | - Michael B Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Eric J Hegedus
- Department of Rehabilitation Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Liana C Wooten
- Department of Rehabilitation Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
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Pulcini CD, Hoffmann JA, Alpern ER, Chaudhary S, Ehrlich PF, Fein JA, Fleegler EW, Goyal MK, Hall M, Jeffries KN, Myers R, Sheehan KM, Zamani M, Zima BT, Hargarten S. A Holistic Approach to Childhood Firearm Injuries. Pediatrics 2024; 153:e2023063322. [PMID: 38087959 PMCID: PMC10752822 DOI: 10.1542/peds.2023-063322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 12/30/2023] Open
Affiliation(s)
- Christian D. Pulcini
- Department of Emergency Medicine & Pediatrics, University of Vermont Medical Center and Children’s Hospital, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Jennifer A. Hoffmann
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, CS Mott Children’s Hospital, University of Michigan Ann Arbor, Ann Arbor, Michigan
| | - Joel A. Fein
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric W. Fleegler
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School; Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Monika K. Goyal
- Department of Pediatrics, Children’s National Hospital, George Washington University, Washington
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Kristyn N. Jeffries
- Department of Pediatrics, Section of Hospital Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rachel Myers
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen M. Sheehan
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark Zamani
- Children’s Hospital Association, Lenexa, Kansas
| | - Bonnie T. Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Stephen Hargarten
- Department of Emergency Medicine, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin
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Huerta CT, Saberi RA, Gilna GP, Escobar VAP, Perez EA, Sola JE, Thorson CM, McCrea HJ. Using intent to get ahead of pediatric cranial firearm injuries. Injury 2024; 55:111167. [PMID: 37923676 DOI: 10.1016/j.injury.2023.111167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/22/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Pediatric firearm injuries (PFI) are a public health crisis. Little is known about how injury intent may influence the outcome of pediatric cranial firearm injuries (PCFI). The current study sought to compare demographics and outcomes of PCFI based on intent of injury. METHODS The Nationwide Readmission Database (2010-2014) was queried to identify patients <18 years old with PCFI. Demographics and outcomes were compared by injury intent (assault, self-inflicted, unintentional), and results were weighted for national estimates to create a population-based cohort study. RESULTS There were 1,365 cases of PCFI identified for an incidence of 11% of all PFI. The majority of patients were male (83 %), >13 years (81 %), and had an injury severity score >15 (79 %). Overall PCFI mortality was 43 %, compared to 6 % for all PFI. Assault was the most common intent (51 %), followed by self-inflicted (25 %), and unintentional (24 %). Assault was more likely to occur in patients from low-income households (61 % vs. 31 % self-inflicted vs. 42 % unintentional), p < 0.001. Unintentional injuries occurred in those <13 years old (40 % vs. 12 % assault vs. 16 % self-inflicted) and more often resulted in facial fracture (19 % vs. 11 % vs. 13 %), all p < 0.001. Readmission rate within the year was 21 %. The majority (56 %) of readmissions were unplanned, and the rate was highest for assault (77 % vs. <1 % self-inflicted vs. 44 % unintentional, p < 0.001). CONCLUSIONS PCFI are associated with significant morbidity and mortality. Demographics and outcomes vary by intent of injury; knowledge of these patterns can direct future interventions to reduce injuries and impact outcomes.
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Affiliation(s)
- Carlos Theodore Huerta
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Rebecca A Saberi
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Gareth P Gilna
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | | | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Heather J McCrea
- Department of Neurosurgery and Pediatrics, University of Miami Miller School of Medicine and Jackson Health System, Miami, FL, United States of America.
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Hanson HR, Formica M, Laraque-Arena D, Zonfrillo MR, Desai P, O'Neil JO, Unni P, Johnson EL, Cobb P, Agarwal M, Beckworth K, Schroter S, Strotmeyer S, Donnelly KA, Middelberg LK, Morse AM, Dodington J, Latuska RF, Anderson B, Lawson KA, Valente M, Levas MN, Kiragu AW, Monroe K, Ruest SM, Lee LK, Charyk Stewart T, Attridge MM, Haasz M, Jafri M, McIntire A, Rogers SC, Uspal NG, Blanchard A, Hazeltine MD, Riech T, Jennissen C, Model L, Fu Q, Clukies LD, Juang D, Ruda MT, Prince JM, Chao S, Yorkgitis BK, Pomerantz WJ. A multicenter evaluation of pediatric emergency department injury visits during the COVID-19 pandemic. Inj Epidemiol 2023; 10:66. [PMID: 38093383 PMCID: PMC10717699 DOI: 10.1186/s40621-023-00476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Injuries, the leading cause of death in children 1-17 years old, are often preventable. Injury patterns are impacted by changes in the child's environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic. METHODS This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children < 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00-T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020. RESULTS The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31 years vs 7.31 in 2019), more commonly White (54% vs 50%, p < 0.001), non-Hispanic (72% vs 69%, p < 0.001) and had private insurance (35% vs 32%, p < 0.001). Injury hospitalizations increased 2.2% (p < 0.001) and deaths increased 0.03% (p < 0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p < 0.001) between 2019 and 2020. Injuries declined for struck by/against (- 4.9%) and overexertion (- 1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019. CONCLUSIONS The proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives.
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Affiliation(s)
- Holly R Hanson
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Margaret Formica
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Danielle Laraque-Arena
- New York Academy of Medicine, New York, New York, USA
- Clinical Epidemiology and Pediatrics, Mailman School of Public Health and Vagelos College of Physicians & Surgeons, Columbia University, Syracuse, NY, USA
| | - Mark R Zonfrillo
- Department of Emergency Medicine, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Puja Desai
- Department of Pediatrics, St. Louis Children's Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph O O'Neil
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Purnima Unni
- Department of Pediatric Trauma, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Estell Lenita Johnson
- Department of Epidemiology, School of Public Health, Injury Free Coalition for Kids, Columbia University, New York City, NY, USA
| | - Patricia Cobb
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maneesha Agarwal
- Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kristen Beckworth
- Center for Childhood Injury Prevention, Texas Children's Hospital, Houston, TX, USA
| | - Stephanie Schroter
- Department of Pediatric Emergency Medicine, University of California, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Stephen Strotmeyer
- Department of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Allegheny County Health Department, Pittsburgh, PA, USA
| | - Katie A Donnelly
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Leah K Middelberg
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amber M Morse
- Division of Pediatric Emergency Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | | | - Richard F Latuska
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brit Anderson
- Department of Pediatric Emergency Medicine, Norton Children's Hospital, Louisville, KY, USA
| | - Karla A Lawson
- Trauma and Injury Research Center, Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - Michael Valente
- Department of Pediatric Emergency Medicine, Children's Health Orange County, Orange, CA, USA
| | - Michael N Levas
- Department of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew Waititu Kiragu
- Department of Pediatrics, University of Minnesota and Children's Minnesota, Minneapolis, MN, USA
| | - Kathy Monroe
- Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephanie M Ruest
- Department of Emergency Medicine, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Tanya Charyk Stewart
- Department of Paediatrics, University of Western Ontario and London Health Sciences Centre, London, ON, Canada
| | - Megan M Attridge
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Maya Haasz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mubeen Jafri
- Department of Pediatric Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Alicia McIntire
- Department of Pediatric Surgery, Randall Children's Hospital at Emanuel Legacy, Portland, OR, USA
| | - Steven C Rogers
- Department of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Hospital, Hartford, CT, USA
| | - Neil G Uspal
- Division of Emergency Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Ashley Blanchard
- Department of Emergency Medicine, Columbia University Medical Center, New York City, NY, USA
| | - Max D Hazeltine
- Department of Surgery, UMass Chan Medical School, Worcester, MA, USA
| | - Teresa Riech
- Department of Pediatric Emergency Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Charles Jennissen
- Department of Pediatrics, Roy J. and Lucille A. Carter College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Emergency Medicine, Roy J. and Lucille A. Carter College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Lynn Model
- Department of Pediatric Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Quinney Fu
- Division of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Lindsay D Clukies
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Michelle T Ruda
- Department of Pediatrics, Children's Memorial Hermann Hospital, UTHealth Houston, Houston, TX, USA
| | - Jose M Prince
- Department of Pediatric Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Stephanie Chao
- Division of Pediatric Surgery, Stanford School of Medicine, Palo Alto, CA, USA
| | - Brian K Yorkgitis
- Department of Surgery, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Wendy J Pomerantz
- Division of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Culyba AJ, Fleegler EW, Pratt AH, Lee LK. Violence Prevention in Pediatrics: Advocacy and Legislation. Pediatr Clin North Am 2023; 70:1225-1238. [PMID: 37865442 DOI: 10.1016/j.pcl.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Given the complexities of youth violence prevention and longstanding violence inequities, advocacy by pediatric clinicians provides a critical voice to represent youth at multiple levels to address the myriad contributors and effects of youth violence. Institutional, community, state, and federal programs, policies, and legislation are required to support a public health approach to the amelioration of youth violence. This article focuses on the role of pediatric clinicians in advocating for youth and families, promoting change within clinical and hospital systems, partnering with communities to advance evidence-informed prevention and intervention, and legislative advocacy to advance violence prevention policy, research, and practice.
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Affiliation(s)
- Alison J Culyba
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Avenue, Suite 302, Pittsburgh, PA 15217, USA.
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Abdullah H Pratt
- Section of Emergency Medicine, The University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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Hoffmann JA, Carter CP, Olsen CS, Chaudhari PP, Chaudhary S, Duffy S, Glomb N, Goyal MK, Grupp-Phelan J, Haasz M, Ketabchi B, Kravitz-Wirtz N, Lerner EB, Shihabuddin B, Wendt W, Cook LJ, Alpern ER. Pediatric Firearm Injury Emergency Department Visits From 2017 to 2022: A Multicenter Study. Pediatrics 2023; 152:e2023063129. [PMID: 37927086 PMCID: PMC10842699 DOI: 10.1542/peds.2023-063129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Pediatric firearm injuries increased during the coronavirus disease 2019 pandemic, but recent trends in firearm injury emergency department (ED) visits are not well described. We aimed to assess how pediatric firearm injury ED visits during the pandemic differed from expected prepandemic trends. METHODS We retrospectively studied firearm injury ED visits by children <18 years old at 9 US hospitals participating in the Pediatric Emergency Care Applied Research Network Registry before (January 2017 to February 2020) and during (March 2020 to November 2022) the pandemic. Multivariable Poisson regression models estimated expected visit rates from prepandemic data. We calculated rate ratios (RRs) of observed to expected visits per 30 days, overall, and by sociodemographic characteristics. RESULTS We identified 1904 firearm injury ED visits (52.3% 15-17 years old, 80.0% male, 63.5% non-Hispanic Black), with 694 prepandemic visits and 1210 visits during the pandemic. Death in the ED/hospital increased from 3.1% prepandemic to 6.1% during the pandemic (P = .007). Firearm injury visits per 30 days increased from 18.0 prepandemic to 36.1 during the pandemic (RR 2.09, 95% CI 1.63-2.91). Increases beyond expected rates were seen for 10- to 14-year-olds (RR 2.61, 95% CI 1.69-5.71), females (RR 2.46, 95% CI 1.55-6.00), males (RR 2.00, 95% CI 1.53-2.86), Hispanic children (RR 2.30, 95% CI 1.30-9.91), and Black non-Hispanic children (RR 1.88, 95% CI 1.34-3.10). CONCLUSIONS Firearm injury ED visits for children increased beyond expected prepandemic trends, with greater increases among certain population subgroups. These findings may inform firearm injury prevention efforts.
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Affiliation(s)
- Jennifer A. Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Cody S. Olsen
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Sofia Chaudhary
- Division of Emergency Medicine, Department of Pediatrics and Department of Emergency Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Susan Duffy
- Departments of Emergency Medicine and Pediatrics, Brown University, Hasbro Children’s Hospital, Providence, RI
| | - Nicolaus Glomb
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, CA
| | - Monika K. Goyal
- Division of Emergency Medicine, Children’s National Hospital, George Washington University, Washington, DC
| | - Jacqueline Grupp-Phelan
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, CA
| | - Maya Haasz
- Department of Pediatrics, Section of Emergency Medicine, Children’s Hospital Colorado, University of Colorado, Aurora, CO
| | - Bijan Ketabchi
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Nicole Kravitz-Wirtz
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA
| | - E. Brooke Lerner
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Bashar Shihabuddin
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Wendi Wendt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Lawrence J. Cook
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Elizabeth R. Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
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Weaver MS, Nasir A, Lord BT, Starin A, Linebarger JS. Supporting the Family After the Death of a Child or Adolescent. Pediatrics 2023; 152:e2023064426. [PMID: 38009001 DOI: 10.1542/peds.2023-064426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/28/2023] Open
Abstract
Whether death occurs in the context of a chronic illness or as the sudden loss of a previously healthy infant, child, or adolescent, the death of a child is a highly stressful and traumatic event. Psychosocial support for families after the death of a child embodies core medical values of professional fidelity, compassion, respect for human dignity, and promotion of the best interests of a grieving family. The pediatrician has an important role in supporting the family unit after the death of a child through a family-centered, culturally humble, trauma-informed approach. This clinical report aims to provide the pediatrician with a review of the current evidence on grief, bereavement, and mourning after the loss of a child and with practical guidance to support family caregivers, siblings, and the child's community. Pediatricians have an important role in helping siblings and helping families understand sibling needs during grief. Ways for pediatricians to support family members with cultural sensitivity are suggested and other helpful resources in the community are described.
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Affiliation(s)
- Meaghann S Weaver
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
- National Center for Ethics in Health Care, Veterans Health Affairs, Washington, District of Columbia
| | - Arwa Nasir
- Department of Pediatrics, University of Nebraska, Omaha, Nebraska
| | - Blyth T Lord
- Courageous Parents Network, Newton, Massachusetts
| | - Amy Starin
- National Association of Social Workers, Washington, District of Columbia
| | - Jennifer S Linebarger
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, Missouri
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Chen RJ, Chen MC, Tsai BCK, Roy R, Chang YR, Wang TF, Kuo WW, Kuo CH, Yao CH, Li CC, Huang CY. Ligustrazine improves the compensative effect of Akt survival signaling to protect liver Kupffer cells in trauma-hemorrhagic shock rats. Chem Biol Drug Des 2023; 102:1399-1408. [PMID: 37612133 DOI: 10.1111/cbdd.14327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/16/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
Trauma-hemorrhagic shock (THS) is a medical emergency that is encountered by physicians in the emergency department. Chuan Xiong is a traditional Chinese medicine and ligustrazine is a natural compound from it. Ligustrazine improves coronary blood flow and reduces cardiac ischemia in animals through Ca2+ and ATP-dependent vascular relaxation. It also decreases the platelets' bioactivity and reduces reactive oxygen species formation. We hypothesized that ligustrazine could protect liver by decreasing the inflammation response, protein production, and apoptosis in THS rats. Ligustrazine at doses of 100 and 1000 μg/mL was administrated in Kupffer cells isolated from THS rats. The protein expressions were detected via western blot. The THS showed increased inflammation response proteins, mitochondria-dependent apoptosis proteins, and had a compensation effect on the Akt pathway. After ligustrazine treatment, the hemorrhagic shock Kupffer cells decreased inflammatory response and mitochondria-dependent apoptosis and promoted a more compensative effect of the Akt pathway. It suggests ligustrazine reduces inflammation response and mitochondria-dependent apoptosis induced by THS in liver Kupffer cells and promotes more survival effects by elevating the Akt pathway. These findings demonstrate the beneficial effects of ligustrazine against THS-induced hepatic injury, and ligustrazine could be a potential medication to treat the liver injury caused by THS.
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Affiliation(s)
- Ray-Jade Chen
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Cheng Chen
- Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Bruce Chi-Kang Tsai
- Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Rakesh Roy
- Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yi-Ru Chang
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tso-Fu Wang
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wei-Wen Kuo
- Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
- Ph.D. Program for Biotechnology Industry, China Medical University, Taichung, Taiwan
| | - Chia-Hua Kuo
- Department of Sports Sciences, University of Taipei, Taipei, Taiwan
| | - Chun-Hsu Yao
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Biomaterials Translational Research Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chi-Cheng Li
- School of Medicine, Tzu Chi University, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Center of Stem Cell & Precision Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chih-Yang Huang
- Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
- Center of General Education, Buddhist Tzu Chi Medical Foundation, Tzu Chi University of Science and Technology, Hualien, Taiwan
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Semenza DC, Stansfield R, Silver IA, Savage B. Reciprocal Neighborhood Dynamics in Gun Violence Exposure, Community Health, and Concentrated Disadvantage in One Hundred US Cities. J Urban Health 2023; 100:1128-1139. [PMID: 37843742 PMCID: PMC10728405 DOI: 10.1007/s11524-023-00796-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023]
Abstract
Gun violence imparts a tremendous human and financial toll on local communities. Researchers have documented extensive mental and physical health consequences of generalized violence exposure but few studies have analyzed the particular impacts of gun violence on community well-being using nationally comprehensive data. We leverage a unique database of almost 16,000 neighborhoods in 100 US cities (2014-2019) to examine how year-over-year rates of gun violence correspond to overall neighborhood well-being and three aspects of community health: (1) health behaviors, (2) physical and mental health status, and (3) health prevention efforts. We simultaneously consider the reciprocal influence of neighborhood well-being on subsequent gun violence while accounting for concentrated disadvantage in communities. The results demonstrate that gun violence is associated with poorer community health in subsequent years, particularly health behaviors and mental/physical health status. Furthermore, we find substantial reciprocal effects for both gun violence and community health in their relationship to neighborhood concentrated disadvantage. These findings highlight the consequential role of gun violence in perpetuating cycles of harm in local communities.
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Affiliation(s)
- Daniel C Semenza
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, NJ, USA.
- Department of Urban-Global Public Health, Rutgers University, Newark, NJ, USA.
- New Jersey Gun Violence Research Center, Rutgers University, Newark, NJ, USA.
| | - Richard Stansfield
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, NJ, USA
| | - Ian A Silver
- Research Triangle Institute, Research Triangle Park, Durham, NC, USA
| | - Brielle Savage
- School of Criminal Justice, Rutgers University, Newark, NJ, USA
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Hollon H, Thacker L, Wolf E, Dinov D, Risney S, Kamdar H, Ferrante C, Ryan MS. A Resident-Led Firearm Curriculum for Pediatrics Residents Improves Safe Storage Counseling. J Pediatr 2023; 263:113680. [PMID: 37607648 DOI: 10.1016/j.jpeds.2023.113680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/21/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE To develop and implement a resident-led firearm safety curriculum, delivered to pediatrics residents, and to evaluate outcomes. STUDY DESIGN A firearm safety curriculum was developed in 2019-2020 at a single academic center, using Kern's framework and cognitive load theory. The curriculum was organized using the "Be SMART" firearm safety model. Sessions were led by resident peers. The content included workshops on firearm safety counseling, advocacy training, and a gun lock program in collaboration with the local police department. Content was integrated into existing residency didactic curriculum. Impact was measured by a pre/posttest knowledge assessment and a systematic chart review. RESULTS The curriculum was provided to 41/66 (62%) pediatrics residents. Knowledge improved (67% to 77% correct) when comparing pre-intervention with post-intervention. A total of 1477 charts were reviewed. Compared with a historical cohort, participants more often asked about presence of a firearm (27% vs 69%, P < .0001) and counseled on firearm safety (9% vs 25%, P < .0001). In the post-intervention timeframe, 25% of eligible families were provided a gun lock. CONCLUSIONS A firearm safety curriculum designed by pediatrics residents and administered to their peers resulted in a statistically significant improvement in inquiries about firearm ownership and safety counseling in an urban tertiary care continuity clinic. These results demonstrate the promising outcomes of a firearm safety program developed by residents and delivered to peers.
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Affiliation(s)
- Hannah Hollon
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond
| | - Leroy Thacker
- Department of Biostatistics, Virginia Commonwealth University
| | - Elizabeth Wolf
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond
| | - Darina Dinov
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond
| | - Scott Risney
- Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell Jr. Children's Hospital
| | - Heemali Kamdar
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond
| | - Christopher Ferrante
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond
| | - Michael S Ryan
- Department of Pediatrics, University of Virginia School of Medicine.
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Wurster LA, Herndon M, Seastrom D, Fritzeen J, Mitchell K, Schmid M, Rumsey K. Quality Improvement Practices and Resources Targeting Firearm Injuries: A Survey of U.S. Pediatric Trauma Centers. J Trauma Nurs 2023; 30:328-333. [PMID: 37937873 DOI: 10.1097/jtn.0000000000000751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND The increase in firearm injuries at U.S. pediatric trauma centers is a national public health crisis. This spike in penetrating trauma has challenged even the most mature pediatric trauma centers. OBJECTIVE This project aims to identify U.S. pediatric trauma center best practices for the evaluation and resources dedicated to pediatric firearm injuries. METHODS This study used an exploratory cross-sectional survey design using a study-specific questionnaire. An electronic survey was distributed to 159 verified U.S. pediatric trauma centers targeting patients younger than 15 years with firearm injuries from 2017 to 2021. Trauma approaches to injury prevention, advocacy, and common performance improvement events were surveyed. A follow-up survey provided a drill-down on the top three performance improvement events. RESULTS A total 159 surveys were distributed, of which 63 (40%) submitted partial responses and 32 (20%) completed the initial survey in full. A 49% increase in pediatric firearm injuries occurred between 2019 and 2020. Eighty-six percent of the trauma centers identified at least one to two opportunities for improvement events related to firearm injuries, with most of these events requiring a tertiary level of review. The top three performance improvement events included the massive transfusion protocol/fluid resuscitation, emergency department procedures, and operating room resource availability. CONCLUSIONS This study provides the first known examination of U.S. pediatric trauma center quality improvement efforts to address the crisis of pediatric firearm injuries. Our results indicate that most pediatric trauma centers are engaged in quality improvement and resource enhancement to combat firearm injuries.
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Affiliation(s)
- Lee Ann Wurster
- Nationwide Children's Hospital, Columbus, Ohio (Ms Wurster); St. Louis Children's Hospital, St. Louis, Missouri (Ms Herndon); Children's Mercy Kansas City, Kansas City, Missouri (Mr Seastrom); Children's National Hospital, Washington, District of Columbia (Ms Fritzeen); Emergency Department, Phoenix Children's Hospital, Phoenix, Arizona (Ms Mitchell); Operations Network at Medically Home, Atlanta, Georgia (Ms Schmid); and Bon Secours Mercy Health, St. Francis Medical Center, Midlothian, Virginia (Dr Rumsey)
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Lei L, Goldstick JE, Maust DT. Impact of firearm injury in children and adolescents on health care costs and use within a family. Prev Med 2023; 175:107681. [PMID: 37633600 PMCID: PMC10592083 DOI: 10.1016/j.ypmed.2023.107681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/29/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
In 2020, firearm injury became the leading cause of death in U.S. children and adolescents. This study examines sequelae of firearm injury among children and adolescents in terms of health care costs and use within a family over time using an event study design. Using data from a large U.S. commercial insurance company from 2013 to 2019, we identified 532 children and adolescents aged 1-19 years who experienced any firearm-related acute hospitalization or emergency department (ED) encounter and 1667 of their family members (833 parents and 834 siblings). Outcomes included total health care costs, any acute hospitalization and ED visits (yes/no), and number of outpatient management visits, each determined on a quarterly basis 2 years before and 3 years after the firearm injury. Among injured children and adolescents, during the first quarter after the firearm injury, quarterly total health care costs were $24,018 higher than pre-injury; probability of acute hospitalization and ED visits were 27.9% and 90.4% higher, respectively; and number of outpatient visits was 1.8 higher (p < .001 for all). Quarterly total costs continued to be elevated during the second quarter post-injury ($1878 higher than pre-injury, p < .01) and number of outpatient visits remained elevated throughout the first year post-injury (0.6, 0.4, and 0.3 higher in the second through fourth quarter, respectively; p < .05 for all). Parents' number of outpatient visits increased during the second and third years after the firearm injury (0.3 and 0.5 higher per quarter than pre-injury; p < .05). Youth firearm injury has long-lasting impact on health care within a family.
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Affiliation(s)
- Lianlian Lei
- Department of Psychiatry, University of Michigan, United States of America.
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, United States of America; Department of Emergency Medicine, University of Michigan, United States of America
| | - Donovan T Maust
- Department of Psychiatry, University of Michigan, United States of America; Institute for Healthcare Policy and Innovation, University of Michigan, United States of America; Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States of America
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Degli Esposti M, Coll CVN, Murray J, Carter PM, Goldstick JE. The Leading Causes of Death in Children and Adolescents in Brazil, 2000-2020. Am J Prev Med 2023; 65:716-720. [PMID: 36963471 DOI: 10.1016/j.amepre.2023.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Despite promising reductions in mortality from infectious diseases, premature death is a still major public health problem in Brazil. However, little is known about which diseases and injury mechanisms are the main causes of premature death. This paper aimed to detail the trends in leading causes of death among children and adolescents in Brazil. METHODS Data were extracted from medical death certificates from the Brazilian Mortality Information System for children and adolescents aged 1-19 years for 2000-2020. The 10 leading causes of death for children and adolescents were defined using primary cause of death codes, grouped by death for diseases and mechanism for injury, according to the ICD-10. All analyses were completed in 2022. RESULTS From 2000 through 2020, there was a total of 772,729 child and adolescent deaths in Brazil. Despite an overall 34% reduction in child and adolescent mortality from 2000 to 2020, improvements were less pronounced for injury-related deaths than for communicable diseases. Therefore, by 2020, over half of deaths were from injury-related causes. Firearm-related injury was by far the leading cause, accounting for 21% of all deaths. There was a 38% reduction in firearm deaths in the last 4 years against a previously increasing trend, and homicide accounted for over 90% of all firearm deaths because suicide by firearm was rare. CONCLUSIONS Injury-related deaths among children and adolescents are a growing concern in Brazil, and firearms are the current leading cause of child and adolescent death.
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Affiliation(s)
- Michelle Degli Esposti
- Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil; Department of Social Policy & Intervention, University of Oxford, Oxford, United Kingdom; Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Carolina V N Coll
- Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil
| | - Joseph Murray
- Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil
| | - Patrick M Carter
- Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jason E Goldstick
- Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Lumbard DC, Nygaard RM, Richardson CJ, Liao LF, Stewart RM, Eastridge BJ, Nicholson SE. Burden of unintentional pediatric firearm injury: An examination of the Nationwide Readmission Database. J Trauma Acute Care Surg 2023; 95:419-425. [PMID: 37158803 DOI: 10.1097/ta.0000000000003930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Significant increases in firearm-related mortality in the US pediatric population drive an urgent need to study these injuries to drive prevention policies. The purpose of this study was (1) to characterize those with and without readmissions, (2) to identify risk factors for 90-day unplanned readmission, and (3) to examine reasons for hospital readmission. METHODS The 2016-2019 Nationwide Readmission Database of the Healthcare Cost and Utilization Project was used to identify hospital admissions with unintentional firearm injury in patients younger than 18 years. Ninety-day unplanned readmission characteristics were assessed and detailed. Multivariable regression analysis was used to assess factors associated with unplanned 90-day readmission. RESULTS Over 4 years, 1,264 unintentional firearm injury admissions resulted in 113 subsequent readmissions (8.9%). There were no significant differences in age or payor, but more women (14.7% vs. 23%) and older children (13-17 years [80.5%]) had readmissions. The mortality rate during primary hospitalization was 5.1%. Survivors of initial firearm injury were more frequently readmitted if they had a mental health diagnosis (22.1% vs. 13.8%; p = 0.017). Readmission diagnosis included complications (15%), mental health or drug/alcohol (9.7%), trauma (33.6%), a combination of the prior three (28.3%), and chronic disease (13.3%). More than a third (38.9%) of the trauma readmissions were for new traumatic injury. Female children, those with longer lengths of stay, and those with more severe injuries were more likely to have unplanned 90-day readmissions. Mental health and drug/alcohol abuse diagnoses were not an independent predictor for readmission. CONCLUSION This study provides insight into the characteristics of and risk factors for unplanned readmission in the pediatric unintentional firearm injury population. In addition to using prevention strategies, the utilization of trauma-informed care must be integrated into all aspects of care for this population to help minimize the long-term psychological impact of surviving firearm injury. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Derek C Lumbard
- From the Department of Surgery (D.C.L., R.M.N., C.J.R.), Hennepin Healthcare, Minneapolis, Minnesota. Department of Surgery (D.C.L., L.F.L., R.M.S., B.J.E., S.E.N.), UT Health San Antonio, San Antonio, Texas
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Kwon EG, Nehra D, Hall M, Herrera-Escobar JP, Rivara FP, Rice-Townsend SE. The association between childhood opportunity index and pediatric hospitalization for firearm injury or motor vehicle crash. Surgery 2023; 174:356-362. [PMID: 37211510 DOI: 10.1016/j.surg.2023.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/01/2023] [Accepted: 04/09/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Community-level factors can profoundly impact children's health, including the risk of violent injury. This study's objective was to understand the relationship between the Childhood Opportunity Index and pediatric firearm injury owing to interpersonal violence compared with a motor vehicle crash. METHODS All pediatric patients (<18 years) who presented with an initial encounter with a firearm injury or motor vehicle crash between 2016 to 2021 were identified from 35 children's hospitals included in the Pediatric Health Information System database. The child-specific community-level vulnerability was determined by the Childhood Opportunity Index, a composite score of neighborhood opportunity level data specific to pediatric populations. RESULTS We identified 67,407 patients treated for injuries related to motor vehicle crashes (n = 61,527) or firearms (n = 5,880). The overall cohort had a mean age of 9.3 (standard deviation 5.4) years; 50.0% were male patients, 44.0% non-Hispanic Black, and were 60.8% publicly insured. Compared with motor vehicle crash injuries, patients with firearm-related injuries were older (12.2 vs 9.0 years), more likely to be male patients (77.7% vs 47.4%), non-Hispanic Black (63.5% vs 42.1%), and had public insurance (76.4 vs 59.3%; all P < .001). In multivariable analysis, children living in communities with lower Childhood Opportunity Index levels were more likely to present with firearm injury than those living in communities with a very high Childhood Opportunity Index. The odds increased as the Childhood Opportunity Index level decreased (odds ratio 1.33, 1.60, 1.73, 2.00 for high, moderate, low, and very low Childhood Opportunity Index, respectively; all P ≤ .001). CONCLUSION Children from lower-Childhood Opportunity Index communities are disproportionately impacted by firearm violence, and these findings have important implications for both clinical care and public health policy.
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Affiliation(s)
- Eustina G Kwon
- Department of General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Deepika Nehra
- Division of Trauma, Burn, and Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, WA
| | | | - Juan P Herrera-Escobar
- Division of Trauma, Burn, and Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, WA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Samuel E Rice-Townsend
- Department of General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA.
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Ross SW, Campion E, Jensen AR, Gray L, Gross T, Namias N, Goodloe JM, Bulger EM, Fischer PE, Fallat ME. Prehospital and emergency department pediatric readiness for injured children: A statement from the American College of Surgeons Committee on Trauma Emergency Medical Services Committee. J Trauma Acute Care Surg 2023; 95:e6-e10. [PMID: 37125944 DOI: 10.1097/ta.0000000000003997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
ABSTRACT Injury is the leading cause of death in children older than 1 year, and children make up 22% of the population. Pediatric readiness (PR) of the nation's emergency departments and state trauma and emergency medical services (EMS) systems is conceptually important and vital to mitigate mortality and morbidity in this population. The extension of PR to the trauma community has become a focused area for training, staffing, education, and equipment at all levels of trauma center designation, and there is evidence that a higher level of emergency department PR is independently associated with long-term survival among injured children. Although less well studied, there is an associated need for EMS PR, which is relevant to the injured child who needs assessment, treatment, triage, and transport to a trauma center. We outline a blueprint along with recommendations for incorporating PR into trauma system development in this opinion from the EMS Committee of the American College of Surgeons Committee on Trauma. These recommendations are particularly pertinent in the rural and underserved areas of the United States but are directed toward all levels of professionals who care for an injured child along the trauma continuum of care.
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Affiliation(s)
- Samuel Wade Ross
- From the Division of Acute Care Surgery, Department of Surgery (S.W.R.), F.H. "Sammy" Ross, Jr. Trauma Center, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, North Carolina; Division of GI, Trauma, and Endocrine Surgery, Department of Surgery (E.C.), University of Colorado, Denver, Colorado; Division of Pediatric Surgery, Department of Surgery (A.R.J.), UCSF School of Medicine, San Francisco, California; Department of Pediatrics (L.G.), The University of Texas at Austin Dell Medical School, Austin, Texas; Department of Pediatrics (T.G.), Children's Hospital New Orleans, Tulane University School of Medicine; LSU Health Sciences Center (T.G.), New Orleans, Louisiana; Division of Trauma, Burns, and Surgical Critical Care, Daughtry Family Department of Surgery (N.N.), Ryder Trauma Center, University of Miami Miller School of Medicine, Miami, Florida; Department of Emergency Medicine (J.M.G.), University of Oklahoma School of Community Medicine, Tulsa, Oklahoma; Division of Trauma, Burns, and Critical Care, Department of Surgery (E.M.B.), University of Washington, Seattle, Washington; Division of Trauma Surgical Critical Care, Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; and Hiram C. Polk, Jr. Department of Surgery (M.E.F.), University of Louisville and Norton Children's Hospital, Louisville, Kentucky
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Dreyer BP. Achieving Child Health Equity: Policy Solutions. Pediatr Clin North Am 2023; 70:863-883. [PMID: 37422319 DOI: 10.1016/j.pcl.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Policy solutions to address child health equity, with evidence to support the policies, are presented. Policies address health care, direct financial support to families, nutrition, support for early childhood and brain development, ending family homelessness, making housing and neighborhoods environmentally safe, gun violence prevention, LGBTQ + health equity, and protecting immigrant children and families. Federal, state, and local policies are addressed. Recommendations of the National Academy of Science, Engineering, and Medicine and the American Academy of Pediatrics are highlighted when appropriate.
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Affiliation(s)
- Benard P Dreyer
- New York University, Grossman School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
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McKay T, Gastineau K, Wrenn JO, Han JH, Storrow AB. Trends in paediatric firearm-related encounters during the COVID-19 pandemic by age group, race/ethnicity and schooling mode in Tennessee. Inj Prev 2023; 29:327-333. [PMID: 37137687 DOI: 10.1136/ip-2023-044852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/26/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Increases in paediatric firearm-related injuries during the COVID-19 pandemic may be due to changes in where children and adolescents spent their time. This study examines changes in the frequency of paediatric firearm-related encounters as a function of schooling mode overall and by race/ethnicity and age group at a large trauma centre through 2021. METHODS We use data from a large paediatric and adult trauma centre in Tennessee from January 2018 to December 2021 (N=211 encounters) and geographically linked schooling mode data. We use Poisson regressions to estimate smoothed monthly paediatric firearm-related encounters as a function of schooling mode overall and stratified by race and age. RESULTS Compared with pre pandemic, we find a 42% increase in paediatric encounters per month during March 2020 to August 2020, when schools were closed, no significant increase during virtual/hybrid instruction, and a 23% increase in encounters after schools returned to in-person instruction. The effects of schooling mode are heterogeneous by patient race/ethnicity and age. Encounters increased among non-Hispanic black children across all periods relative to pre pandemic. Among non-Hispanic white children, encounters increased during the closure period and decreased on return to in-person instruction. Compared with pre pandemic, paediatric firearm-related encounters increased 205% for children aged 5-11 and 69% for adolescents aged 12-15 during the school closure period. CONCLUSION COVID-19-related changes to school instruction mode in 2020 and 2021 are associated with changes in the frequency and composition of paediatric firearm-related encounters at a major trauma centre in Tennessee.
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Affiliation(s)
- Tara McKay
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee, USA
| | - Kelsey Gastineau
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jesse O Wrenn
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jin H Han
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Wallace JG, Chernet R, Formica MK, Adeonigbagbe O, Flores RL, Marchesani R, Goldberg D, Wridt P, Laraque-Arena D. Gun violence and the voices of youth on community safety in the time of COVID-19 in East Harlem, NY: a youth participatory action research cross-sectional study. Inj Epidemiol 2023; 10:34. [PMID: 37438814 PMCID: PMC10339469 DOI: 10.1186/s40621-023-00440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 06/22/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The USA has failed to codify the protection of children from gun violence (GV) as a human right. This study employs a youth participatory action research methodology, within the framework of the United Nations Convention on the Rights of the Child (UNCRC), to investigate the relationships between GV exposure, self-identified gender and perceptions of children's rights and safety. METHODS An anonymous survey based on UNICEF USA's Child Friendly Cities Initiative interactive survey tool targeting adolescents was modified by East Harlem, New York high school student co-researchers in collaboration with near-peer graduate students. The 61-question survey was administered at an East Harlem high school. Analysis consisted of univariate, bivariate and logistic regression using SPSS®. RESULTS A total of 153 students completed the survey: 48.4% self-identified as male and 45.8% as female. Thirty-five percent reported witnessing GV. Most (79.1%) were aware of child rights regardless of gender or GV exposure but there were differences in perceptions of safety. Fifteen percent of females reported never feeling safe at school compared to 3% of males (p = 0.01). Females were 2.2 times as likely as males to report transportation waiting areas as never safe (p = 0.008). Almost a third of females reported never feeling safe from sexual harassment in public, compared to 10% of males (p = 0.004). In multivariable logistic regression adjusted for gender, race/ethnicity and grade level, students who witnessed GV were 4.6 times more likely to report never feeling safe from violence (95% CI 1.7-12.4). Thirty percent of students who witnessed GV reported not attending school because of safety concerns. Students who witnessed GV had 2.2 times the odds of carrying a weapon to school (95% CI 1.1-4.5). These patterns continued for other perceptions of safety. CONCLUSIONS The students in this study affirmed their rights to participate and express their views on matters that may affect them, as articulated in the UNCRC. The study revealed differences in perceptions of safety by self-identified gender and identified gun violence as a major contributor of youth's perception of lack of safety. The study evinces the efficacy of employing YPAR methodology to identify and answer youth concerns of community safety and prioritize honoring child rights.
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Affiliation(s)
| | | | | | | | | | - Robert Marchesani
- Counseling In Schools Based at the Heritage School, New York, NY, USA
| | | | | | - Danielle Laraque-Arena
- New York Academy of Medicine, 1216 Fifth Avenue, New York, NY, 10029, USA.
- Mailman School of Public Health and Vagelos College of Physicians and Surgeons, Columbia University, New York, USA.
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