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Boggs JM, Quintana LM, Beck A, Clarke CL, Richardson L, Conley A, Buckingham ET, Richards JE, Betz ME. A Randomized Control Trial of a Digital Health Tool for Safer Firearm and Medication Storage for Patients with Suicide Risk. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:358-368. [PMID: 38206548 DOI: 10.1007/s11121-024-01641-6] [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] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Most patients with suicide risk do not receive recommendations to reduce access to lethal means due to a variety of barriers (e.g., lack of provider time, training). Determine if highly efficient population-based EHR messaging to visit the Lock to Live (L2L) decision aid impacts patient-reported storage behaviors. Randomized trial. Integrated health care system serving Denver, CO. Served by primary care or mental health specialty clinic in the 75-99.5th risk percentile on a suicide attempt or death prediction model. Lock to Live (L2L) is a web-based decision aid that incorporates patients' values into recommendations for safe storage of lethal means, including firearms and medications. Anonymous survey that determined readiness to change: pre-contemplative (do not believe in safe storage), contemplative (believe in safe storage but not doing it), preparation (planning storage changes) or action (safely storing). There were 21,131 patients randomized over a 6-month period with a 27% survey response rate. Many (44%) had access to a firearm, but most of these (81%) did not use any safe firearm storage behaviors. Intervention patients were more likely to be categorized as preparation or action compared to controls for firearm storage (OR = 1.30 (1.07-1.58)). When examining action alone, there were no group differences. There were no statistically significant differences for any medication storage behaviors. Selection bias in those who responded to survey. Efficiently sending an EHR invitation message to visit L2L encouraged patients with suicide risk to consider safer firearm storage practices, but a stronger intervention is needed to change storage behaviors. Future studies should evaluate whether combining EHR messaging with provider nudges (e.g., brief clinician counseling) changes storage behavior.ClinicalTrials.gov: NCT05288517.
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Affiliation(s)
- Jennifer M Boggs
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA.
| | - LeeAnn M Quintana
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA
| | - Christina L Clarke
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA
| | - Laura Richardson
- Department of Behavioral Health Services, Kaiser Permanente Colorado, 10350 E Dakota Ave. #125, Denver, CO, 80247, USA
| | - Amy Conley
- Department of Behavioral Health Services, Kaiser Permanente Colorado, 10350 E Dakota Ave. #125, Denver, CO, 80247, USA
| | - Edward T Buckingham
- Department of Behavioral Health Services, Kaiser Permanente Colorado, 10350 E Dakota Ave. #125, Denver, CO, 80247, USA
- Colorado Permanente Medical Group, Kaiser Permanente Colorado, 1835 Franklin St., Denver, CO, 80218, USA
| | - Julie E Richards
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Seattle, WA, 98101, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, 12505 E. 16th Ave., Anschutz Inpatient Pav. 2, 1st floor, Aurora, CO, 80045, USA
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Duraiswamy S, Dirago C, Poulson M, Torres C, Sanchez S, Kenzik K, Dechert T, Scantling D. Gun Laws, Stay-at-Home Orders, and Poverty: Surges in Pandemic Firearm Violence in Large US Cities. J Surg Res 2024; 293:204-216. [PMID: 37778088 DOI: 10.1016/j.jss.2023.08.025] [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: 05/27/2023] [Revised: 07/11/2023] [Accepted: 08/26/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION The COVID-19 pandemic heralded a surge in firearm homicides (FH) in many, but not all, urban centers. We aimed to determine the relationship of firearm restrictive legislation, stay-at-home orders (SaHOs), and FH during the height of the COVID-19 pandemic in US cities. METHODS Demographics and socioeconomic data were captured from the 2020 US Census for large (population ≥250,000) cities. FH data were captured from the Gun Violence Archive. We retrieved firearm recovery estimates from the Bureau of Alcohol, Tobacco, and Firearms Firearms Trace Database. Firearm restrictive legislation was gathered from the State Firearm Laws Database. SaHO durations were found from press releases and government sources. Variables with P ≤ 0.200 in univariate linear regression were entered into a final multivariable model. RESULTS A median of 7.5 FH per 100,000 people occurred in the 85 included US cities across 32 states in 2020 (range, 0.35-69.80 per 100,000). In multivariable regression, longer SaHOs (β: 0.033, 95% confidence interval [CI]: 0.014-0.053, P = 0.001) and higher poverty (β: 0.471, 95% CI: 0.280-0.670, P < 0.001) were associated with increases in FH. Handgun-specific laws (β: -0.793, 95% CI: -1.430 to -0.160, P = 0.015) were associated with lower FH. CONCLUSIONS We found that poverty and longer SaHOs were associated with increased FH in large US cities during the height of the pandemic, while handgun-specific laws were associated with a decrease. Reducing poverty, mitigating the negative effects of SaHOs, and expanding handgun-specific legislation may protect from surges in FH during future crises.
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Affiliation(s)
- Swetha Duraiswamy
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Camille Dirago
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Michael Poulson
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Crisanto Torres
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Sabrina Sanchez
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Kelly Kenzik
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Tracey Dechert
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Dane Scantling
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts. https://twitter.com/Dane_Scantling
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Pan I, Zinko J, Weedn V, Nestadt PS. Long gun suicides in the state of Maryland following the firearm safety act of 2013. Suicide Life Threat Behav 2023; 53:29-38. [PMID: 36040306 PMCID: PMC9908857 DOI: 10.1111/sltb.12919] [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: 02/21/2022] [Revised: 07/02/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In 2013, the state of Maryland passed the Firearms Safety Act limiting the private sales of handguns, which did not apply to long guns often used for hunting (e.g., rifles and shotguns). This decreased the accessibility of handguns relative to long guns. We assessed the frequency of long gun suicides in the years before and after the policy change during winter season, which encompasses hunting season in Maryland. METHODS We performed a retrospective analysis on all 4107 well-characterized adult suicides caused by firearms in Maryland from 2003 through 2019. Logistic regression was performed, stratifying by decedent sex, race, and age. RESULTS While handgun suicides decreased in the period after 2013's Firearm Safety Act (p < 0.008), wintertime long gun suicides increased after 2013 (p < 0.004). Caucasian race (p < 0.006), male sex (p < 0.005), and middle age (p < 0.001) were significantly associated with wintertime long gun suicides after 2013. CONCLUSION Our findings suggest that while the 2013 Firearms Safety Act decreased handgun suicides significantly, it did not reduce long gun suicides and there may even have been replacement with long guns during hunting season, when rifles are out and accessible. This association was most prominent among the demographics most likely to hunt (Caucasian, middle-aged, and male).
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Affiliation(s)
- Isabella Pan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - James Zinko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Victor Weedn
- Office of the Chief Medical Examiner, Baltimore, Maryland, USA
| | - Paul S. Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Liu Y, Siegel M, Sen B. Association of State-Level Firearm-Related Deaths With Firearm Laws in Neighboring States. JAMA Netw Open 2022; 5:e2240750. [PMID: 36346633 PMCID: PMC9644258 DOI: 10.1001/jamanetworkopen.2022.40750] [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: 11/09/2022] Open
Abstract
IMPORTANCE Firearms are easily transported over state borders; hence permissive firearm laws in one state may have an interstate association with firearm-related deaths in nearby states. OBJECTIVES To examine whether certain firearm laws have an interstate association with firearm-related deaths in nearby states. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional observational study used data on state firearm-related deaths in the 48 contiguous states of the US between January 1, 2000, and December 31, 2019. A spatial autoregressive model with fixed effects for state and year was used to evaluate within-state, interstate, and overall associations between firearm laws and firearm-related deaths. Analyses were performed during January 2022. EXPOSURES The following 9 types of laws were evaluated: universal background checks for all firearms purchase, background checks for handgun sales at gun shows, license requirement to purchase all firearms, state dealer license requirement for handgun sales, requirement of retaining records of handgun sales, ban on purchasing a handgun on behalf of another, prohibition of firearm possession by persons who committed violent misdemeanors, required relinquishment of firearms for persons becoming prohibited from possessing them, and discretion in granting a concealed carry permit. MAIN OUTCOMES AND MEASURES State-level total firearm-related death rates, suicide rates, and homicide rates. RESULTS In sum, the study period included 662 883 firearm-related deaths of all intents. License requirement for firearm purchase had a within-state association (effect size, -1.79 [95% CI, -2.73 to -0.84]), interstate association (effect size, -10.60 [95% CI, -17.63 to -3.56]), and overall association (effect size, -12.38 [95% CI, -19.93 to -4.83]) per 100 000 population decrease in total firearm-related deaths. This law also had within-state association (effect size, -1.26 [95% CI, -1.72 to -0.80]), interstate association (effect size, -9.01 [95% CI, -15.00 to -3.02]), and overall association (effect size, -10.27 [95% CI, -16.53 to -4.01]) per 100 000 population decrease in firearm-related homicide. CONCLUSIONS AND RELEVANCE The findings of this pooled cross-sectional analysis suggest that certain firearm laws in one state were associated with other states' firearm-related deaths. Synergic legislative action in adjacent states, federal firearm legislation, and measures that reduce migration of firearms across state borders should be part of the overarching strategy to prevent firearm-related deaths.
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Affiliation(s)
- Ye Liu
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham
| | - Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Bisakha Sen
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham
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Degli Esposti M, Gravel J, Kaufman EJ, Delgado MK, Richmond TS, Wiebe DJ. County-Level Variation in Changes in Firearm Mortality Rates Across the US, 1989 to 1993 vs 2015 to 2019. JAMA Netw Open 2022; 5:e2215557. [PMID: 35666501 PMCID: PMC9171565 DOI: 10.1001/jamanetworkopen.2022.15557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Firearm violence remains a critical public health challenge, disproportionately impacting some US regions. County-level variation may hold key insights into how firearm mortality rates vary across the US. OBJECTIVE To model county-level changes in firearm mortality rates (total, homicide, and suicide) from 1989 to 1993 vs 2015 to 2019 and identify and characterize hot spots showing unexpected changes over time. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional study with 2 time points using a novel small area estimation method to analyze restricted access mortality microdata by cause of death and US county. The analysis included 3111 US counties from 49 states and the District of Columbia from January 1, 1989, to December 31, 2019. Bayesian spatial models were fitted to map geographical variation in changes in age-standardized firearm mortality rates (per 100 000 person-years) from 1989 to 1993 vs 2015 to 2019. County outliers (or hot spots) were defined as having observed rates that fell outside the 95% credible intervals of their expected posterior predictive distribution. These counties were characterized using visualization and descriptive statistics of their characteristics. Data were analyzed from June to December 2021. EXPOSURES County of residence. MAIN OUTCOMES AND MEASURES Five-year age-standardized mortality rates by US county, age, and cause of death for 1989 to 1993 and 2015 to 2019. RESULTS Between 1989 and 2019, 1 036 518 firearm deaths were recorded in counties across the US. Suicide was the most common cause of firearm mortality (589 285 deaths) followed by homicide (412 231 deaths). Age-standardized rates (deaths per 100 000 individuals) for firearm deaths and suicides increased from 1989 to 1993 vs 2015 to 2019 (mean [SD] change, 0.16 [8.78] for firearm deaths and 1.21 [6.91] for suicides), while firearm homicides decreased (mean [SD] change, -0.39 [3.96]). However, these national trends were not homogeneous across counties and often varied by geographical region. The West and Midwest showed the most pronounced increases in firearm suicide rates, whereas the Southeast showed localized increases in firearm homicide rates, despite the national decreasing trend. Critical hot spots were identified in urban counties of Alabama, and firearm homicide rates (per 100 000) in Baltimore City, Maryland, almost doubled from 29.71 to 47.43, and by 2015 to 2019 it accounted for 66.7% of all firearm homicide in Maryland. By contrast, District of Columbia showed promising improvements over time, decreasing from 56.5 firearm homicides per 100 000 in 1989 to 1993 to 14.45 in 2015 to 2019. CONCLUSIONS AND RELEVANCE There was substantial variation in rates and changes in firearm deaths among US counties. Geographical hot spots may be useful to inform targeted prevention efforts and local policy responses.
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Affiliation(s)
- Michelle Degli Esposti
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Jason Gravel
- Department of Criminal Justice, Temple University, Philadelphia, Pennsylvania
| | - Elinore J. Kaufman
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - M. Kit Delgado
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Therese S. Richmond
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Biobehavioral Health Sciences Department, University of Pennsylvania School of Nursing, Philadelphia
| | - Douglas J. Wiebe
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
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6
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Shiner B, Peltzman T, Cornelius SL, Gui J, Jiang T, Riblet N, Gottlieb DJ, Watts BV. Influence of contextual factors on death by suicide in rural and urban settings. J Rural Health 2021; 38:336-345. [PMID: 33900641 DOI: 10.1111/jrh.12579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To examine the association between contextual factors, represented by geographic and community health variables, and suicide among rural and urban Department of Veterans Affairs health care users (VA users). METHODS We performed a retrospective cohort study of 12,700,847 VA users between 2003 and 2017. We assigned contextual factors based on individuals' home address at the ZIP Code (area deprivation), county (sunlight exposure, altitude, and community health), and state level (firearm ownership), using publicly available data sources. We grouped contextual factors by quintiles or prespecified thresholds, depending on the nature of each variable. We obtained mortality data from the National Death Index. We measured the effect of living in a place with the highest versus lowest level of each contextual factor on odds of suicide using logistic regression, adjusting for individual compositional factors abstracted from VA electronic medical records data. We used random forest modeling to build prediction models for suicide based on contextual factors among rural and urban veterans. FINDINGS Almost all contextual factors we examined were significantly associated with suicide among rural and urban VA users, even after adjusting for individual compositional factors. However, no contextual variables were strong protective or risk factors (0.5<OR>2.0), and prediction models leveraging these contextual factors had poor accuracy among both rural (0.51, 95% CI: 0.48-0.54) and urban (0.53, 95% CI: 0.51-0.55) VA users. CONCLUSIONS A wide variety of contextual factors is significantly associated with suicide among rural and urban VA users. However, the factors we measured contributed very little to individual-level suicide risk.
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Affiliation(s)
- Brian Shiner
- VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | | | | | - Jiang Gui
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Tammy Jiang
- Boston University School of Public Heath, Boston, Massachusetts, USA
| | - Natalie Riblet
- VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Daniel J Gottlieb
- VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Bradley V Watts
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA.,Veterans Rural Health Resource Center, White River Junction, Vermont, USA.,VA Office of Systems Redesign and Improvement, Washington, DC, USA
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Kim DY, Phillips SW. When COVID-19 and guns meet: A rise in shootings. JOURNAL OF CRIMINAL JUSTICE 2021; 73:101783. [PMID: 33518825 PMCID: PMC7825997 DOI: 10.1016/j.jcrimjus.2021.101783] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 05/07/2023]
Abstract
OBJECTIVE The present study examines the impact of the COVID-19 stay-at-home order on gun violence in Buffalo, New York: fatal shootings, all non-fatal shootings, non-fatal shootings with injury, and non-fatal shootings without injury. It also estimated its impact on gang and non-gang related shootings. METHODS Weekly crime data are analyzed at the city level using ARIMA and poisson models. Forecasting is used to verify the validity of both ARIMA and poisson models. RESULTS The effect of the pandemic was conditional upon the types of gun violence and impact models of intervention. The pandemic caused a temporary increase in fatal shootings while leading to a long-term increase in all non-fatal shootings, non-fatal shootings with injury, non-fatal shootings without injury, and gang related shootings. CONCLUSIONS The pandemic has changed the volume of gun violence possibly due to increased strain and/or changed routine activities. This study not only promotes further research but also has policy implications for public health and safety. From a public policy perspective, criminal justice agencies should focus more attention and resources on gun violence resulting from a sense of strain and fear among individuals during the pandemic.
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Affiliation(s)
- Dae-Young Kim
- State University of New York - Buffalo State, United States
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8
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Morrison CN, Kaufman EJ, Humphreys DK, Wiebe DJ. Firearm Homicide Incidence, Within-state Firearm Laws, and Interstate Firearm Laws in US Counties. Epidemiology 2021; 32:36-45. [PMID: 33093328 PMCID: PMC7708450 DOI: 10.1097/ede.0000000000001262] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Firearm homicides occur less frequently in US states with more firearm control laws. However, firearms are easily transported across state lines, and laws in one location may affect firearm violence in another. This study examined associations between within-state firearm laws and firearm homicide while accounting for interference from laws in other nearby states. METHODS The units of analysis were 3,107 counties in the 48 contiguous US states, arrayed in 15 yearly panels for 2000 to 2014 (n = 46,605). The dependent measure was firearm homicides accessed from the Centers for Disease Control and Prevention (CDC) Compressed Mortality Data. The main independent measures were counts of firearm laws and the proportion of laws within categories (e.g., background checks, child access prevention laws). We calculated these measures for interstate laws using a geographic gravity function between county centroids. Bayesian conditional autoregressive Poisson models related within-state firearm laws and interstate firearm laws to firearm homicides. RESULTS There were 172,726 firearm homicides in the included counties over the 15 years. States had between 3 and 100 firearm laws. Within-state firearm laws (incidence rate ratio [IRR] = 0.995, 95% confidence interval [CI] = 0.992, 0.997) and interstate firearm laws (IRR = 0.993, 95% CI = 0.990, 0.996) were independently associated with fewer firearm homicides, and associations for within-state laws were strongest where interstate laws were weakest. CONCLUSIONS Additional firearm laws are associated with fewer firearm homicides both within the states where the laws are enacted and elsewhere in the United States. Interference from interstate firearm laws may bias associations for studies of within-state laws and firearm homicide.
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Affiliation(s)
- Christopher N. Morrison
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York NY
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne Australia
| | - Elinore J. Kaufman
- Division of Trauma, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA
| | - David K. Humphreys
- Department of Social Policy and Intervention, University of Oxford, Oxford UK
| | - Douglas J. Wiebe
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia PA
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Bryan CJ, Bryan AO, Anestis MA. Positive and Negative Affective Processes Associated With Firearm Acquisition and Ownership. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2020. [DOI: 10.1521/jscp.2020.39.10.861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: To examine positive and negative affective processes associated with firearm acquisition and firearm ownership. Methods: An online cross-sectional survey assessing firearm ownership, reasons for firearm ownership, intentions to acquire a firearm in the next 12 months, and positive and negative affective states was administered to 6,200 U.S. adults (49.0% male, 51.0% female). Results: Mean negative and positive affect were significantly elevated among protective firearm owners (i.e., those who kept firearms for the primary purpose of self-protection) and participants intending to acquire a firearm. Protective firearm owners intending to acquire another firearm reported significantly higher negative affect than all other subgroups. Within this subgroup, negative affect and positive affect were positively correlated. Among all other subgroups, negative and positive affect were either negatively correlated or uncorrelated. Discussion: The intention to acquire firearms and protective firearm ownership are associated with both positive and negative affectivity. Typical cognitive-affective processes may be disrupted among protective firearm owners intending to acquire another firearm.
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10
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Bryan CJ, Bryan AO, Anestis MD. Associations among exaggerated threat perceptions, suicidal thoughts, and suicidal behaviors in U.S. firearm owners. J Psychiatr Res 2020; 131:94-101. [PMID: 32950708 DOI: 10.1016/j.jpsychires.2020.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/02/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
Firearm availability has traditionally been conceptualized as an environmental risk factor for suicide mortality. Firearm acquisition for the primary purpose of self-protection (i.e., protective gun ownership) is often motivated by exaggerated threat expectancies-a central component of anticipatory anxiety-but firearm acquisition may paradoxically reinforce or exacerbate threat expectancies and contribute to behavioral disinhibition. Firearm ownership may therefore confer increased risk for suicide mortality through biobehavioral mechanisms. The present study conducted an initial test of this hypothesis by examining associations among firearm ownership, intentions to acquire additional firearms, threat expectancies, and past-month suicidal thoughts and behaviors using data collected from a national sample of 6200 U.S. adults. Results indicated threat expectancies and rates of suicide-related behaviors were significantly elevated among protective gun owners and participants who intended to acquire a firearm within the next year as compared to non-gun owners and non-protective gun owners. Threat expectancies were associated with significantly increased risk for past-month suicide-related behavior. Results suggest that threat expectancies in particular, and anticipatory anxiety more generally, may be biobehavioral processes associated with the correlation of firearm ownership and increased suicide risk.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA.
| | - AnnaBelle O Bryan
- National Center for Veterans Studies, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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11
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Liu Y, Siegel M, Sen B. Neighbors Do Matter: Between-State Firearm Laws and State Firearm-Related Deaths in the U.S., 2000-2017. Am J Prev Med 2020; 59:648-657. [PMID: 32943308 DOI: 10.1016/j.amepre.2020.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/09/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Firearm injury is a major U.S. public health concern. This study aims to evaluate whether the relationship between state firearm laws and state firearm deaths are affected by comparatively lenient firearm laws in neighboring states. METHODS This observational study used 2000‒2017 data on firearm deaths and firearm laws of the 48 contiguous states of the U.S. (Alaska, Hawaii, and the District of Columbia excluded). The associations among state firearm deaths, state firearm laws, and presence of neighboring states with more lenient laws were analyzed using negative binomial regression models with state- and year-fixed effects. Analyses were conducted in 2019‒2020. RESULTS There were 578,022 firearm deaths of all intents during the study period or 11.1 firearm deaths (IQR=8.5-14.0) per 100,000 population. The presence of more state firearm laws was associated with decreased firearm deaths (incident rate ratio=0.991, 95% CI=0.987, 0.996). However, weaker firearm laws in neighboring states correlated with more firearm deaths within a state (incident rate ratio=1.016, 95% CI=1.004, 1.028). Failing to account for weaker laws in neighboring states led to the underestimation of the impact of 1 additional law on state's own firearm deaths (incident rate ratio=0.994, 95% CI=0.989, 0.998 vs 0.991, 95% CI=0.987, 0.996) by approximately 20%. CONCLUSIONS Weaker firearm laws in neighboring states may undermine the effectiveness of a state's own firearm laws in curbing firearm deaths. Coordinated legislative action across neighboring states may be more effective than an individual state taking legislative action.
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Affiliation(s)
- Ye Liu
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael Siegel
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Bisakha Sen
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
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12
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Nestadt PS, MacKrell K, McCourt AD, Fowler DR, Crifasi CK. Prevalence of long gun use in Maryland firearm suicides. Inj Epidemiol 2020; 7:4. [PMID: 32127045 PMCID: PMC6996182 DOI: 10.1186/s40621-019-0230-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background Firearms account for the majority of US suicides, largely due to lethality and accessibility. Under Federal and Maryland law, long guns are less regulated than handguns which is a concern for increased suicide risk. This study uses Maryland data to ascertain the impact of long guns on suicides in the state. We hypothesize that the prevalence of long gun use among firearm suicides will be increased in rural and young populations. Methods This is a cross sectional study using police and medical examiner narratives to identify firearm type involved in all 3931 Maryland gun suicides from 2003 to 2018. Proportions of firearm suicides utilizing long guns were calculated. Urban-rural differences were determined using the National Center for Health Statistics’ classification system. Logistic regression was used to calculate odds ratios of long gun to handgun suicides across the urban-rural spectrum, controlling for decedent demographics. Results From 2003 to 2018, 28.4% of Maryland gun suicides used long guns. The proportion of long guns used was highest in the most rural counties, where 51.6% of firearm suicides were by long gun, compared to 16.8% in the most urban counties. Long guns were disproportionately used by the young. For decedents 18 or younger, 44.6% used long guns, compared to 20.2% in those 65 or older. Compared to the most urban counties, firearm suicide decedents in the most rural counties were 3.74x more likely to use long guns (OR = 3.74; 95% CI 2.19, 6.40; p < .001) after adjusting for demographics, intoxication, and hunting season. Conclusions Long guns are used in a large proportion of Maryland firearm suicides, particularly in rural areas and disproportionately in youth suicides. Long guns must be considered as part of access to lethal means or policy strategies in efforts to reduce the burden of firearm suicide.
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Affiliation(s)
- Paul S Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA. .,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Kevin MacKrell
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Alexander D McCourt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - David R Fowler
- Office of the Chief Medical Examiner of Maryland, Baltimore, USA
| | - Cassandra K Crifasi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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König D, Swoboda P, Cramer RJ, Krall C, Postuvan V, Kapusta ND. Austrian firearm legislation and its effects on suicide and homicide mortality: A natural quasi-experiment amidst the global economic crisis. Eur Psychiatry 2020; 52:104-112. [DOI: 10.1016/j.eurpsy.2018.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 12/22/2022] Open
Abstract
AbstractBackground:Restriction of access to suicide methods has been shown to effectively reduce suicide mortality rates.Aims:To examine how the global economic crisis of 2008 and the firearm legislation reform of 1997 affected suicide and homicide mortality rate within Austria.Methods:Official data for the years 1985–2016 for firearm certificates, suicide, homicide, unemployment rates and alcohol consumption were examined using auto regressive error and Poisson regression models.Results:Firearm certificates, total suicide mortality rate, suicide and homicides by firearms, and the fraction of firearm suicides/homicides among all suicides/homicides decreased after the firearm legislation reform in 1997. However, significant trend changes can be observed after 2008. The availability of firearm certificates significantly increased and was accompanied by significant changes in trends of firearm suicide and homicide rates. Concurrently, the total suicide mortality rate in 2008, for the first time since 1985, stopped its decreasing trend. While the total homicide rate further decreased, the fraction of firearm homicides among all homicides significantly increased.Conclusion:The initially preventative effect of the firearm legislation reform in Austria in 1997 seems to have been counteracted by the global economic downturn of 2008. Increased firearm availability was associated with corresponding increases in both firearm suicide and firearm homicide mortality. Restrictive firearm legislation should be an imperative part of a country’s suicide prevention programme. Although firearm legislation reform may have long-lasting effects, societal changes may facilitate compensatory firearm acquisitions and thus counteract preventive efforts, calling in turn again for adapted counter-measures.
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Bauer BW, Capron DW. How Behavioral Economics and Nudges Could Help Diminish Irrationality in Suicide-Related Decisions. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2019; 15:44-61. [PMID: 31697611 DOI: 10.1177/1745691619866463] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
People regularly make decisions that are not aligned with their own self-interests. These irrational decisions often stem from humans having bounded rationality (e.g., limited computational power), which produces reliable cognitive biases that occur outside of people's awareness and influences the decisions people make. There are many important decisions leading up to a suicide attempt, and it is likely that these same biases exist within suicide-related decisions. This article presents an argument for the likely existence of cognitive biases within suicide-related decision making and how they may influence people to make irrational decisions. In addition, this article provides new evidence for using a behavioral economic intervention-nudges-as a potential way to combat rising suicide rates. We explore how nudges can help increase means safety, disseminate suicide prevention skills/materials, diminish well-known biases (e.g., confirmation bias), and uncover biases that may be occurring when making suicide-related decisions.
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Affiliation(s)
- Brian W Bauer
- Department of Psychology, University of Southern Mississippi
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi
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15
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Ghiani M, Hawkins SS, Baum CF. Associations Between Gun Laws and Suicides. Am J Epidemiol 2019; 188:1254-1261. [PMID: 30874719 DOI: 10.1093/aje/kwz069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 01/08/2023] Open
Abstract
We examined the impact of a state gun law environment on suicides overall and within demographic subgroups. We linked 211,766 firearm suicides and 204,625 nonfirearm suicides in the 50 states of the United States for 2005-2015 to the population in each state, year, race/ethnicity, sex, and age, as well as to an index of state-level gun control. Difference-in-differences, zero-inflated, negative-binomial models were used to evaluate the impact of strengthening gun control on firearm and nonfirearm suicides. We subsequently stratified by sex and tested for interactions with race/ethnicity and age. We found 25 states strengthened gun control by an average of 6 points. Such an increase may result in a 3.3% (incidence rate ratio = 0.967; 95% confidence interval: 0.938, 0.996) decrease in firearm suicides. Although no impact on nonfirearm suicides was found overall, interaction models showed an increase in nonfirearm suicides among black men, white women, black women, and older individuals. Strengthening gun control may reduce firearm suicides overall but may increase nonfirearm suicides in some populations. The results indicate stricter gun laws should be advocated for and that additional policies are needed for populations who shifted to nonfirearm suicides.
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Affiliation(s)
- Marco Ghiani
- Department of Economics, Boston College, Chestnut Hill, Massachusetts
| | | | - Christopher F Baum
- Department of Economics, Boston College, Chestnut Hill, Massachusetts
- Department of Macroeconomics, German Institute for Economic Research
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16
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Hoffman SJ, Poirier MJP, Rogers Van Katwyk S, Baral P, Sritharan L. Impact of the WHO Framework Convention on Tobacco Control on global cigarette consumption: quasi-experimental evaluations using interrupted time series analysis and in-sample forecast event modelling. BMJ 2019; 365:l2287. [PMID: 31217191 PMCID: PMC6582266 DOI: 10.1136/bmj.l2287] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the impact of the WHO Framework Convention on Tobacco Control (FCTC) on global cigarette consumption. DESIGN Two quasi-experimental impact evaluations, using interrupted time series analysis (ITS) and in-sample forecast event modelling. SETTING AND POPULATION 71 countries for which verified national estimates of cigarette consumption from 1970 to 2015 were available, representing over 95% of the world's cigarette consumption and 85% of the world's population. MAIN OUTCOME MEASURES The FCTC is an international treaty adopted in 2003 that aims to reduce harmful tobacco consumption and is legally binding on the 181 countries that have ratified it. Main outcomes were annual national estimates of cigarette consumption per adult from 71 countries since 1970, allowing global, regional, and country comparisons of consumption levels and trends before and after 2003, with counterfactual control groups modelled using pre-intervention linear time trends (for ITS) and in-sample forecasts (for event modelling). RESULTS No significant change was found in the rate at which global cigarette consumption had been decreasing after the FCTC's adoption in 2003, using either ITS or event modelling. Results were robust after realigning data to the year FCTC negotiations commenced (1999), or to the year when the FCTC first became legally binding in each country. By contrast to global consumption, high income and European countries showed a decrease in annual consumption by over 1000 cigarettes per adult after 2003, whereas low and middle income and Asian countries showed an increased annual consumption by over 500 cigarettes per adult when compared with a counterfactual event model. CONCLUSIONS This study finds no evidence to indicate that global progress in reducing cigarette consumption has been accelerated by the FCTC treaty mechanism. This null finding, combined with regional differences, should caution against complacency in the global tobacco control community, motivate greater implementation of proven tobacco control policies, encourage assertive responses to tobacco industry activities, and inform the design of more effective health treaties.
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Affiliation(s)
- Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, Ontario, M3J 1P3 Canada
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Health Research Methods, Evidence, and Impact and McMaster Health Forum, McMaster University, Hamilton, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mathieu J P Poirier
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, Ontario, M3J 1P3 Canada
- Department of Health Research Methods, Evidence, and Impact and McMaster Health Forum, McMaster University, Hamilton, Canada
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
| | - Susan Rogers Van Katwyk
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, Ontario, M3J 1P3 Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Prativa Baral
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, Ontario, M3J 1P3 Canada
| | - Lathika Sritharan
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, Ontario, M3J 1P3 Canada
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Dhungel B, Sugai MK, Gilmour S. Trends in Suicide Mortality by Method from 1979 to 2016 in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101794. [PMID: 31117173 PMCID: PMC6571574 DOI: 10.3390/ijerph16101794] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 11/16/2022]
Abstract
Suicide is a major public health concern in Japan. This study aimed to characterize the trends in suicide mortality in Japan by method since 1979. Using data from the Japan vital registration system, we calculated age-standardized rates of suicide mortality separately by sex and method. We conducted a log-linear regression of suicide mortality rates separately by sex, and linear regression analysis of the proportion of deaths due to hanging, including a test for change in level and trend in 1998. While crude suicide rates were static over the time period, age-adjusted rates declined. The significant increase in suicide mortality in 1998 was primarily driven by large changes in the rate of hanging, with suicide deaths after 1998 having 36.7% higher odds of being due to hanging for men (95% CI: 16.3–60.8%), and 21.9% higher odds of being due to hanging for women (95% CI: 9.2–35.9%). Hanging has become an increasingly important method for committing suicide over the past 40 years, and although suicide rates have been declining continuously over this time, more effort is needed to prevent hanging and address the potential cultural drivers of suicide if the rate is to continue to decline in the future.
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Affiliation(s)
- Bibha Dhungel
- Graduate School of Public Health, St. Luke's International University, Tokyo 104-0045, Japan.
| | - Maaya Kita Sugai
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.
- Institute of Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo 104-0045, Japan.
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Websdale N, Ferraro K, Barger SD. The domestic violence fatality review clearinghouse: introduction to a new National Data System with a focus on firearms. Inj Epidemiol 2019; 6:6. [PMID: 31245255 PMCID: PMC6582678 DOI: 10.1186/s40621-019-0182-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background In the US more than 1 in 4 women and 1 in 7 men have experienced severe physical violence by an intimate partner. The most severe violence, violence that ends in death, disproportionately affects women. Current or former male intimate partners commit the majority of homicides of females and fifty to 60 % of these homicides are perpetrated with firearms. Most murder-suicides involve intimate partners and the vast majority of these cases are women murdered by intimate partners using a firearm. Little data exist to illuminate the social and legal circumstances surrounding firearm use in intimate partner homicide. Here we describe US Domestic Violence Fatality Review Teams and the planning and development of a National Clearinghouse for Domestic Violence Fatality Reviews. Among other things, the National Clearinghouse will centrally record and harmonize reviews across the US through standardized reporting templates and protocols for gathering de-identified intimate partner homicide case information. Conclusion Domestic violence fatality reviews provide a promising yet underutilized data source to understand the links between firearms and domestic violence related deaths. The nascent Clearinghouse can inform policy approaches to address intimate partner homicide as well as firearm-related violence in the United States.
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19
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Soltani M, Wastila LJ. Blue Bridge. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2018; 42:862-864. [PMID: 30378013 DOI: 10.1007/s40596-018-0997-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 10/16/2018] [Indexed: 06/08/2023]
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20
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Weerasinghe M, Konradsen F, Eddleston M, Pearson M, Jayamanne S, Gunnell D, Hawton K, Agampodi S. Potential Interventions for Preventing Pesticide Self-Poisoning by Restricting Access Through Vendors in Sri Lanka. CRISIS 2018; 39:479-488. [PMID: 29932017 DOI: 10.1027/0227-5910/a000525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In South Asia, up to one in five individuals who use pesticides for self-harm purchase them immediately prior to the event. AIMS From reviewing the literature we proposed four interventions: (a) farmer identification cards (ID); (b) prescriptions; (c) cooling-off periods; and (d) training pesticide vendors. We aimed to identify the most promising intervention. METHOD The study was conducted in Sri Lanka. We mapped stakeholders' interest and power in relation to each intervention, and followed this by a ranking exercise. Seven focus group discussions (FGDs) were conducted to assess facilitators and barriers to implementation. RESULTS Vendor training was the most supported intervention, being ranked first by the stakeholders. The participants in the FGDs strongly supported training of vendors as it was seen to be easy to implement and was considered more convenient. Farmer IDs, prescriptions, and cooling-off periods were thought to have more barriers than facilitators and they were strongly opposed by end users (farmers and vendors), who would potentially block their implementation. LIMITATIONS Cost considerations for implementing the proposed intervention were not considered. CONCLUSION Training vendors might be the most appropriate intervention to restrict sales of pesticides to people at risk of suicidal behavior. This requires field testing.
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Affiliation(s)
- Manjula Weerasinghe
- 1 Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,2 South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.,3 Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Flemming Konradsen
- 2 South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.,4 Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Michael Eddleston
- 2 South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.,3 Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, UK.,4 Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Melissa Pearson
- 2 South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.,3 Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Shaluka Jayamanne
- 2 South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.,5 Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - David Gunnell
- 6 Population Health Sciences, University of Bristol, UK
| | - Keith Hawton
- 7 Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK
| | - Suneth Agampodi
- 1 Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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Kaufman EJ, Morrison CN, Branas CC, Wiebe DJ. State Firearm Laws and Interstate Firearm Deaths From Homicide and Suicide in the United States: A Cross-sectional Analysis of Data by County. JAMA Intern Med 2018; 178:692-700. [PMID: 29507953 PMCID: PMC5885268 DOI: 10.1001/jamainternmed.2018.0190] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Firearm laws in one state may be associated with increased firearm death rates from homicide and suicide in neighboring states. OBJECTIVE To determine whether counties located closer to states with lenient firearm policies have higher firearm death rates. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of firearm death rates by county for January 2010 to December 2014 examined data from the US Centers for Disease Control and Prevention for firearm suicide and homicide decedents for 3108 counties in the 48 contiguous states of the United States. EXPOSURES Each county was assigned 2 scores, a state policy score (range, 0-12) based on the strength of its state firearm laws, and an interstate policy score (range, -1.33 to 8.31) based on the sum of population-weighted and distance-decayed policy scores for all other states. Counties were divided into those with low, medium, and high home state and interstate policy scores. MAIN OUTCOMES AND MEASURES County-level rates of firearm, nonfirearm, and total homicide and suicide. With multilevel Bayesian spatial Poisson models, we generated incidence rate ratios (IRR) comparing incidence rates between each group of counties and the reference group, counties with high home state and high interstate policy scores. RESULTS Stronger firearm laws in a state were associated with lower firearm suicide rates and lower overall suicide rates regardless of the strength of the other states' laws. Counties with low state scores had the highest rates of firearm suicide. Rates were similar across levels of interstate policy score (low: IRR, 1.34; 95% credible interval [CI], 1.11-1.65; medium: IRR, 1.36, (95% CI, 1.15-1.65; and high: IRR, 1.43; 95% CI, 1.20-1.73). Counties with low state and low or medium interstate policy scores had the highest rates of firearm homicide. Counties with low home state and interstate scores had higher firearm homicide rates (IRR, 1.38; 95% CI, 1.02-1.88) and overall homicide rates (IRR, 1.32; 95% CI, 1.03-1.67). Counties in states with low firearm policy scores had lower rates of firearm homicide only if the interstate firearm policy score was high. CONCLUSIONS AND RELEVANCE Strong state firearm policies were associated with lower suicide rates regardless of other states' laws. Strong policies were associated with lower homicide rates, and strong interstate policies were also associated with lower homicide rates, where home state policies were permissive. Strengthening state firearm policies may prevent firearm suicide and homicide, with benefits that may extend beyond state lines.
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Affiliation(s)
- Elinore J Kaufman
- Department of Surgery, New York-Presbyterian Weill Cornell Medicine, New York
| | - Christopher N Morrison
- Penn Injury Science Center, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | - Charles C Branas
- Department of Epidemiology, Columbia University, New York, New York
| | - Douglas J Wiebe
- Penn Injury Science Center, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
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Emmert AD, Hall GP, Lizotte AJ. Do Weapons Facilitate Adolescent Delinquency? An Examination of Weapon Carrying and Delinquency Among Adolescents. CRIME AND DELINQUENCY 2018; 64:342-362. [PMID: 29725135 PMCID: PMC5926245 DOI: 10.1177/0011128717714466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article examines whether weapon carrying influences the frequency and variety of violent, property, and drug delinquency adolescents commit through fixed-effects analyses of data from the Rochester Youth Development Study (RYDS). We conclude that weapon carrying contributes to violent, substance, and property delinquency, and delinquent behaviors learned during weapon carrying continue to affect substance and property delinquency long after carrying has ceased.
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Rajasingh CM, Tennakoon L, Staudenmayer KL. Self-inflicted gunshot wounds: readmission patterns. J Surg Res 2018; 223:22-28. [DOI: 10.1016/j.jss.2017.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/21/2017] [Accepted: 10/12/2017] [Indexed: 11/16/2022]
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24
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Ramchand R, Franklin E, Thornton E, Deland SM, Rouse JC. Violence, Guns, and Suicide in New Orleans: Results from a Qualitative Study of Recent Suicide Decedents. J Forensic Sci 2018; 63:1444-1449. [DOI: 10.1111/1556-4029.13742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/21/2017] [Accepted: 12/28/2017] [Indexed: 01/01/2023]
Affiliation(s)
| | - Enchanté Franklin
- RAND Gulf States Policy Institute New Orleans LA
- Orleans Parish Coroner's Office New Orleans LA
| | | | - Sarah M. Deland
- Orleans Parish Coroner's Office New Orleans LA
- Tulane University School of Medicine New Orleans LA
| | - Jeffrey C. Rouse
- Orleans Parish Coroner's Office New Orleans LA
- Tulane University School of Medicine New Orleans LA
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Sipsma HL, Canavan ME, Rogan E, Taylor LA, Talbert-Slagle KM, Bradley EH. Spending on social and public health services and its association with homicide in the USA: an ecological study. BMJ Open 2017; 7:e016379. [PMID: 29025831 PMCID: PMC5652551 DOI: 10.1136/bmjopen-2017-016379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine whether state-level spending on social and public health services is associated with lower rates of homicide in the USA. DESIGN Ecological study. SETTING USA. PARTICIPANTS All states in the USA and the District of Columbia for which data were available (n=42). PRIMARY OUTCOME MEASURE Homicide rates for each state were abstracted from the US Department of Justice Federal Bureau of Investigation's Uniform Crime Reporting. RESULTS After adjusting for potential confounding variables, we found that every $10 000 increase in spending per person living in poverty was associated with 0.87 fewer homicides per 100 000 population or approximately a 16% decrease in the average homicide rate (estimate=-0.87, SE=0.15, p<0.001). Furthermore, there was no significant effect in the quartile of states with the highest percentages of individuals living in poverty but significant effects in the quartiles of states with lower percentages of individuals living in poverty. CONCLUSIONS Based on our findings, spending on social and public health services is associated with significantly lower homicide rates at the state level. Although we cannot infer causality from this research, such spending may provide promising avenues for homicide reduction in the USA, particularly among states with lower levels of poverty.
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Affiliation(s)
- Heather L Sipsma
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Department of Public Health, Benedictine University, Lisle, IL, USA
| | - Maureen E Canavan
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Erika Rogan
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Kristina M Talbert-Slagle
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
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Anestis MD, Khazem LR, Anestis JC. Differentiating suicide decedents who died using firearms from those who died using other methods. Psychiatry Res 2017; 252:23-28. [PMID: 28237760 DOI: 10.1016/j.psychres.2017.02.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/21/2016] [Accepted: 02/21/2017] [Indexed: 11/17/2022]
Abstract
Studies have documented a link between gun ownership and suicide, but little is known about characteristics of those most likely to use a gun in a suicide attempt rather than alternative methods. We examined which factors differentiate suicide decedents who died using a gun from those who died by other methods. We further examined whether such findings are consistent within the subcomponent of our larger sample comprised entirely of gun owning suicide decedents. Data reflect 267 suicide decedents, with data provided by individuals who identified as having lost someone to suicide (loss survivors). Within the full sample, a higher proportion of gun-owning and male suicide decedents died by firearm. Further, individuals who had previously discussed suicide or engaged in one or more non-lethal suicide attempts were less likely to die by suicide using a gun. Within the subsample of gun owning suicide decedents, a greater proportion of decedents who stored guns at home and in unsecure locations died from self-inflected gunshot wounds. These findings add clarity to the relationship between firearm ownership and death by suicide at the individual level. Furthermore, these findings are consistent with the notion that means safety implementation may represent a vital suicide prevention tool.
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Affiliation(s)
| | - Lauren R Khazem
- University of Southern Mississippi, United States of America
| | - Joye C Anestis
- University of Southern Mississippi, United States of America
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Harris JK, Jonson-Reid M, Carothers BJ, Fowler P. The Structure of Policy Networks for Injury and Violence Prevention in 15 US Cities. Public Health Rep 2017; 132:381-388. [PMID: 28426291 DOI: 10.1177/0033354917705367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Changes in policy can reduce violence and injury; however, little is known about how partnerships among organizations influence policy development, adoption, and implementation. To understand partnerships among organizations working on injury and violence prevention (IVP) policy, we examined IVP policy networks in 15 large US cities. METHODS In summer 2014, we recruited 15 local health departments (LHDs) to participate in the study. They identified an average of 28.9 local partners (SD = 10.2) working on IVP policy. In late 2014, we sent survey questionnaires to 434 organizations, including the 15 LHDs and their local partners, about their partnerships and the importance of each organization to local IVP policy efforts; 319 participated. We used network methods to examine the composition and structure of the policy networks. RESULTS Each IVP policy network included the LHD and an average of 21.3 (SD = 6.9) local partners. On average, nonprofit organizations constituted 50.7% of networks, followed by government agencies (26.3%), schools and universities (11.8%), coalitions (11.2%), voluntary organizations (9.6%), hospitals (8.5%), foundations (2.2%), and for-profit organizations (0.7%). Government agencies were perceived as important by the highest proportion of partners. Perceived importance was significantly associated with forming partnerships in most networks; odds ratios ranged from 1.07 (95% CI, 1.02-1.13) to 2.35 (95% CI, 1.68-3.28). Organization type was significantly associated with partnership formation in most networks after controlling for an organization's importance to the network. CONCLUSIONS Several strategies could strengthen local IVP policy networks, including (1) developing connections with partners from sectors that are not well integrated into the networks and (2) encouraging indirect or less formal connections with important but missing partners and partner types.
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Affiliation(s)
- Jenine K Harris
- 1 Brown School, Washington University in St Louis, St Louis, MO, USA
| | | | - Bobbi J Carothers
- 1 Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Patrick Fowler
- 1 Brown School, Washington University in St Louis, St Louis, MO, USA
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Yoshioka E, Saijo Y, Kawachi I. An analysis of secular trends in method-specific suicides in Japan, 1950-1975. Popul Health Metr 2017; 15:14. [PMID: 28381284 PMCID: PMC5382522 DOI: 10.1186/s12963-017-0131-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 03/30/2017] [Indexed: 11/24/2022] Open
Abstract
Background In Japan, a dramatic rise in suicide rates was observed in the 1950s, especially among the younger population, and then the rate decreased rapidly again in the 1960s. The aim of this study was to assess secular trends in method-specific suicides by gender and age in Japan between 1950 and 1975. We paid special attention to suicides by poisoning (solid and liquid substances), and their contribution to dramatic swings in the overall suicide rate in Japan during the 1950s and 1960s. Methods Mortality and population data were obtained from the Vital Statistics of Japan and Statistics Bureau, Ministry of Internal Affairs and Communications in Japan, respectively. We calculated method-specific age-standardized suicide rates by gender and age group (15–29, 30–49, or 50+ years). Results The change in the suicide rate during the research period was larger in males than females in all age groups, and was more marked among people aged 15–29 years compared to those aged 30–49 years and 50 years or over. Poisoning by solid and liquid substances overwhelmingly contributed to the dramatic change in the overall suicide rates in males and females aged 15–49 years in the 1950s and 1960s. For the peak years of the rise in poisoning suicides, bromide was the most frequently used substance. Conclusions Our results for the 1950s and 1960s in Japan illustrated how assessing secular trends in method-specific suicides by gender and age could provide a deeper understanding of the dramatic swings in overall suicide rate. Although rapid increases or decreases in suicide rates have been also observed in some countries or regions recently, trends in method-specific suicides have not been analyzed because of a lack of data on method-specific suicide in many countries. Our study illustrates how the collection and analysis of method-specific data can contribute to an understanding of dramatic shifts in national suicide rates.
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Affiliation(s)
- Eiji Yoshioka
- Department of Social Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, Japan. .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building 7th Floor, Boston, MA, USA.
| | - Yasuaki Saijo
- Department of Social Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, Japan
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building 7th Floor, Boston, MA, USA
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Kristoufek L, Moat HS, Preis T. Estimating suicide occurrence statistics using Google Trends. EPJ DATA SCIENCE 2016; 5:32. [PMID: 32355600 PMCID: PMC7175644 DOI: 10.1140/epjds/s13688-016-0094-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/29/2016] [Indexed: 06/11/2023]
Abstract
UNLABELLED Data on the number of people who have committed suicide tends to be reported with a substantial time lag of around two years. We examine whether online activity measured by Google searches can help us improve estimates of the number of suicide occurrences in England before official figures are released. Specifically, we analyse how data on the number of Google searches for the terms 'depression' and 'suicide' relate to the number of suicides between 2004 and 2013. We find that estimates drawing on Google data are significantly better than estimates using previous suicide data alone. We show that a greater number of searches for the term 'depression' is related to fewer suicides, whereas a greater number of searches for the term 'suicide' is related to more suicides. Data on suicide related search behaviour can be used to improve current estimates of the number of suicide occurrences. ELECTRONIC SUPPLEMENTARY MATERIAL The online version of this article (doi:10.1140/epjds/s13688-016-0094-0) contains supplementary material.
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Affiliation(s)
- Ladislav Kristoufek
- Data Science Lab, Behavioural Science, Warwick Business School, University of Warwick, Coventry, CV4 7AL UK
- Institute of Economic Studies, Faculty of Social Sciences, Charles University, Opletalova 26, Prague, 110 00 Czech Republic
| | - Helen Susannah Moat
- Data Science Lab, Behavioural Science, Warwick Business School, University of Warwick, Coventry, CV4 7AL UK
| | - Tobias Preis
- Data Science Lab, Behavioural Science, Warwick Business School, University of Warwick, Coventry, CV4 7AL UK
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Prevention of firearm-related injuries with restrictive licensing and concealed carry laws. J Trauma Acute Care Surg 2016; 81:952-960. [DOI: 10.1097/ta.0000000000001251] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The objective of this article is to review what research we do have, what research we do not have, and how we can use what research we do have to reduce gun violence. It is also suggested how we can use new legislation to do more of the research we desperately need. For while we can conduct many experiments in enforcement strategies without new legislation, we cannot adequately test most legislative proposals without actually passing legislation. In cybernetic terms, it is `smart' policy to treat new legislation as experiments, and to design it in ways that will optimize our ability to learn from each new law.
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Puzo Q, Qin P, Mehlum L. Long-term trends of suicide by choice of method in Norway: a joinpoint regression analysis of data from 1969 to 2012. BMC Public Health 2016; 16:255. [PMID: 26968155 PMCID: PMC4788936 DOI: 10.1186/s12889-016-2919-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/01/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Suicide mortality and the rates by specific methods in a population may change over time in response to concurrent changes in relevant factors in society. This study aimed to identify significant changing points in method-specific suicide mortality from 1969 to 2012 in Norway. METHOD Data on suicide mortality by specific methods and by sex and age were retrieved from the Norwegian Cause-of-Death Register. Long-term trends in age-standardized rates of suicide mortality were analyzed by using joinpoint regression analysis. RESULTS The most frequently used suicide method in the total population was hanging, followed by poisoning and firearms. Men chose suicide by firearms more often than women, whereas poisoning and drowning were more frequently used by women. The joinpoint analysis revealed that the overall trend of suicide mortality significantly changed twice along the period of 1969 to 2012 for both sexes. The male age-standardized suicide rate increased by 3.1% per year until 1989, and decreased by 1.2% per year between 1994 and 2012. Among females the long-term suicide rate increased by 4.0% per year until 1988, decreased by 5.5% through 1995, and then stabilized. Both sexes experienced an upward trend for suicide by hanging during the 44-year observation period, with a particularly significant increase in 15-24 year old males. The most distinct change among men was seen for firearms after 1988 with a significant decrease through 2012 of around 5% per year. For women, significant reductions since 1985-88 were observed for suicide by drowning and poisoning. CONCLUSIONS The present study demonstrates different time trends for different suicide methods with significant reductions in suicide by firearms, drowning and poisoning after the peak in the suicide rate in the late 1980s. Suicide by means of hanging continuously increased, but did not fully compensate for the reduced use of other methods. This lends some support for the effectiveness of method-specific suicide preventive measures, such as restrictions to the access to firearms, which had been implemented in Norway during the relevant time period.
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Affiliation(s)
- Quirino Puzo
- National Centre for Suicide Research and Prevention, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Faculty of Medicine, University of Oslo, Oslo, Norway
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Anestis M, Capron DW. The associations between state veteran population rates, handgun legislation, and statewide suicide rates. J Psychiatr Res 2016; 74:30-4. [PMID: 26736038 DOI: 10.1016/j.jpsychires.2015.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/11/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Within the US, veterans exhibit an elevated suicide rate, with firearms serving as the most common method. Research has demonstrated that several state laws regulating handgun ownership are associated with lower suicide rates. METHOD Publically available databases were utilized to extract relevant data. RESULTS Statewide veteran population rates (per 100,000) predicted overall suicide rates, firearm suicide rates, and the proportion of suicides by firearms. Furthermore, the association between veteran population and overall suicide rate was largely explained by the elevated proportion of suicides by firearms in states with higher veteran populations. Lastly, results demonstrated states without handgun legislation in place exhibited higher veteran populations. CONCLUSIONS Findings indicate veterans may impact statewide suicide rates through their propensity to use firearms as their method and that the tendency for veterans to live in states without handgun legislation may exacerbate this phenomenon.
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Affiliation(s)
- Michael Anestis
- University of Southern Mississippi, Hattiesburg, MS, United States.
| | - Daniel W Capron
- University of Southern Mississippi, Hattiesburg, MS, United States
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Santaella-Tenorio J, Cerdá M, Villaveces A, Galea S. What Do We Know About the Association Between Firearm Legislation and Firearm-Related Injuries? Epidemiol Rev 2016; 38:140-57. [PMID: 26905895 PMCID: PMC6283012 DOI: 10.1093/epirev/mxv012] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 11/14/2022] Open
Abstract
Firearms account for a substantial proportion of external causes of death, injury, and disability across the world. Legislation to regulate firearms has often been passed with the intent of reducing problems related to their use. However, lack of clarity around which interventions are effective remains a major challenge for policy development. Aiming to meet this challenge, we systematically reviewed studies exploring the associations between firearm-related laws and firearm homicides, suicides, and unintentional injuries/deaths. We restricted our search to studies published from 1950 to 2014. Evidence from 130 studies in 10 countries suggests that in certain nations the simultaneous implementation of laws targeting multiple firearms restrictions is associated with reductions in firearm deaths. Laws restricting the purchase of (e.g., background checks) and access to (e.g., safer storage) firearms are also associated with lower rates of intimate partner homicides and firearm unintentional deaths in children, respectively. Limitations of studies include challenges inherent to their ecological design, their execution, and the lack of robustness of findings to model specifications. High quality research on the association between the implementation or repeal of firearm legislation (rather than the evaluation of existing laws) and firearm injuries would lead to a better understanding of what interventions are likely to work given local contexts. This information is key to move this field forward and for the development of effective policies that may counteract the burden that firearm injuries pose on populations.
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Affiliation(s)
- Julian Santaella-Tenorio
- Correspondence to Dr. Julian Santaella-Tenorio, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 515, New York, NY 10032 (e-mail: )
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Abstract
BACKGROUND Little is known about whether particular suicide methods have contributed differently to the recent unfavourable suicide mortality trends in Japan. Analysing such trends may shed light on the effect of potentially preventable factors, such as the impact of restricting access to certain popular suicide methods, on overall rates. Therefore, we assessed recent trends in method-specific suicide by gender and age in Japan. METHOD Suicide mortality and population data between 1990 and 2011 were obtained from the Vital Statistics of Japan and used to calculate method-specific mortality rates. Suicide methods were divided into seven groups: overdose, gases, hanging, drowning, cutting, jumping and other means. Age was divided into four groups: 15-24, 25-44, 45-64 and 65+ years. We applied joinpoint regression to the data and quantified the observed changes. RESULTS The results of the joinpoint regression analyses showed a sharp increase in overall suicide rates for males and females of all ages until the late 1990s. Suicide from hanging and jumping, in particular, contributed to this increase. After 2000, an increasing trend in overall suicide rates in both males and females aged 15-24 and 25-44 years was observed, with overdose, gases and hanging contributing to this increasing trend. CONCLUSIONS Our findings revealed that different suicide methods varied in their contribution to the recent overall suicide transition in Japan. Regarding factors associated with the recent increase in suicides by overdose, gases, hanging and jumping, further research is needed in order to promote and implement effective means restriction strategies.
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Motivational Interviewing for Means Restriction Counseling With Patients at Risk for Suicide. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2014.09.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roszko PJD, Ameli J, Carter PM, Cunningham RM, Ranney ML. Clinician Attitudes, Screening Practices, and Interventions to Reduce Firearm-Related Injury. Epidemiol Rev 2016; 38:87-110. [PMID: 26905894 PMCID: PMC7297261 DOI: 10.1093/epirev/mxv005] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 12/14/2022] Open
Abstract
Firearm injury is a leading cause of injury-related morbidity and mortality in the United States. We sought to systematically identify and summarize existing literature on clinical firearm injury prevention screening and interventions. We conducted a systematic search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycInfo, and ClinicalTrials.gov for English-language original research (published 1992-2014) on clinical screening methods, patient-level firearm interventions, or patient/provider attitudes on the same. Unrelated studies were excluded through title, abstract, and full-text review, and the remaining articles underwent data abstraction and quality scoring. Of a total of 3,260 unique titles identified, 72 were included in the final review. Fifty-three articles examined clinician attitudes/practice patterns; prior training, experience, and expectations correlated with clinicians' regularity of firearm screening. Twelve articles assessed patient interventions, of which 6 were randomized controlled trials. Seven articles described patient attitudes; all were of low methodological quality. According to these articles, providers rarely screen or counsel their patients-even high-risk patients-about firearm safety. Health-care-based interventions may increase rates of safe storage of firearms for pediatric patients, suicidal patients, and other high-risk groups. Some studies show that training clinicians can increase rates of effective firearm safety screening and counseling. Patients and families are, for the most part, accepting of such screening and counseling. However, the current literature is, by and large, not high quality. Rigorous, large-scale, adequately funded studies are needed.
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Affiliation(s)
| | | | | | | | - Megan L. Ranney
- Correspondence to Dr. Megan L. Ranney, Department of Emergency Medicine, Rhode Island Hospital/Alpert Medical School of Brown University, 593 Eddy Street, Claverick 2, Providence, RI 02903 (e-mail:)
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Anestis MD. Prior suicide attempts are less common in suicide decedents who died by firearms relative to those who died by other means. J Affect Disord 2016; 189:106-9. [PMID: 26432034 DOI: 10.1016/j.jad.2015.09.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/24/2015] [Accepted: 09/05/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicide prevention efforts often center on the identification of risk factors (e.g., prior suicide attempts); however, lists of risk factors without consideration of context may prove incapable of impacting suicide rates. One contextual variable worth considering is attempt method. METHODS Utilizing data from the National Violent Death Reporting System (2005-2012), I examined suicide deaths (n=71,775) by firearms and other means to determine whether prior suicide attempts were more common in one group versus the other. RESULTS Significantly fewer suicide decedents who died by firearms reported a prior history of suicide attempts (12.10%) than did decedents who died by other means (28.66%). This result was further replicated within each state that contributed data to the NVDRS. LIMITATIONS Only 17 states have contributed to the NVDRS thus far and, within those states, not all suicide deaths were reported. Due to the nature of the data, I was unable to test proposed mediators within our model. CONCLUSIONS Suicide decedents who die by firearms may die on their first attempt more often than other decedents due to a capability and willingness to utilize a highly lethal means. Current risk assessment protocols may be ill equipped to identify such individuals prospectively on their own. Broader methods of implementing means restriction (e.g., legislation) may thus be pivotal in suicide prevention efforts.
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Affiliation(s)
- Michael D Anestis
- University of Southern Mississippi, Hattiesburg, MS 39401, United States.
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Wintemute GJ. Alcohol misuse, firearm violence perpetration, and public policy in the United States. Prev Med 2015; 79:15-21. [PMID: 25937594 DOI: 10.1016/j.ypmed.2015.04.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/24/2015] [Accepted: 04/26/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Firearm violence is a significant public health problem in the United States, and alcohol is frequently involved. This article reviews existing research on the relationships between alcohol misuse; ownership, access to, and use of firearms; and the commission of firearm violence, and discusses the policy implications of these findings. METHOD Narrative review augmented by new tabulations of publicly-available data. RESULTS Acute and chronic alcohol misuse is positively associated with firearm ownership, risk behaviors involving firearms, and risk for perpetrating both interpersonal and self-directed firearm violence. In an average month, an estimated 8.9 to 11.7 million firearm owners binge drink. For men, deaths from alcohol-related firearm violence equal those from alcohol-related motor vehicle crashes. Enforceable policies restricting access to firearms for persons who misuse alcohol are uncommon. Policies that restrict access on the basis of other risk factors have been shown to reduce risk for subsequent violence. CONCLUSION The evidence suggests that restricting access to firearms for persons with a documented history of alcohol misuse would be an effective violence prevention measure. Restrictions should rely on unambiguous definitions of alcohol misuse to facilitate enforcement and should be rigorously evaluated.
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Affiliation(s)
- Garen J Wintemute
- University of California, Davis, 2315 Stockton Blvd., Sacramento, CA 95817, USA.
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Swedler DI, Simmons MM, Dominici F, Hemenway D. Firearm Prevalence and Homicides of Law Enforcement Officers in the United States. Am J Public Health 2015; 105:2042-8. [PMID: 26270316 DOI: 10.2105/ajph.2015.302749] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In the United States, state firearm ownership has been correlated with homicide rates. More than 90% of homicides of law enforcement officers (LEOs) are committed with firearms. We examined the relationship between state firearm ownership rates and LEO occupational homicide rates. METHODS We obtained the number LEOs killed from 1996 to 2010 from a Federal Bureau of Investigation (FBI) database. We calculated homicide rates per state as the number of officers killed per number of LEOs per state, obtained from another FBI database. We obtained the mean household firearm ownership for each state from the Behavioral Risk Factor Surveillance System. RESULTS Using Poisson regression and controlling for factors known to affect homicide rates, we associated firearm ownership with the homicide rates for LEOs (incidence rate ratio = 1.044; P = .005); our results were supported by cross-sectional and longitudinal sensitivity analyses. LEO homicide rates were 3 times higher in states with high firearm ownership compared with states with low firearm ownership. CONCLUSIONS High public gun ownership is a risk for occupational mortality for LEOs in the United States. States could consider methods for reducing firearm ownership as a way to reduce occupational deaths of LEOs.
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Affiliation(s)
- David I Swedler
- At the time of this study, David I. Swedler was with Environmental Health Sciences, Harvard School of Public Health, Harvard University, Boston, MA, and Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, MA. Molly M. Simmons is with the Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Francesca Dominici is with the Department of Biostatistics, Harvard School of Public Health. David Hemenway is with the Department of Health Policy and Management, Harvard School of Public Health
| | - Molly M Simmons
- At the time of this study, David I. Swedler was with Environmental Health Sciences, Harvard School of Public Health, Harvard University, Boston, MA, and Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, MA. Molly M. Simmons is with the Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Francesca Dominici is with the Department of Biostatistics, Harvard School of Public Health. David Hemenway is with the Department of Health Policy and Management, Harvard School of Public Health
| | - Francesca Dominici
- At the time of this study, David I. Swedler was with Environmental Health Sciences, Harvard School of Public Health, Harvard University, Boston, MA, and Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, MA. Molly M. Simmons is with the Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Francesca Dominici is with the Department of Biostatistics, Harvard School of Public Health. David Hemenway is with the Department of Health Policy and Management, Harvard School of Public Health
| | - David Hemenway
- At the time of this study, David I. Swedler was with Environmental Health Sciences, Harvard School of Public Health, Harvard University, Boston, MA, and Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, MA. Molly M. Simmons is with the Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Francesca Dominici is with the Department of Biostatistics, Harvard School of Public Health. David Hemenway is with the Department of Health Policy and Management, Harvard School of Public Health
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Anestis MD, Anestis JC. Suicide Rates and State Laws Regulating Access and Exposure to Handguns. Am J Public Health 2015; 105:2049-58. [PMID: 26270305 DOI: 10.2105/ajph.2015.302753] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Using previous research, we examined the impact of 4 handgun laws (waiting periods, universal background checks, gun locks, and open carrying regulations) on suicide rates. METHODS We used publicly available databases to collect information on statewide laws, suicide rates, and demographic characteristics for 2013. RESULTS Each law was associated with significantly lower firearm suicide rates and the proportion of suicides resulting from firearms. In addition, each law, except for that which required a waiting period, was associated with a lower overall suicide rate. Follow-up analyses showed a significant indirect effect on overall suicide rates through the proportion of suicides by firearms, indicating that the reduced overall suicide rate was attributable to fewer suicide attempts, fewer handguns in the home, suicide attempts using less lethal means, or a combination of these factors. States that implemented any of these laws saw a decreased suicide rate in subsequent years, whereas the only state that repealed 1 of these laws saw an increased suicide rate. CONCLUSIONS Our results were supportive of a potentially vital role in suicide prevention for state legislation that limits access and exposure to handguns.
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Affiliation(s)
- Michael D Anestis
- Michael D. Anestis and Joye C. Anestis are with the University of Southern Mississippi, Hattiesburg
| | - Joye C Anestis
- Michael D. Anestis and Joye C. Anestis are with the University of Southern Mississippi, Hattiesburg
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Simonetti JA, Rowhani-Rahbar A, Mills B, Young B, Rivara FP. State Firearm Legislation and Nonfatal Firearm Injuries. Am J Public Health 2015; 105:1703-9. [PMID: 26066935 PMCID: PMC4504301 DOI: 10.2105/ajph.2015.302617] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated whether stricter state-level firearm legislation was associated with lower hospital discharge rates for nonfatal firearm injuries. METHODS We estimated discharge rates for hospitalized and emergency department-treated nonfatal firearm injuries in 18 states in 2010 and used negative binomial regression to determine whether strength of state firearm legislation was independently associated with total nonfatal firearm injury discharge rates. RESULTS We identified 26 744 discharges for nonfatal firearm injuries. The overall age-adjusted discharge rate was 19.0 per 100 000 person-years (state range = 3.3-36.6), including 7.9 and 11.1 discharges per 100 000 for hospitalized and emergency department-treated injuries, respectively. In models adjusting for differences in state sociodemographic characteristics and economic conditions, states in the strictest tertile of legislative strength had lower discharge rates for total (incidence rate ratio [IRR] = 0.60; 95% confidence interval [CI] = 0.44, 0.82), assault-related (IRR = 0.58; 95% CI = 0.34, 0.99), self-inflicted (IRR = 0.18; 95% CI = 0.14, 0.24), and unintentional (IRR = 0.53; 95% CI = 0.34, 0.84) nonfatal firearm injuries. CONCLUSIONS There is significant variation in state-level hospital discharge rates for nonfatal firearm injuries, and stricter state firearm legislation is associated with lower discharge rates for such injuries.
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Affiliation(s)
- Joseph A Simonetti
- Joseph A. Simonetti, Ali Rowhani-Rahbar, Brianna Mills, and Frederick P. Rivara are with the Harborview Injury Prevention and Research Center, University of Washington, Seattle. Joseph A. Simonetti and Bessie Young are with the Seattle-Denver Center of Innovation, VA Puget Sound Healthcare System, Seattle, WA. Ali Rowhani-Rahbar and Brianna Mills are with the Department of Epidemiology, University of Washington, Seattle. Bessie Young is with the Kidney Research Institute, University of Washington, Seattle. Frederick P. Rivara is with the Department of Pediatrics, University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Joseph A. Simonetti, Ali Rowhani-Rahbar, Brianna Mills, and Frederick P. Rivara are with the Harborview Injury Prevention and Research Center, University of Washington, Seattle. Joseph A. Simonetti and Bessie Young are with the Seattle-Denver Center of Innovation, VA Puget Sound Healthcare System, Seattle, WA. Ali Rowhani-Rahbar and Brianna Mills are with the Department of Epidemiology, University of Washington, Seattle. Bessie Young is with the Kidney Research Institute, University of Washington, Seattle. Frederick P. Rivara is with the Department of Pediatrics, University of Washington, Seattle
| | - Brianna Mills
- Joseph A. Simonetti, Ali Rowhani-Rahbar, Brianna Mills, and Frederick P. Rivara are with the Harborview Injury Prevention and Research Center, University of Washington, Seattle. Joseph A. Simonetti and Bessie Young are with the Seattle-Denver Center of Innovation, VA Puget Sound Healthcare System, Seattle, WA. Ali Rowhani-Rahbar and Brianna Mills are with the Department of Epidemiology, University of Washington, Seattle. Bessie Young is with the Kidney Research Institute, University of Washington, Seattle. Frederick P. Rivara is with the Department of Pediatrics, University of Washington, Seattle
| | - Bessie Young
- Joseph A. Simonetti, Ali Rowhani-Rahbar, Brianna Mills, and Frederick P. Rivara are with the Harborview Injury Prevention and Research Center, University of Washington, Seattle. Joseph A. Simonetti and Bessie Young are with the Seattle-Denver Center of Innovation, VA Puget Sound Healthcare System, Seattle, WA. Ali Rowhani-Rahbar and Brianna Mills are with the Department of Epidemiology, University of Washington, Seattle. Bessie Young is with the Kidney Research Institute, University of Washington, Seattle. Frederick P. Rivara is with the Department of Pediatrics, University of Washington, Seattle
| | - Frederick P Rivara
- Joseph A. Simonetti, Ali Rowhani-Rahbar, Brianna Mills, and Frederick P. Rivara are with the Harborview Injury Prevention and Research Center, University of Washington, Seattle. Joseph A. Simonetti and Bessie Young are with the Seattle-Denver Center of Innovation, VA Puget Sound Healthcare System, Seattle, WA. Ali Rowhani-Rahbar and Brianna Mills are with the Department of Epidemiology, University of Washington, Seattle. Bessie Young is with the Kidney Research Institute, University of Washington, Seattle. Frederick P. Rivara is with the Department of Pediatrics, University of Washington, Seattle
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Myung W, Lee GH, Won HH, Fava M, Mischoulon D, Nyer M, Kim DK, Heo JY, Jeon HJ. Paraquat prohibition and change in the suicide rate and methods in South Korea. PLoS One 2015; 10:e0128980. [PMID: 26035175 PMCID: PMC4452788 DOI: 10.1371/journal.pone.0128980] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 05/04/2015] [Indexed: 11/23/2022] Open
Abstract
The annual suicide rate in South Korea is the highest among the developed countries. Paraquat is a highly lethal herbicide, commonly used in South Korea as a means for suicide. We have studied the effect of the 2011 paraquat prohibition on the national suicide rate and method of suicide in South Korea. We obtained the monthly suicide rate from 2005 to 2013 in South Korea. In our analyses, we adjusted for the effects of celebrity suicides, and economic, meteorological, and seasonal factors on suicide rate. We employed change point analysis to determine the effect of paraquat prohibition on suicide rate over time, and the results were verified by structural change analysis, an alternative statistical method. After the paraquat prohibition period in South Korea, there was a significant reduction in the total suicide rate and suicide rate by poisoning with herbicides or fungicides in all age groups and in both genders. The estimated suicide rates during this period decreased by 10.0% and 46.1% for total suicides and suicides by poisoning of herbicides or fungicides, respectively. In addition, method substitution effect of paraquat prohibition was found in suicide by poisoning by carbon monoxide, which did not exceed the reduction in the suicide rate of poisoning with herbicides or fungicides. In South Korea, paraquat prohibition led to a lower rate of suicide by paraquat poisoning, as well as a reduction in the overall suicide rate. Paraquat prohibition should be considered as a national suicide prevention strategy in developing and developed countries alongside careful observation for method substitution effects.
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Affiliation(s)
- Woojae Myung
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Information Statistics, Korea National Open University, Seoul, Korea
- Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - Geung-Hee Lee
- Department of Information Statistics, Korea National Open University, Seoul, Korea
| | - Hong-Hee Won
- Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - Maren Nyer
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - Doh Kwan Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Yoon Heo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
- Department of Clinical Research Design and Evaluation and Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, Korea
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Weerasinghe M, Konradsen F, Eddleston M, Pearson M, Gunnell D, Hawton K, Jayamanne S, Pabasara C, Jayathilaka T, Dissanayaka K, Rajapaksha S, Thilakarathna P, Agampodi S. Risk factors associated with purchasing pesticide from shops for self-poisoning: a protocol for a population-based case-control study. BMJ Open 2015; 5:e007822. [PMID: 25995242 PMCID: PMC4442210 DOI: 10.1136/bmjopen-2015-007822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Pesticide self-poisoning is one of the most frequently used methods of suicide worldwide, killing over 300,000 people annually. Around 15-20% of pesticide self-poisonings occur soon after the person has bought the pesticide from a shop. We aim to determine the characteristics of individuals who purchase pesticides directly from shops and how they differ from individuals who access pesticides from other sources such as home, home garden or farmland. This information will help inform possible vendor/shop-based intervention strategies aimed at reducing access to pesticides used for self-harm. METHODS AND ANALYSIS This study will investigate risk factors associated with purchasing pesticides for acts of self-poisoning from pesticide shops, including cases identified over a 9-month period using a population-based case-control group approach. Four interviewer-administered data collection tools will be used for this study: a semistructured questionnaire, Beck Suicidal Intent Scale (SIS), Clinical Interview Schedule-Sinhalese version (CIS-Sn) and Alcohol Use Disorders Identification Test (AUDIT). Each case (expected n=33) will be compared with two groups of individuals: (1) those who have self-poisoned using pesticides from the home, home garden or farmland and (2) those who bought pesticides from the same shops as the above cases, but not did not self-poison. Logistic regression models will be used to identify risk factors of purchasing pesticides for self-poisoning from shops. ETHICS AND DISSEMINATION The study has received ethical approval from the Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. A sensitive data collection technique will be used and ethical issues will be considered throughout the study. Results will be disseminated in scientific peer-reviewed articles.
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Affiliation(s)
- Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Flemming Konradsen
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Public Health, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Public Health, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
- Pharmacology, Toxicology and Therapeutics, University of Edinburgh, Edinburgh, UK
| | - Melissa Pearson
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Pharmacology, Toxicology and Therapeutics, University of Edinburgh, Edinburgh, UK
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
| | - Shaluka Jayamanne
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Chathurani Pabasara
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Tharidu Jayathilaka
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Kalpani Dissanayaka
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Sandamali Rajapaksha
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Prasanna Thilakarathna
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
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Anestis MD, Khazem LR, Law KC, Houtsma C, LeTard R, Moberg F, Martin R. The Association Between State Laws Regulating Handgun Ownership and Statewide Suicide Rates. Am J Public Health 2015; 105:2059-67. [PMID: 25880944 DOI: 10.2105/ajph.2014.302465] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We examined the impact of 3 state laws (permit to purchase a handgun, registration of handguns, license to own a handgun) on suicide rates. METHODS We used 2010 data from publicly available databases and state legislatures to assess the relationships between our predictors and outcomes. RESULTS Results largely indicated that states with any of these laws in place exhibited lower overall suicide rates and suicide by firearms rates and that a smaller proportion of suicides in such states resulted from firearms. Furthermore, results indicated that laws requiring registration and license had significant indirect effects through the proportion of suicides resulting from firearms. The latter results imply that such laws are associated with fewer suicide attempts overall, a tendency for those who attempt to use less-lethal means, or both. Exploratory longitudinal analyses indicated a decrease in overall suicide rates immediately following implementation of laws requiring a license to own a handgun. CONCLUSIONS The results are thus supportive of the potential of handgun legislation to have an impact on suicide rates.
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Affiliation(s)
- Michael D Anestis
- All of the authors are with University of Southern Mississippi, Hattiesburg
| | - Lauren R Khazem
- All of the authors are with University of Southern Mississippi, Hattiesburg
| | - Keyne C Law
- All of the authors are with University of Southern Mississippi, Hattiesburg
| | - Claire Houtsma
- All of the authors are with University of Southern Mississippi, Hattiesburg
| | - Rachel LeTard
- All of the authors are with University of Southern Mississippi, Hattiesburg
| | - Fallon Moberg
- All of the authors are with University of Southern Mississippi, Hattiesburg
| | - Rachel Martin
- All of the authors are with University of Southern Mississippi, Hattiesburg
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Hassamal S, Keyser-Marcus L, Crouse Breden E, Hobron K, Bhattachan A, Pandurangi A. A brief analysis of suicide methods and trends in Virginia from 2003 to 2012. BIOMED RESEARCH INTERNATIONAL 2015; 2015:104036. [PMID: 25705647 PMCID: PMC4331312 DOI: 10.1155/2015/104036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/11/2015] [Accepted: 01/12/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The objective is to analyze and compare Virginia suicide data from 2003 to 2012 to US suicide data. METHODS Suicide trends by method, age, gender, and race were obtained from Virginia's Office of the Chief Medical Examiner's annual reports. RESULTS Similar to US suicide rates, suicide rates in Virginia increased between 2003 and 2012 from 10.9/100,000 people to 12.9/100,000 people. The most common methods were firearm, asphyxia, and intentional drug overdose, respectively. The increase in asphyxia (r = 0.77, P ≤ 0.01) and decrease in CO poisoning (r = -0.89, P ≤ 0.01) were significant. Unlike national trends, intentional drug overdoses decreased (r = -0.55, P = 0.10). Handgun suicides increased (r = 0.61, P = 0.06) and are the most common method of firearm suicide. Hanging was the most common method of asphyxia. Helium suicides also increased (r = 0.75, P = 0.05). Middle age females and males comprise the largest percentage of suicide. Unlike national data, the increase in middle age male suicides occurred only in the 55-64-year-old age group (r = 0.79, P ≤ 0.01) and decreased in the 35-44-year-old age group (r = -0.60, P = 0.07) and 10-14-year-old age group (r = -0.73, P = 0.02). Suicide in all female age ranges remained stable. Caucasians represent the highest percentage of suicide. CONCLUSION There has been a rise in suicide in Virginia and suicide rates and trends have closely resembled the national average albeit some differences. Suicide prevention needs to be enhanced.
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Affiliation(s)
- Sameer Hassamal
- Department of Psychiatry, Virginia Commonwealth University, P.O. Box 980710, Richmond, VA 23298, USA
| | - Lori Keyser-Marcus
- Department of Psychiatry, Virginia Commonwealth University, P.O. Box 980710, Richmond, VA 23298, USA
| | - Ericka Crouse Breden
- Department of Psychiatry, Virginia Commonwealth University, P.O. Box 980710, Richmond, VA 23298, USA
| | - Kathrin Hobron
- Office of the Chief Medical Examiner, Department of Forensic Epidemiology, Virginia Department of Health, P.O. Box 2448, Richmond, VA 23219, USA
| | - Atit Bhattachan
- Department of Psychiatry, University of Pittsburgh, P.O. Box 850, Pittsburgh, PA 15213, USA
| | - Ananda Pandurangi
- Department of Psychiatry, Virginia Commonwealth University, P.O. Box 980710, Richmond, VA 23298, USA
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47
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Fisher LB, Overholser JC, Dieter L. Methods of committing suicide among 2,347 people in Ohio. DEATH STUDIES 2015; 39:39-43. [PMID: 24932592 PMCID: PMC4268074 DOI: 10.1080/07481187.2013.851130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The present study explored gender differences in suicidal methods, aiming to identify ways to improve our identification of individuals at risk for suicide. Preferred suicide methods vary by demographics; however, method-specific risk factors have not been consistently identified. All suicidal deaths (N=2,347) in a large urban county were identified over a 15-year period (1994-2008). The majority of men used shooting and hanging. In contrast, women relied on a variety of methods, including self-poisoning, shooting, hanging, and carbon monoxide poisoning. Significant demographic differences are evident among individuals who die by shooting and self-poisoning.
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Affiliation(s)
- Lauren B Fisher
- a Department of Psychology , Case Western Reserve University , Cleveland , Ohio , USA
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48
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Hoffman SJ, Røttingen JA. Assessing the Expected Impact of Global Health Treaties: Evidence From 90 Quantitative Evaluations. Am J Public Health 2015; 105:26-40. [PMID: 25393196 DOI: 10.2105/ajph.2014.302085] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We assessed what impact can be expected from global health treaties on the basis of 90 quantitative evaluations of existing treaties on trade, finance, human rights, conflict, and the environment. It appears treaties consistently succeed in shaping economic matters and consistently fail in achieving social progress. There are at least 3 differences between these domains that point to design characteristics that new global health treaties can incorporate to achieve positive impact: (1) incentives for those with power to act on them; (2) institutions designed to bring edicts into effect; and (3) interests advocating their negotiation, adoption, ratification, and domestic implementation. Experimental and quasiexperimental evaluations of treaties would provide more information about what can be expected from this type of global intervention.
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Affiliation(s)
- Steven J Hoffman
- Steven J. Hoffman is with the Faculty of Law, University of Ottawa, Canada, and the Department of Global Health and Population, Harvard School of Public Health, Boston, MA. John-Arne Røttingen is with the Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway, and the Institute of Health and Society, University of Oslo, Norway
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49
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Abstract
Suicide is a public health problem affecting people across the lifespan. It is currently the 10th leading cause of death, with rates having remained relatively flat for the past century. This article summarizes the problem of suicide and suicidal behavior along with suicide prevention efforts in the United States. Part 1 provides an overview of the epidemiology of suicide, including groups most at risk of suicide and suicidal behavior. Part 2 provides a review of common risk factors, organized by developmental life stage. A brief discussion of the lesser well-researched area of protective factors follows. Part 3 provides an overview of suicide prevention today, including the major types of prevention strategies, their successes, including means restriction, quality improvement in behavioral services, and comprehensive programs; and limitations to date, such as a lack of evidence for impact on actual deaths or behavior, small sample sizes, and low base rates. Finally, part 4 discusses challenges and future directions with an eye toward the great many opportunities that exist for prevention.
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Affiliation(s)
- Deborah M Stone
- Division of Violence Prevention (DVP), National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Alex E Crosby
- Division of Violence Prevention (DVP), National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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50
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Cornette MM, Schlotthauer AE, Berlin JS, Clark DC, French LM, Miller ML, Pfeiffer HM. The public health approach to reducing suicide: opportunities for curriculum development in psychiatry residency training programs. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2014; 38:575-584. [PMID: 24923779 DOI: 10.1007/s40596-014-0127-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 10/11/2013] [Indexed: 06/03/2023]
Abstract
The authors review the current status of suicide prevention curricula in psychiatry training programs, describe the public health approach to suicide prevention, discuss public health strategies for reducing suicides and the unique role played by psychiatrists with respect to suicide prevention, and offer public health-oriented suicide prevention curriculum guidelines for psychiatry residents.
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Affiliation(s)
- Michelle M Cornette
- American Association of Suicidology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,
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