1
|
Manzler CA, Gorka SM, Tabares JV, Bryan CJ. Impact of handgun ownership and biological sex on startle reactivity to predictable and unpredictable threats. Int J Psychophysiol 2024; 197:112297. [PMID: 38185419 PMCID: PMC10922634 DOI: 10.1016/j.ijpsycho.2024.112297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/18/2023] [Accepted: 12/31/2023] [Indexed: 01/09/2024]
Abstract
Extant literature suggests that many individuals obtain firearms because they perceive the world as unsafe and believe that firearm ownership increases physical protection. Converging evidence suggests that firearm owners are vulnerable to uncertainty and experience chronic anticipatory anxiety in daily life; however, biological sex is thought to potentially moderate this association. Studies have yet to examine this hypothesis using objective markers of anticipatory anxiety. The present study therefore examined the impact of handgun ownership and biological sex on psychophysiological reactivity to predictable (P-) and unpredictable (U-) threat (N = 133). Male and female adult participants were classified into two groups: a) individuals who do not currently own any handguns (n = 52), and b) individuals who currently own one or more handguns (n = 81). Startle eyeblink potentiation was recorded as an index of aversive reactivity during a well-validated threat-of-shock paradigm designed to probe anticipatory anxiety (during U-threat) and fear (during P-threat). Results revealed no main effect of group on startle reactivity to P- or U-threat. Females displayed greater startle reactivity to threat (P- and U-) compared with males. The main effect was qualified by a significant group x biological sex interaction. Male handgun owners exhibited greater startle to U-threat, but not P-threat, relative to non-handgun owners. There was no effect of group on startle reactivity in females. Findings revealed that biological sex and threat type influenced threat reactivity. Male handgun owners displayed increased sensitivity to stressors that are uncertain, which may reflect an objective mechanism related to firearm ownership.
Collapse
Affiliation(s)
- Charles A Manzler
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA
| | - Stephanie M Gorka
- Suicide and Trauma Reduction InitiatiVE (STRIVE), Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210, USA; Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH 43210, USA.
| | - Jeffrey V Tabares
- Suicide and Trauma Reduction InitiatiVE (STRIVE), Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - Craig J Bryan
- Suicide and Trauma Reduction InitiatiVE (STRIVE), Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210, USA
| |
Collapse
|
2
|
Roess AA, Henderson LF, Adams LM, Renshaw KD. Association Between Firearm Purchasing in Response to the COVID-19 Pandemic and Symptoms of Anxiety, Depression, and Stress, August 2021. AJPM FOCUS 2024; 3:100171. [PMID: 38293250 PMCID: PMC10825591 DOI: 10.1016/j.focus.2023.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Introduction Firearm sales and firearm-related injuries and deaths increased during the pandemic. Little is known about motivations for firearm purchasing in response to the COVID-19 pandemic and the mental health status of first-time purchasers. The purpose of this study was to estimate the association between firearm purchasing in response to the COVID-19 pandemic and anxiety symptoms, depressive symptoms, and stress. Methods The authors analyzed data from a survey that approximated a nationally representative sample of American adults (N=3,528) who either did not own firearms (n=2,327) or purchased firearms for the first time in response to the pandemic (n=240). Self-reported stress, depressive symptoms, and anxiety symptoms were determined using standardized self-assessment questionnaires (Perceived Stress Scale, Patient Health Questionnaire, and Depression Anxiety Stress Scale, respectively). Using multivariable logistic regression, the association between firearm purchasing and each mental health measure were assessed after controlling for demographics and other determinants. Results In each model, first-time firearm owners were more likely to be younger, live in urban areas, believe the government does too much for its citizens, stay home, stock up on items, and keep their children at home. First-time owners had significantly higher odds of anxiety and depressive symptoms than non-owners (AOR=1.05; 95% CI=1.04, 1.07 and AOR=1.15; 95% CI=1.04, 1.26, respectively). Conclusions First-time firearm purchasers report higher depressive and anxiety symptoms than non-owners, suggesting that there may be a risk of suicide and other related firearm violence.
Collapse
Affiliation(s)
- Amira A. Roess
- Department of Global and Community Health George Mason University, Fairfax, Virginia
| | - Laura F. Henderson
- Department of Global and Community Health George Mason University, Fairfax, Virginia
| | - Leah M. Adams
- Department of Psychology, George Mason University, Fairfax, Virginia
| | - Keith D. Renshaw
- Department of Psychology, George Mason University, Fairfax, Virginia
| |
Collapse
|
3
|
Asarnow JR, Clarke GN, Miranda JM, Edelmann AC, Sheppler CR, Firemark AJ, Zhang L, Babeva K, Venables C, Comulada S. Zero Suicide Quality Improvement: Developmental and Pandemic-Related Patterns in Youth at Risk for Suicide Attempts. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 9:1-14. [PMID: 38799772 PMCID: PMC11114629 DOI: 10.1080/23794925.2023.2208382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
The Zero Suicide (ZS) approach to health system quality improvement (QI) aspires to reduce/eliminate suicides through enhancing risk detection and suicide-prevention services. This first report from our randomized trial evaluating a stepped care for suicide prevention intervention within a health system conducting ZS-QI describes 1) our screening and case identification process, 2) variation among adolescents versus young adults; and 3) pandemic-related patterns during the first COVID-19 pandemic year. Between April 2017 and January 2021, youths aged 12-24 with elevated suicide risk were identified through an electronic health record (EHR) case-finding algorithm followed by direct assessment screening to confirm risk. Eligible/enrolled youth were evaluated for suicidality, self-harm, and risk/protective factors. Case finding, screening, and enrollment yielded 301 participants showing suicide risk-indicators: 97% past-year suicidal ideation, 83% past suicidal behavior; 90% past non-suicidal self-injury (NSSI). Compared to young adults, adolescents reported: more past-year suicide attempts (47% vs 21%, p<.001) and NSSI (past 6-months, 64% vs 39%, p<.001); less depression, anxiety, posttraumatic stress, and substance use; and greater social connectedness. Pandemic-onset was associated with lower participation of racial-ethnic minority youths (18% vs 33%, p<.015) and lower past-month suicidal ideation and behavior. Results support the value of EHR case-finding algorithms for identifying youths with potentially elevated risk who could benefit from suicide-prevention services, which merit adaptation for adolescents versus young adults. Lower racial-ethnic minority participation after the COVID-19 pandemic-onset underscores challenges for services to enhance health equity during a period with restricted in-person health care, social distancing, school closures, and diverse stresses.
Collapse
Affiliation(s)
- Joan R Asarnow
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | - Greg N Clarke
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
| | - Jeanne M Miranda
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | - Anna C Edelmann
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
| | | | - Alison J Firemark
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
| | - Lily Zhang
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | - Kalina Babeva
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
- Seattle Children’s Hospital, Seattle, WA
| | - Chase Venables
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | - Scott Comulada
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
| |
Collapse
|
4
|
Bond AE, Brooks JR, Rodriguez TR, Bandel SL, Anestis MD. Examining characteristics and experiences of Black firearm owners. J Clin Psychol 2023. [PMID: 37190950 DOI: 10.1002/jclp.23532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/05/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The present study sought to better understand the characteristics of those who own firearms in the Black community; and to understand how Black firearm owners differ from nonfirearm owning Black individuals on a variety of variables related to safety, threat concerns, and suicide risk. METHODS Two samples were utilized in this study. The first was a subsample of those who identified as Black from a nationally representative sample (N = 502) seeking to understand firearm ownership within the United States. The second used a subsample of those who identified as Black (N = 1086) from a representative sample from New Jersey, Minnesota, and Mississippi. Variables related to safety and threat concerns were included in the second sample. RESULTS In both samples, multiple demographic variables, such as being a woman and having higher education, predicted firearm ownership. In the second sample, experiences of everyday discrimination and crime experiences were associated with firearm ownership. Additionally, Black firearm owners reported significantly more suicidal ideation than Black nonfirearm owners. CONCLUSION The findings demonstrate the unique characteristics and experiences of Black firearm owners and show that firearm ownership is associated with increased suicide risk factors for Black adults. Findings should be used to advocate for the creation of more culturally relevant suicide prevention and firearm means safety strategies.
Collapse
Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Jasmin R Brooks
- Department of Psychology, The University of Houston, Houston, Texas, USA
| | - Taylor R Rodriguez
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Shelby L Bandel
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| |
Collapse
|
5
|
Roess AA, Henderson LF, Adams LM, Renshaw KD. Predictors of firearm purchasing during the coronavirus pandemic in the United States: a cross-sectional study. Public Health 2023; 219:159-164. [PMID: 37244224 DOI: 10.1016/j.puhe.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES This study aimed to compare determinants of firearm purchasing related to the pandemic. STUDY DESIGN This was a cross-sectional survey. METHODS A total of 3853 online panel participants completed a survey between December 22, 2020, and January 2, 2021, to approximate a nationally representative sample of US adults (aged ≥18 years). Four firearm ownership groups were created: non-owners, a proxy for first-time COVID-19 owners, prepandemic owners with COVID-19 purchase, and prepandemic owners without COVID-19 purchase. Explanatory variables were in four domains: demographics, concern about the pandemic, actions taken in response to COVID-19, and emotional response to COVID-19. Multivariate analysis estimated the adjusted odds of the outcomes. RESULTS Respondents were categorized as non-owners (n = 2440), pandemic-related purchasers with no other firearms (n = 257), pandemic-related purchasers with other firearms (n = 350), and those who did not purchase in response to the pandemic but have other firearms (n = 806). Multivariable logistic regression found that compared with non-owners, those who had firearms at home with no pandemic-related purchases are more likely to be male, live in rural settings, have higher income, and be Republican. CONCLUSIONS The results highlight the changing profile of American firearm owners and identify that those who purchased firearms for the first time (in response to the pandemic) should be the focus of tailored public health interventions, including provision of education about recommended firearm storage to reduce firearm violence, particularly because they are more likely to have children at home, and belong to demographic groups that may have less experience with firearm safety.
Collapse
Affiliation(s)
- A A Roess
- Department of Global and Community Health, College of Public Health, George Mason University, 4400 University Blvd, Fairfax, VA, 22030, USA.
| | - L F Henderson
- Department of Global and Community Health, College of Public Health, George Mason University, 4400 University Blvd, Fairfax, VA, 22030, USA
| | - L M Adams
- Department of Psychology, George Mason University, 4400 University Blvd, Fairfax, VA, 22030, USA
| | - K D Renshaw
- Department of Psychology, George Mason University, 4400 University Blvd, Fairfax, VA, 22030, USA
| |
Collapse
|
6
|
Monteith LL, Holliday R, Miller CN, Schneider AL, Brenner LA, Hoffmire CA. Prevalence and Correlates of Firearm Access Among Post-9/11 US Women Veterans Using Reproductive Healthcare: a Cross-Sectional Survey. J Gen Intern Med 2022; 37:714-723. [PMID: 36042091 PMCID: PMC9481791 DOI: 10.1007/s11606-022-07587-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Suicide rates have increased among women Veterans, with increased use of firearms as the method. Addressing suicide risk in this population requires understanding the prevalence and correlates of firearm access in healthcare settings frequented by women Veterans. OBJECTIVES Characterize the prevalence and correlates of firearm ownership and storage practices among women Veterans using Department of Veterans Affairs (VA) reproductive healthcare (RHC) services. DESIGN Cross-sectional national survey conducted in 2018-2019 (17.9% response rate). PARTICIPANTS Post-9/11 women Veterans using RHC (n=350). MAIN MEASURES VA Military Sexual Trauma Screen, PTSD Checklist for DSM-5, Hurt/Insult/Threaten/Scream, Columbia-Suicide Severity Rating Scale screener, self-reported firearm access. KEY RESULTS 38.0% (95% confidence interval [95% CI]: 32.9, 43.3) of participants reported personally owning firearms, and 38.9% (95% CI: 33.7, 44.2) reported other household members owned firearms. Among those with firearms in or around their homes, 17.8% (95% CI: 12.3, 24.4) and 21.9% (95% CI: 15.9, 28.9) reported all were unsafely stored (loaded or unlocked, respectively). Women who experienced recent intimate partner violence were less likely to report personally owning firearms (adjusted prevalence ratio [APR]=0.75; 95% CI: 0.57, 0.996). Those who experienced military sexual harassment (APR=1.46; 95% CI=1.09, 1.96), were married (APR=1.74; 95% CI: 1.33, 2.27), or lived with other adult(s) (APR=6.26; 95% CI: 2.87, 13.63) were more likely to report having household firearms owned by someone else. Storing firearms loaded was more prevalent among women with lifetime (APR=1.47; 95% CI=1.03, 2.08) or past-month (APR=1.69; 95% CI=1.15, 2.48) suicidal ideation and less likely among those with other adult(s) in the home (unadjusted PR=0.62; 95% CI=0.43, 0.91). Those with parenting responsibilities (APR=0.61; 95% CI=0.38, 0.97) were less likely to store firearms unlocked. CONCLUSIONS Firearm access is prevalent among post-9/11 women Veterans using VA RHC. Interpersonal factors may be important determinants of firearm access in this population. Safe firearm storage initiatives are needed among women Veterans using RHC, particularly for those with suicidal ideation.
Collapse
Affiliation(s)
- Lindsey L Monteith
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Aurora, CO, 80045, USA. .,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Ryan Holliday
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Aurora, CO, 80045, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christin N Miller
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Aurora, CO, 80045, USA
| | - Alexandra L Schneider
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Aurora, CO, 80045, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Aurora, CO, 80045, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Claire A Hoffmire
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Aurora, CO, 80045, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
7
|
The association between gun shows and firearm injuries: An analysis of 259 gun shows across 23 US cities. Prev Med 2022; 161:107110. [PMID: 35716808 DOI: 10.1016/j.ypmed.2022.107110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/09/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022]
Abstract
Guns shows are estimated to account for 4-9% of firearm sales in the US. Increased regulation of firearm sales at gun shows has been proposed as one approach to reducing firearm injury rates. This study evaluated the association between gun shows and local firearm injury rates. Data regarding the date and location of gun shows from 2017 to 2019 were abstracted from the Big Show Journal. Firearm injury rates were estimated using discharges from trauma centers serving counties within a 25-mile radius of each gun show. Clinical data were derived from the National Trauma Databank (NTDB). We used Poisson regression modeling to adjust for potential confounders including seasonality. We evaluated injury rates before and after 259 gun shows in 23 US locations using firearm injury data from 36 trauma centers. There were 1513 hospitalizations for firearm injuries pre-gun show and 1526 post-gun show. The adjusted mean 2-week rate of all-cause firearm injury per 1,000,000 person-years was 1.79 (1.16-2.76) before and 1.82 (1.18-2.83) after a gun show, with an incident rate ratio of 1.02 (0.94, 1.08). The adjusted mean 2-week rate did not vary significantly by intent after a gun show, (p = 0.24). Within two weeks after a gun show, rates of hospitalization for all-cause firearm injury do not increase significantly within the surrounding communities. The relatively small increase in available firearms after a show and the short time horizon evaluated may account for the absence of an association between gun show firearm sales and local firearm injury rates.
Collapse
|
8
|
Abstract
We introduce an approach to identify latent topics in large-scale text data. Our approach integrates two prominent methods of computational text analysis: topic modeling and word embedding. We apply our approach to written narratives of violent death (e.g., suicides and homicides) in the National Violent Death Reporting System (NVDRS). Many of our topics reveal aspects of violent death not captured in existing classification schemes. We also extract gender bias in the topics themselves (e.g., a topic about long guns is particularly masculine). Our findings suggest new lines of research that could contribute to reducing suicides or homicides. Our methods are broadly applicable to text data and can unlock similar information in other administrative databases. There is an escalating need for methods to identify latent patterns in text data from many domains. We introduce a method to identify topics in a corpus and represent documents as topic sequences. Discourse atom topic modeling (DATM) draws on advances in theoretical machine learning to integrate topic modeling and word embedding, capitalizing on their distinct capabilities. We first identify a set of vectors (“discourse atoms”) that provide a sparse representation of an embedding space. Discourse atoms can be interpreted as latent topics; through a generative model, atoms map onto distributions over words. We can also infer the topic that generated a sequence of words. We illustrate our method with a prominent example of underutilized text: the US National Violent Death Reporting System (NVDRS). The NVDRS summarizes violent death incidents with structured variables and unstructured narratives. We identify 225 latent topics in the narratives (e.g., preparation for death and physical aggression); many of these topics are not captured by existing structured variables. Motivated by known patterns in suicide and homicide by gender and recent research on gender biases in semantic space, we identify the gender bias of our topics (e.g., a topic about pain medication is feminine). We then compare the gender bias of topics to their prevalence in narratives of female versus male victims. Results provide a detailed quantitative picture of reporting about lethal violence and its gendered nature. Our method offers a flexible and broadly applicable approach to model topics in text data.
Collapse
|
9
|
Carter PM, Losman E, Roche JS, Malani PN, Kullgren JT, Solway E, Kirch M, Singer D, Walton MA, Zeoli AM, Cunningham RM. Firearm ownership, attitudes, and safe storage practices among a nationally representative sample of older U.S. adults age 50 to 80. Prev Med 2022; 156:106955. [PMID: 35065980 DOI: 10.1016/j.ypmed.2022.106955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/07/2022] [Accepted: 01/15/2022] [Indexed: 11/19/2022]
Abstract
Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for older adult populations. To inform prevention efforts, we conducted a probability-based web survey (12/1/2019-12/23/2019) of 2048 older adults (age 50-80) to characterize national estimates of firearm ownership, safety practices, and attitudes about health screening, counseling, and policy initiatives. Among older U.S. adults, 26.7% [95%CI = 24.8%-28.8%] report owning one or more firearms. The primary motivation for ownership was protection (69.5%), with 90.4% highlighting a fear of criminal assault. 39.4% of firearm owners reported regularly storing firearm(s) unloaded and locked, with 24.2% regularly storing at least one loaded and unlocked. While most firearm owners found healthcare screening (69.2% [95%CI: 64.9-73.1]) and safety counseling (63.2% [95%CI = 58.8-67.3]) acceptable, only 3.7% of older adults reported being asked about firearm safety by a healthcare provider in the past year. Among firearm owners, there was support for state-level policy interventions, including allowing family/police to petition courts to restrict access when someone is a danger to self/others (78.9% [95%CI = 75.1-82.3]), comprehensive background checks (85.0% [95%CI = 81.5-87.9]), restricting access/ownership under domestic violence restraining orders (88.1%; 95%CI = 84.9-90.7], and removing firearms from older adults with dementia/confusion (80.6%; 95%CI = 76.8-84.0]. Healthcare and policy-level interventions maintained higher support among non-owners than owners (p's < 0.001). Overall, data highlights opportunities exist for more robust firearm safety prevention efforts among older adults, particularly healthcare-based counseling and state/federal policies that focus on addressing lethal means access among at-risk individuals.
Collapse
Affiliation(s)
- Patrick M Carter
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ. of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America.
| | - Eve Losman
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America.
| | - Jessica S Roche
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America.
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States of America.
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America; Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd., NCRC 16-330W, Ann Arbor, MI 48019, United States of America; Dept of Health Management/Policy, Univ. of Michigan School of Public Health, 1415 Washington Heights 3790A, SPH I, Ann Arbor, MI 48109, United States of America; Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd., Ann Arbor, MI 48105, United States of America.
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America.
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America.
| | - Dianne Singer
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America; Child Health Evaluation and Research Center, University of Michigan, North Ingalls Building, 300N. Ingalls St., 6th Floor, Ann Arbor, MI 48109, United States of America.
| | - Maureen A Walton
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Addiction Center, Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI 48109, United States of America.
| | - April M Zeoli
- School of Criminal Justice, Michigan State University, 655 Auditorium Rd., East Lansing, MI 48824, United States of America.
| | - Rebecca M Cunningham
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ. of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America.
| |
Collapse
|
10
|
Miller M, Zhang W, Azrael D. Firearm Purchasing During the COVID-19 Pandemic: Results From the 2021 National Firearms Survey. Ann Intern Med 2022; 175:219-225. [PMID: 34928699 PMCID: PMC8697522 DOI: 10.7326/m21-3423] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The surge in background checks beginning in March 2020 suggested an acceleration in firearm purchases. Little was known about the people who bought these guns. OBJECTIVE To estimate the number and describe characteristics of firearm purchasers over a period spanning prepandemic and pandemic time, characterize new gun owners, and estimate the number of persons newly exposed to household firearms. DESIGN Probability-based online survey conducted in April 2021. Survey weights generated nationally representative estimates. SETTING United States, 1 January 2019 to 26 April 2021. PARTICIPANTS 19 049 of 29 985 (64%) English-speaking adults responded to the survey invitation; 5932 owned firearms, including 1933 who had purchased firearms since 2019, of whom 447 had become new gun owners. MEASUREMENTS The estimated number and characteristics of adults who, since 2019, have purchased firearms, distinguishing those who became new gun owners from those who did not, and the estimated number of household members newly exposed to firearms. RESULTS An estimated 2.9% of U.S. adults (7.5 million) became new gun owners from 1 January 2019 to 26 April 2021. Most (5.4 million) had lived in homes without guns, collectively exposing, in addition to themselves, over 11 million persons to household firearms, including more than 5 million children. Approximately half of all new gun owners were female (50% in 2019 and 47% in 2020 to 2021), 20% were Black (21% in 2019 and in 2020-2021), and 20% were Hispanic (20% in 2019 and 19% in 2020-2021). By contrast, other recent purchasers who were not new gun owners were predominantly male (70%) and White (74%), as were gun owners overall (63% male, 73% White). LIMITATIONS Retrospective assessment of when respondents purchased firearms. National estimates about new gun owners were based on 447 respondents. CONCLUSION Efforts to reduce firearm injury should consider the recent acceleration in firearm purchasing and the characteristics of new gun owners. PRIMARY FUNDING SOURCE The Joyce Foundation.
Collapse
Affiliation(s)
- Matthew Miller
- Northeastern University and Harvard Injury Control Research Center, Boston, Massachusetts (M.M.)
| | - Wilson Zhang
- Harvard Injury Control Research Center, Boston, Massachusetts (W.Z., D.A.)
| | - Deborah Azrael
- Harvard Injury Control Research Center, Boston, Massachusetts (W.Z., D.A.)
| |
Collapse
|
11
|
Individual and Neighborhood Level Characteristics of Pediatric Firearm Injuries Presenting at Trauma Centers in Colorado. J Trauma Acute Care Surg 2022; 93:385-393. [DOI: 10.1097/ta.0000000000003520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Martínez-Alés G, Gimbrone C, Rutherford C, Kandula S, Olfson M, Gould MS, Shaman J, Keyes KM. Role of Firearm Ownership on 2001-2016 Trends in U.S. Firearm Suicide Rates. Am J Prev Med 2021; 61:795-803. [PMID: 34420829 PMCID: PMC8608719 DOI: 10.1016/j.amepre.2021.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In the U.S., state-level household firearm ownership is strongly associated with firearm suicide mortality rates. Whether the recent increases in firearm suicide are explained by state-level household firearm ownership rates and trends remains unknown. METHODS Mortality data from the U.S. National Vital Statistics System and an estimate of state-level household firearm ownership rate were used to conduct hierarchical age-period-cohort (random-effects) modeling of firearm suicide mortality between 2001 and 2016. Models were adjusted for individual-level race and sex and for state-level poverty rate, unemployment rate, median household income in U.S. dollars, population density, and elevation. RESULTS Between 2001 and 2016, the crude national firearm suicide mortality rate increased from 6.8 to 8.0 per 100,000, and household firearm ownership rate remained relatively stable, at around 40%. Both variables were markedly heterogeneous and correlated at the state level. Age-period-cohort models revealed period effects (affecting people across ages) and cohort effects (affecting specific birth cohorts) underlying the recent increases in firearm suicide. Individuals born after 2000 had higher firearm suicide rates than most cohorts born before. A 2001-2006 decreasing period effect was followed, after 2009, by an increasing period effect that peaked in 2015. State-level household firearm ownership rates and trends did not explain cohort effects and only minimally explained period effects. CONCLUSIONS State-level firearm ownership rates largely explain the state-level differences in firearm suicide but only marginally explain recent increases in firearm suicide. Although firearms in the home increase firearm suicide risk, the recent national rise in firearm suicide might be the result of broader, more distal causes of suicide risk.
Collapse
Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, La Paz University Hospital, Madrid, Spain.
| | - Catherine Gimbrone
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Caroline Rutherford
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Sasikiran Kandula
- Department of Environmental Health Sciences (EHS), Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Mark Olfson
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, Columbia University, New York, New York
| | - Madelyn S Gould
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, Columbia University, New York, New York
| | - Jeffrey Shaman
- Department of Environmental Health Sciences (EHS), Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|
13
|
Hill TD, Wen M, Ellison CG, Wu G, Dowd-Arrow B, Su D. Modeling recent gun purchases: A social epidemiology of the pandemic arms race. Prev Med Rep 2021; 24:101634. [PMID: 34976686 PMCID: PMC8684007 DOI: 10.1016/j.pmedr.2021.101634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/07/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
We consider the social patterning of recent pandemic gun purchases. Overall, 6% of the sample reported purchasing a new gun during the pandemic. Pandemic gun purchasers tend to be male, younger, US-born, and living in the south. Pandemic gun purchasers tend to be less educated and recently unemployed. Pandemic gun purchasers tend to be Republicans and experiencing religious change.
In this paper, we document the social patterning of recent gun purchases to advance a contemporary social epidemiology of the pandemic arms race. We employ cross-sectional survey data from the 2020 Health, Ethnicity and Pandemic Study, which included a national sample of 2,709 community-dwelling adults living in the United States. We use binary logistic regression to model recent pandemic gun purchases as a function of age, sex, race/ethnicity, nativity status, region of residence, marital status, number of children, education, household income, pandemic job change, religious service attendance, pandemic religion change, and political party. Overall, 6% of the sample reported purchasing a new gun during the pandemic. Multivariate regression results suggest that pandemic gun purchasers tend to be male, younger, US-born, less educated, recently unemployed, experiencing changes in their religious beliefs, Republicans, and residents of southern states. To our knowledge, we are among the first to formally document a new population of pandemic gun owners that is characterized by youth, US-nativity, and religious volatility. Our analyses underscore the need for public health initiatives designed to enhance gun-related safety during pandemics, including, for example, addressing underlying motivations for recent gun purchases and improving access to training programs.
Collapse
Affiliation(s)
- Terrence D Hill
- Department of Sociology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - Ming Wen
- Department of Sociology, The University of Utah, 390 1530 E #301, Salt Lake City, UT 84112, USA
| | - Christopher G Ellison
- Department of Sociology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - Guangzhen Wu
- Department of Sociology, The University of Utah, 390 1530 E #301, Salt Lake City, UT 84112, USA
| | - Benjamin Dowd-Arrow
- Public Health Program, Florida State University, 526 Bellamy Building, Tallahassee, FL 32306, USA
| | - Dejun Su
- Department of Health Promotion, The University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE 68198, USA
| |
Collapse
|
14
|
Anestis JC, Anestis MD, Preston OC, Rodriguez TR. Dispositional characteristics in firearm ownership and purchasing behavior during the 2020 purchasing surge. Soc Sci Med 2021; 289:114408. [PMID: 34653931 DOI: 10.1016/j.socscimed.2021.114408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 01/29/2023]
Abstract
RATIONALE In 2020 the U.S. saw a firearm purchasing surge that was synchronous with the onset of the SARS-CoV-2 (COVID-19) pandemic and notable community unrest. Extant literature has highlighted a potential cohort effect among 2020 firearm purchasers and the importance of characterizing these individuals to inform policy and interventions. Dispositional traits have received minimal attention in the firearm literature overall, despite research that indicates dispositional traits impact intervention interest, access, and effectiveness. OBJECTIVE The current study examined two dispositional traits indicated as important in firearm research - threat sensitivity (THT) and disinhibition (DIS). We hypothesized that 1) firearm owners overall would have lower THT and higher DIS relative to non-firearm owners, 2) mean levels of DIS (but not THT) would be higher among firearm owners who purchased during the 2020 purchasing surge relative to firearm owners who did not and non-firearm owners, and 3) DIS (but not THT) would be related to future plans for purchasing such that mean levels of DIS would be highest amongst those who have plans. METHODS This study used an online-recruited sample (N = 3500) matched to 2010 US Census data. RESULTS Firearm owners demonstrated lower THT and higher DIS than non-firearm owners. 2020 firearm purchasers had higher DIS compared to non-firearm owners and non-purchasing firearm owners, while firearm owners who did not purchase had lower THT compared to non-owners and 2020 purchasers. Plans to purchase in the next 12 months was associated with higher DIS relative to those undecided or without plans. CONCLUSIONS In combination with prior research, findings suggest elevated DIS may drive purchasing as a danger and distress management strategy, while low THT may protect against emotion-based firearm purchasing. Further research is needed to clarify the directionality of these relationships and to identify other dispositional characteristics of those purchasing firearms in 2020.
Collapse
Affiliation(s)
- Joye C Anestis
- Department of Health Behavior, Society, & Policy, School of Public Health, Rutgers, The State University of New Jersey, USA.
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, Rutgers, the State University of New Jersey, USA; Department of Urban-Global Public Health, School of Public Health, Rutgers, the State University of New Jersey, USA
| | | | - Taylor R Rodriguez
- New Jersey Gun Violence Research Center, Rutgers, the State University of New Jersey, USA; Department of Psychology, School of Arts & Sciences, Rutgers, the State University of New Jersey, USA
| |
Collapse
|
15
|
Sokol RL, Schmidt C, Miller AL, Walton MA, Zimmerman M, Resnicow K, Cunningham RM, Carter PM. Motivations for firearm possession and storage practices among urban young adults: differences between parents and non-parents. Inj Prev 2021; 27:409-412. [PMID: 32912966 PMCID: PMC7943649 DOI: 10.1136/injuryprev-2020-043856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate motivations for firearm possession among urban young adults and determine if differences emerge between parents and non-parents, and to identify if storage practices differed according to motivation for firearm possession and parenting status. METHODS We used cross-sectional data among young adults seeking urban emergency department treatment at Hurley Medical Center between 2017 and 2018. Our analyses, completed in 2020, included 194 firearm-possessing young adults, 95 of whom were young parents. RESULTS Firearm-possessing parents were more likely to have a firearm for protection, than for any other motivation, compared with firearm-possessing non-parents (OR: 2.38, 95% CI 1.06 to 5.46). A significant interaction between parenting status and motivation for possession indicated the association between protective motivations and locked storage was significantly different between parents and non-parents, whereby there was a decreased odds of locked storage among non-parents who were motivated to possess a firearm for protection compared with any other motivation, but this association did not exist for parents (interaction OR=10.57, p<0.05). CONCLUSION Parental motivation for possessing a firearm most often lies in the desire to protect families. This motivation, however, does not necessitate unsafe storage.
Collapse
Affiliation(s)
| | - Carissa Schmidt
- Health Behavior & Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Alison L Miller
- Health Behavior & Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, Ann Arbor, MI, USA,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Marc Zimmerman
- Health Behavior & Health Education, University of Michigan, Ann Arbor, Michigan, USA,University of Michigan Injury Prevention Center, Ann Arbor, MI, USA,Michigan Youth Violence Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth Resnicow
- Health Behavior & Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca M Cunningham
- University of Michigan Injury Prevention Center, Ann Arbor, MI, USA,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA,Michigan Youth Violence Prevention Center, University of Michigan, Ann Arbor, MI, USA,Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA,Emergency Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Patrick M Carter
- Health Behavior & Health Education, University of Michigan, Ann Arbor, Michigan, USA,University of Michigan Injury Prevention Center, Ann Arbor, MI, USA,Michigan Youth Violence Prevention Center, University of Michigan, Ann Arbor, MI, USA,Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
16
|
Hill TD, Dowd-Arrow B, Ellison CG, Garcia-Alexander G, Bartkowski JP, Burdette AM. Sexual Dysfunction and Gun Ownership in America: When Hard Data Meet a Limp Theory. Am J Mens Health 2021; 15:15579883211044342. [PMID: 34521291 PMCID: PMC8447103 DOI: 10.1177/15579883211044342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although there has been no direct empirical evidence linking sexual dysfunction (SD) with gun ownership, speculation has been widespread and persistent for decades. In this paper, we formally examine the association between SD and gun ownership. Our primary hypothesis, derived from the psychosexual theory of gun ownership, asserts that men experiencing SD are more likely to personally own guns than other men. To test this hypothesis, we used recently collected data from the 2021 Crime, Health, and Politics Survey (CHAPS), a national probability sample of 780 men, and binary logistic regression to model gun ownership as a function of SD. Our key finding is that men experiencing SD are no more likely to own guns than men without SD. This interpretation was supported across several indicators of SD (performance anxiety, erection trouble, and ED medication) and gun ownership (personal gun ownership, purchasing a gun during the pandemic, and keeping a gun in one's bedroom). To our knowledge, we are the first to have directly tested the association between SD and gun ownership in America. Our findings are important because they contribute to our understanding of factors associated with gun ownership by challenging the belief that phallic symbolism and masculinity somehow drive men with SD to purchase guns. Our results also remind us of the perils of gun culture rhetoric, which, in this case, function to discredit gun owners and to further stigmatize men with ED. We conclude by calling for more evidence-based discussions of SD and guns in society.
Collapse
Affiliation(s)
- Terrence D Hill
- Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Benjamin Dowd-Arrow
- Department of Sociology, Public Health Program, and Pepper Institute on Aging and Public Policy, Florida State University, Tallahassee, FL, USA
| | | | | | - John P Bartkowski
- Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Amy M Burdette
- Department of Sociology, Public Health Program, and Pepper Institute on Aging and Public Policy, Florida State University, Tallahassee, FL, USA
| |
Collapse
|
17
|
Lynch KR, Jackson DB, Logan TK. Coercive Control, Stalking, and Guns: Modeling Service Professionals' Perceived Risk of Potentially Fatal Intimate Partner Gun Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP7997-NP8018. [PMID: 30943829 DOI: 10.1177/0886260519839419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intimate partner homicides often involve coercive control prior to the murder while stalking following separation has been associated with control within the relationship as well as with lethal violence. The goal of the present study was to investigate how rural and urban community professionals who encounter intimate partner violence (IPV) victims perceive potential risk factors for intimate partner homicide related to firearms and coercive control. Criminal justice and victim service professionals (N = 133) from one urban and four rural communities participated in structured key informant interviews. A purposeful sampling procedure was employed to target professionals with expertise in domestic violence and/or firearms, followed by snowball sampling to maximize the response rate. The only risk factor that was directly associated with perceived risk of potentially fatal intimate partner gun violence was the perceived risk of an abuser threatening a victim with a gun. However, coercive control, separation, and stalking all mediated the relationship between the perceived risk of an abuser's access to a gun and the perceived risk of an abuser threatening the victim with a gun. These results highlight the importance of controlling behavior following separation for risk assessment and that participants in the present study were aware of the potentially dangerous ramifications of such nonphysically violent risk factors for the risk of injury or death by a firearm at the hands of an intimate partner.
Collapse
Affiliation(s)
| | | | - T K Logan
- University of Kentucky, Lexington, USA
| |
Collapse
|
18
|
Blosnich JR, Clark KA, Mays VM, Cochran SD. Sexual and Gender Minority Status and Firearms in the Household: Findings From the 2017 Behavioral Risk Factor Surveillance System Surveys, California and Texas. Public Health Rep 2020; 135:778-784. [PMID: 33026962 DOI: 10.1177/0033354920954789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Although lesbian, gay, bisexual, and transgender (LGBT) people have a higher prevalence of reporting a lifetime suicide attempt than non-LGBT people, suicide prevention research on access to lethal means (eg, firearms) among LGBT people is limited. Our study examined (1) the presence of firearms in the home and (2) among respondents with firearms in the home, the storage of firearms as stored unloaded, stored as loaded and locked, or stored as loaded and unlocked. METHODS We used data from the 2017 Behavioral Risk Factor Surveillance System surveys from California and Texas (N = 11 694), which were the only states to include items about both sexual orientation and gender identity and the status of firearms in the home. We used logistic regression analysis to assess the association of sexual orientation and gender identity with having firearms in the home while accounting for sociodemographic characteristics and survey state. All analyses were weighted to account for the complex sampling design. RESULTS Approximately 4.2% of the sample identified as lesbian, gay, and bisexual (LGB). About 18.2% of LGB people reported firearms in the home compared with 29.9% of their heterosexual peers. After adjusting for sex, age, race/ethnicity, educational attainment, and military veteran status, LGB respondents had significantly lower odds of reporting firearms in the home than their heterosexual peers (adjusted odds ratio = 0.47; 95% CI, 0.27-0.84). Among respondents with firearms in the home, firearm storage did not differ by sexual orientation. CONCLUSIONS Further research is needed to examine whether lower odds of firearms in the home are protective against suicide deaths among LGB populations.
Collapse
Affiliation(s)
- John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA.,98139 Center for Health Equity Research & Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Kirsty A Clark
- 8783 Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Vickie M Mays
- Department of Psychology, University of California, Los Angeles, CA, USA.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA.,Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, University of California, Los Angeles, CA, USA
| | - Susan D Cochran
- 8783 Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.,Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, University of California, Los Angeles, CA, USA.,Department of Statistics, University of California, Los Angeles, CA, USA
| |
Collapse
|
19
|
Sokol RL, Victor BG, Piellusch EK, Nielsen SB, Ryan JP, Perron BE. Prevalence and context of firearms-related problems in child protective service investigations. CHILD ABUSE & NEGLECT 2020; 107:104572. [PMID: 32512264 PMCID: PMC7494624 DOI: 10.1016/j.chiabu.2020.104572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/20/2020] [Accepted: 05/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite the significance of firearm safety, we need additional data to understand the prevalence and context surrounding firearm-related problems within the child welfare system. OBJECTIVE Estimate proportion of cases reporting a firearm-related problem during case initiation and the contexts in which these problems exist. SAMPLE AND SETTING 75,809 caseworker-written investigation summaries that represented all substantiated referrals of maltreatment in Michigan from 2015 to 2017. METHODS We developed an expert dictionary of firearm-related terms to search investigation summaries. We retrieved summaries that contained any of the terms to confirm whether a firearm was present (construct accurate) and whether it posed a threat to the child. Finally, we coded summaries that contained firearm-related problems to identify contexts in which problems exist. RESULTS Of the 75,809 substantiated cases, the dictionary flagged 2397 cases that used a firearm term (3.2 %), with a construct accuracy rate of 96 %. Among construct accurate cases, 79 % contained a firearm-related problem. The most common intent for a firearm-related problem was violence against a person (45 %). The co-occurrence of domestic violence and/or substance use with a firearm-related problem was high (41 % and 48 %, respectively). 49 % of summaries that contained a firearm-related problem did not provide information regarding storage. CONCLUSION When caseworkers document a firearm within investigative summaries, a firearm-related risk to the child likely exists. Improved documentation of firearms and storage practices among investigated families may better identify families needing firearm-related services.
Collapse
Affiliation(s)
- Rebeccah L Sokol
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Bryan G Victor
- School of Social Work, Indiana University, 902 West New York Street, Indianapolis, IN, 46202, USA
| | - Emily K Piellusch
- School of Social Work, University of Michigan, 1080 S University, Ann Arbor, MI, 48109, USA
| | - Sophia B Nielsen
- School of Social Work, University of Michigan, 1080 S University, Ann Arbor, MI, 48109, USA
| | - Joseph P Ryan
- School of Social Work, University of Michigan, 1080 S University, Ann Arbor, MI, 48109, USA
| | - Brian E Perron
- School of Social Work, University of Michigan, 1080 S University, Ann Arbor, MI, 48109, USA
| |
Collapse
|
20
|
Blosnich JR, Karras E, Bossarte RM. Response Variations to Survey Items About Firearms in the 2004 and 2017 Behavioral Risk Factor Surveillance System. Am J Health Promot 2020; 35:255-261. [PMID: 32700542 DOI: 10.1177/0890117120943114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this investigation was to document the prevalence and correlates of refusing to answer a US federal health survey item about firearms in the household. DESIGN The cross-sectional analysis was conducted with 2004 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) survey data from Texas, Oregon, Idaho, California, Kansas, and Utah states whose surveys included items about firearms in the household. PARTICIPANTS Probability-based samples of adults over the age of 18 (n = 34 488 in 2017 BRFSS; n = 33 136 in 2004 BRFSS). MEASURES Dichotomized measure of whether respondents answered versus refused to answer "Are any firearms now kept in or around your home?" ANALYSIS Weighted multiple logistic regression was used to assess how sociodemographic and health-related characteristics were associated with item refusal. RESULTS Approximately 1.8% (95% CI: 1.6-2.1) of respondents in 2004 and 3.9% (95% CI: 3.4-4.5) of respondents in 2017 sample refused the firearms item (P < .01). Men were more likely than women (2004: adjusted odds ratio [aOR] = 1.81, 95% CI: 1.24-2.62; 2017: aOR = 1.60, 95% CI = 1.17-2.18) and Latino/a respondents were less likely than white respondents (2004: aOR = 0.24, 95% CI: 0.10-0.60; 2017: aOR = 0.21, 95% CI: 0.13-0.34) to refuse the firearms question. In 2004, refusal was more likely among older than younger respondents, but in 2017, age was not associated with refusal. CONCLUSIONS Refusal to firearm-related survey items along sociodemographic characteristics warrants further research. Community-informed strategies (eg, focus groups, cognitive testing, in-depth interviews) could improve the context and wording of firearm-related items to maximize response to these items in public health surveys.
Collapse
Affiliation(s)
- John R Blosnich
- Suzanne Dworak-Peck School of Social Work, 5116University of Southern California, Los Angeles, CA, USA.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Elizabeth Karras
- Injury Control Research Center, West Virginia University, Morgantown, West Virginia, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,8267Department of Veterans Affairs, Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| | - Robert M Bossarte
- Injury Control Research Center, West Virginia University, Morgantown, West Virginia, USA.,8267Department of Veterans Affairs, Center of Excellence for Suicide Prevention, Canandaigua, NY, USA.,Department of Epidemiology and Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
| |
Collapse
|
21
|
Gresham M, Demuth S. Who Owns a Handgun? An Analysis of the Correlates of Handgun Ownership in Young Adulthood. CRIME AND DELINQUENCY 2020; 66:541-571. [PMID: 32405082 PMCID: PMC7219980 DOI: 10.1177/0011128719847457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Previous research on firearms has not adequately addressed a fundamental question about handgun ownership: Why do some people own handguns while most in the United States do not? We use data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine adolescent and adult correlates of handgun ownership, including socialization, victimization and fear of crime, political ideology, and societal insecurities. We also investigate the differences between "typical" owners and "atypical" owners who own more handguns. We find that socialization, victimization, conservatism, and societal insecurity all independently increase the likelihood of handgun ownership, and atypical handgun owners are more likely to be conservative and to have experienced victimization than typical owners.
Collapse
|
22
|
Abstract
OBJECTIVES Examine the effect of different types of firearms on readmission due to acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD) in firearm-injury victims. BACKGROUND Survivors of firearm-related injuries suffer long-term sequelae such as disability, work loss, and deterioration in the quality of life. There is a paucity of data describing the long-term mental health outcomes in these patients. METHODS We performed a 5-year (2011-2015) analysis of the Nationwide Readmission Database. All adult patients with firearm injuries were stratified into 3 groups by firearm type: handgun, shotgun, and semiautomatic rifle. Outcome measures were the incidence and predictors of ASD/PTSD. RESULTS A total of 100,704 victims of firearm-related injuries were identified, of which 13.3% (n = 13,393) were readmitted within 6 months of index hospitalization, 6.7% (n = 8970) of these due to ASD/PTSD. Mean age was 34 ± 14 years, 88% were men. Of those readmitted due to ASD/PTSD, 24% (n = 2153) sustained a handgun-related injury on index hospitalization, 12% (n = 1076) shotgun, and 64% (n = 5741) semiautomatic gun (P = 0.039). On regression analysis, semiautomatic gun and shotgun victims had higher odds of developing ASD/PTSD upon readmission [odds ratio (OR): 2.05 (1.10-4.12) and OR: 1.41 (1.08-2.11)] compared to handgun. Female sex [OR: 1.79 (1.05-3.05)] and younger age representing those younger than 25 years [OR: 4.66 (1.12-6.74)] were also independently associated with higher odds of ASD/PTSD. CONCLUSIONS Apart from the lives lost, survivors of semiautomatic rifle- and shotgun-related injuries suffer long-term mental health sequalae. These secondary and debilitating mental health outcomes are important considerations for capturing the overall burden of the disease.
Collapse
|
23
|
Clark KA, Blosnich JR, Coulter RW, Bamwine P, Bossarte RM, Cochran SD. Sexual Orientation Differences in Gun Ownership and Beliefs About Gun Safety Policy, General Social Survey 2010-2016. VIOLENCE AND GENDER 2020; 7:6-10. [PMID: 32181266 PMCID: PMC7071063 DOI: 10.1089/vio.2019.0019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The aim of this study was to investigate sexual orientation differences in gun ownership and gun safety beliefs among U.S. adults. We used information from the General Social Survey (2010-2016) to assess presence of guns in the household, personal gun ownership, and endorsement of a gun safety law among sexual minority (n = 195) versus heterosexual (n = 4359) respondents. Methods employed multivariate logistic regression analyses adjusted for confounding including gender, age, race/ethnicity, education level, size of household, urbanicity, military veteran status, and political views. Gay/bisexual men were more likely to endorse a gun safety law (adjusted odds ratio [aOR] = 3.24, 95% confidence interval [CI] = 1.79-5.88) and less likely to report guns in the household (aOR = 0.34, 95% CI = 0.18-0.65) than heterosexual men. In contrast, lesbian/bisexual and heterosexual women similarly endorsed a gun safety law and reported household guns. However, among women reporting a household gun, lesbian/bisexual women were more likely to be the personal gun owner (aOR = 3.97, 95% CI = 1.43-11.03). Attitudes toward a gun safety law and gun ownership differ by sexual orientation, but patterns vary by gender. We recommend that clinicians inquire about gun ownership and gun storage practices with both heterosexual and sexual minority patients.
Collapse
Affiliation(s)
- Kirsty A. Clark
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | - John R. Blosnich
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Prevention, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- West Virginia University Injury Control Research Center, Morgantown, West Virginia
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Robert W.S. Coulter
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Patricia Bamwine
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Robert M. Bossarte
- West Virginia University Injury Control Research Center, Morgantown, West Virginia
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Susan D. Cochran
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| |
Collapse
|
24
|
Schleimer JP, Kravitz-Wirtz N, Pallin R, Charbonneau AK, Buggs SA, Wintemute GJ. Firearm ownership in California: A latent class analysis. Inj Prev 2019; 26:456-462. [PMID: 31601624 DOI: 10.1136/injuryprev-2019-043412] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/08/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine whether firearm ownership and ownership-related motivations and practices can be classified into reasonably distinct types. METHODS Cross-sectional data on firearm owners (n=429) were obtained from the 2018 California Safety and Well-Being Survey, a state-representative web-based survey. We conducted a latent class analysis using six self-reported indicators of firearm ownership: (1) number of firearms owned, (2) types of firearms owned, (3) primary reason for firearm ownership, (4) firearm storage, (5) loaded handgun carrying and (6) high-capacity magazine ownership. RESULTS We identified five markedly different classes of firearm ownership. There were two classes of single-firearm owners and three classes of multiple-firearm owners. Only members of one class (9% of owners) were likely to have carried a loaded handgun and to own high-capacity magazines or assault-type weapons. Members of this class were also likely to own 5+ firearms, own for protection against people, and store a firearm in the least secure manner (loaded and unlocked). CONCLUSION There were distinct classes of firearm ownership in California, and all higher-risk behaviours studied were exhibited disproportionately by members of a single class. This latent class structure, which may help identify higher-risk groups of firearm owners, could inform future research on risk assessment and on focused interventions to reduce firearm injury and death.
Collapse
Affiliation(s)
- Julia P Schleimer
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis, Sacramento, California, USA
| | - Nicole Kravitz-Wirtz
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis, Sacramento, California, USA
| | - Rocco Pallin
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis, Sacramento, California, USA
| | - Amanda K Charbonneau
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis, Sacramento, California, USA
| | - Shani A Buggs
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis, Sacramento, California, USA
| | - Garen J Wintemute
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis, Sacramento, California, USA
| |
Collapse
|
25
|
Butterworth SE, Anestis MD. Political Beliefs, Region of Residence, and Openness to Firearm Means Safety Measures to Prevent Suicide. Arch Suicide Res 2019; 23:616-633. [PMID: 29952717 DOI: 10.1080/13811118.2018.1486250] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Firearms account for approximately half of all suicides in the United States and are highly lethal, widely available, and popular; thus, are an ideal candidate for targeted means safety interventions. However, despite their value as a suicide prevention tool, firearm means safety strategies are not widely utilized, possibly due to factors which impede openness to their use. This study examines the relationship between region, political beliefs, and openness to firearm means safety in a sample of 300 American firearm owners. Overall, firearm owners were more willing to engage in means safety for others than for themselves and to store firearms safely than temporarily remove them from the home. Social policy views and region were significantly associated with openness to firearm means safety measures, however, economic policy views were not. This study provides further context for the development and implementation of efficacious means safety measures capable of overcoming potential barriers to their use.
Collapse
|
26
|
Promoting Safe Firearm Storage in an Urban Neighborhood: The Views of Parents Concerning the Role of Health Care Providers. J Community Health 2019; 45:338-341. [PMID: 31549353 DOI: 10.1007/s10900-019-00748-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pediatric clinics are uniquely positioned to assess and advocate for the health and safety of Chicago's children in relation to accidental firearm-related injury and death. The best means of counseling families should be tailored to the individual community and patient population. We aimed to determine rates of firearm ownership and attitudes towards counseling about firearms in a community on the west side of Chicago with high rates of gun violence. An anonymous survey about gun ownership was administered at a federally qualified health center. The survey was completed by 206 adults with children less than 18 living in the home. A minority of participants (8.3%; n = 17) indicated that a gun was kept in or around the home. The majority of firearm owners reported using safe storage practices. However, just over half of the gun owners and non-gun owners had a favorable opinion of counseling about firearm safety in healthcare settings. Other strategies in addition to physician counseling will be required to promote safe firearm storage in this neighborhood with high rates of community violence.
Collapse
|
27
|
Perspectives from firearm stakeholders on firearm safety promotion in pediatric primary care as a suicide prevention strategy: a qualitative study. J Behav Med 2019; 42:691-701. [PMID: 31367934 DOI: 10.1007/s10865-019-00074-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
The primary objective of the current study was to examine the perspective of firearm stakeholders, including firearm safety course instructors, members of law enforcement, and firearm retailers, with regard to the implementation of an evidence-based approach to firearm safety promotion, the Firearm Safety Check, as a universal suicide prevention strategy in pediatric primary care. Twelve firearm stakeholders participated in semi-structured interviews. Using an integrated analytic approach, several themes emerged from the interviews. With regard to acceptability of the intervention, participants generally found counseling caregivers to store firearms safely and the provision of firearm locking mechanisms to be acceptable, but expressed concern about screening for firearm ownership in health systems. Participants identified distinct roles of responsibility for firearm advocacy groups, firearm owners, healthcare clinicians, and caregivers with regard to the promotion and execution of safe firearm storage. Participants called for partnerships between healthcare systems and firearm stakeholders, and also identified potential threats to these partnerships, including lack of trust firearm owners may have in health systems and the government. Finally, participants suggested strategies for preventing firearm-related suicides. Findings support a growing body of literature suggesting the value in researchers, health systems, and firearm stakeholders partnering around a shared agenda of firearm safety promotion as a strategy to prevent suicide.
Collapse
|
28
|
Horwitz AG, Smith DL, Held P, Zalta AK. Characteristics of Veteran and Civilian Suicide Decedents: A Sex-Stratified Analysis. Am J Prev Med 2019; 56:e163-e168. [PMID: 30898537 PMCID: PMC6475460 DOI: 10.1016/j.amepre.2018.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Few studies have examined characteristics distinguishing Veteran and civilian suicide decedents. An understanding of unique risk factors for Veteran suicide is critical to develop effective preventive interventions. This is particularly imperative for female Veterans, who have near double the suicide mortality rate of same-aged female civilians. The objectives of this study were to examine whether Veteran and civilian suicide decedents differed on risk factors and suicide-event characteristics, and to determine whether predictors changed based on sex. METHODS Data from 116,515 suicides collected by the National Violent Death Reporting System in 27 states between 2003 and 2015 were analyzed in 2018 in sex-stratified analyses. Logistic regression models examined population differences in risk factors and suicide-event characteristics. RESULTS Relative to male civilians, male Veterans were more likely to have a contributing physical health problem (AOR=1.10, 95% CI=1.06, 1.14) and to use a firearm for their suicide (AOR=1.41, 95% CI=1.36, 1.47); they were less likely to have substance use problems (AOR=0.70, 95% CI=0.66, 0.75), depressed mood (AOR=0.93, 95% CI=0.90, 0.97), or financial problems (AOR=0.91, 95% CI=0.86, 0.97). Female Veterans were more likely to use a firearm for their suicide (AOR=1.39, 95% CI=1.19, 1.63) relative to female civilians. CONCLUSIONS Firearm use as a suicide method was a key distinguishing feature of Veteran suicide. Means restriction and firearm safety are pertinent to preventing Veteran suicide. Given low utilization of mental health care and frequent presence of physical health problems in this population, safe storage messages may have a greater preventive impact if delivered in primary care or other nonpsychiatric settings.
Collapse
Affiliation(s)
- Adam G Horwitz
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; Department of Psychiatry, Rush University Medical Center, Chicago, Illinois.
| | - Dale L Smith
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois; Department of Psychology, Olivet Nazarene University, Bourbonnais, Illinois
| | - Philip Held
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois
| | - Alyson K Zalta
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois; Department of Psychological Science, University of California, Irvine, Irvine, California
| |
Collapse
|
29
|
Slovak K, Pope N, Giger J, Kheibari A. An Evaluation of the Counseling on Access to Lethal Means (CALM) Training with an Area Agency on Aging. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2019; 62:48-66. [PMID: 30247989 DOI: 10.1080/01634372.2018.1522410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/07/2018] [Indexed: 06/08/2023]
Abstract
Firearms are a significant risk factor in suicide and older adults are disproportionately impacted in suicide by this means. This study investigated the impact of Counseling on Access to Lethal Means (CALM) training with geriatric case managers at an Area Agency on Aging. A concurrent mixed methods approach was used to explore 1) geriatric case managers' attitudes, beliefs, and behavioral intentions about counseling on access to lethal means following CALM training, and 2) perceived barriers to assessing for suicidality and counseling clients on access to firearms. The CALM evaluation data was collected immediately posttest at CALM training, at three-month follow up. Results indicated that 38% of respondents reported they had, since CALM training, discussed reducing access to lethal means with clients and/or families. At three-month follow up, data showed that most beliefs, attitudes, and behavioral intentions about counseling clients and families on this topic increased. Focus group findings indicated that training had a positive effect on participants' attitudes, beliefs, and behavioral intentions about counseling on access to lethal means.The findings of the present study offer additional evidence and implication for trainings of this type.
Collapse
Affiliation(s)
- Karen Slovak
- a Social Work , aMalone University , Canton , USA
- b College of Social Work , bUnviversity of Kentucky , Lexington , USA
| | - Natalie Pope
- a Social Work , aMalone University , Canton , USA
- b College of Social Work , bUnviversity of Kentucky , Lexington , USA
| | - Jarod Giger
- a Social Work , aMalone University , Canton , USA
- b College of Social Work , bUnviversity of Kentucky , Lexington , USA
| | - Athena Kheibari
- a Social Work , aMalone University , Canton , USA
- b College of Social Work , bUnviversity of Kentucky , Lexington , USA
| |
Collapse
|
30
|
Beidas RS, Jager-Hyman S, Becker-Haimes EM, Wolk CB, Ahmedani BK, Zeber JE, Fein JA, Brown GK, Gregor CA, Lieberman A, Marcus SC. Acceptability and Use of Evidence-Based Practices for Firearm Storage in Pediatric Primary Care. Acad Pediatr 2018; 19:670-676. [PMID: 30508600 PMCID: PMC6542719 DOI: 10.1016/j.acap.2018.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 11/05/2018] [Accepted: 11/11/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Promoting safe firearm storage in pediatric primary care is one way to address youth suicide by firearm. The study objective was to determine the perspectives of primary care physicians (PCPs) and leaders of primary care practices regarding the acceptability and use of screening, counseling, and firearm locks-all components of an adapted evidence-based intervention known as the Firearm Safety Check. METHODS In 2016, an online survey was conducted in two large US health systems. PCPs (n = 204) and leaders (n = 57) from 83 clinics were invited to participate. Respondents included 71 clinics (86%), 103 PCPs (50%), and 40 leaders (70%). Main outcomes included acceptability (6-point Likert scale, with higher scores indicating better acceptability) and use of the 3 intervention components (4-point Likert scale, with higher scores indicating greater use), as measured by an adapted validated instrument. RESULTS Analyses were conducted in 2017. PCP acceptability of screening (mean = 4.28; standard deviation [SD] = 1.12) and counseling (mean = 4.56; SD = 0.89) were high, but acceptability for firearm lock provision was more neutral (mean = 3.78; SD = 1.16). Most PCPs endorsed sometimes screening (85%) and counseling (80%). Few PCPs offered firearm locks to caregivers (15%). Leaders reported consistent information. CONCLUSION The acceptability of screening for firearms and safe storage counseling was high; both components were used commonly but not routinely. The acceptability of providing firearm locks was neutral, and use was rarely endorsed. This study provides important insights about areas of focus for future implementation efforts from policy and research perspectives.
Collapse
Affiliation(s)
- Rinad S Beidas
- Department of Psychiatry (RS Beidas, S Jager-Hyman, EM Becker-Haimes, CB Wolk, GK Brown, CA Gregor, and A Lieberman),.
| | - Shari Jager-Hyman
- Department of Psychiatry (RS Beidas, S Jager-Hyman, EM Becker-Haimes, CB Wolk, GK Brown, CA Gregor, and A Lieberman)
| | - Emily M Becker-Haimes
- Department of Psychiatry (RS Beidas, S Jager-Hyman, EM Becker-Haimes, CB Wolk, GK Brown, CA Gregor, and A Lieberman)
| | - Courtney Benjamin Wolk
- Department of Psychiatry (RS Beidas, S Jager-Hyman, EM Becker-Haimes, CB Wolk, GK Brown, CA Gregor, and A Lieberman)
| | - Brian K Ahmedani
- Division of Emergency Medicine, Children's Hospital of Philadelphia (JA Fein)
| | - John E Zeber
- School of Social Policy and Practice, University of Pennsylvania (SC Marcus), Philadelphia, Pa; Center for Health Policy and Health Services Research, Henry Ford Health System (BK Ahmedani), Detroit, Mich
| | - Joel A Fein
- Center for Applied Health Research, Baylor Scott & White Health (JE Zeber), Temple, Tex
| | - Gregory K Brown
- Department of Psychiatry (RS Beidas, S Jager-Hyman, EM Becker-Haimes, CB Wolk, GK Brown, CA Gregor, and A Lieberman)
| | - Courtney A Gregor
- Department of Psychiatry (RS Beidas, S Jager-Hyman, EM Becker-Haimes, CB Wolk, GK Brown, CA Gregor, and A Lieberman)
| | - Adina Lieberman
- Department of Psychiatry (RS Beidas, S Jager-Hyman, EM Becker-Haimes, CB Wolk, GK Brown, CA Gregor, and A Lieberman)
| | - Steven C Marcus
- Department of Medical Ethics & Health Policy (RS Beidas), University of Pennsylvania Perelman School of Medicine
| |
Collapse
|
31
|
Benjamin Wolk C, Van Pelt AE, Jager-Hyman S, Ahmedani BK, Zeber JE, Fein JA, Brown GK, Gregor CA, Lieberman A, Beidas RS. Stakeholder Perspectives on Implementing a Firearm Safety Intervention in Pediatric Primary Care as a Universal Suicide Prevention Strategy: A Qualitative Study. JAMA Netw Open 2018; 1:e185309. [PMID: 30646398 PMCID: PMC6324366 DOI: 10.1001/jamanetworkopen.2018.5309] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
IMPORTANCE The rate of youth suicide has increased steadily over the past several decades due, in part, to an increase in suicide by firearm. Implementation of evidence-based approaches to increase safe firearm storage practices are important for reducing youth suicide. OBJECTIVE To assess the needs of stakeholders who would be affected by implementing an evidence-based approach to firearm safety promotion-Firearm Safety Check, which includes screening for the presence of firearms in the home, brief motivational interviewing-informed counseling regarding safe firearm storage, and provision of free firearm locks-in pediatric primary care settings. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, 58 stakeholders were interviewed over a 7-month period across 9 stakeholder groups from 2 large and diverse health systems. Participants included parents of youth; physicians; nurses and nurse practitioners; leaders of pediatric primary care practices, behavioral health, and quality improvement; system leaders; third-party payers; and members of national credentialing bodies. Data analysis were conducted from September 2017 to April 2018. MAIN OUTCOMES AND MEASURES Interview guides were informed by the Consolidated Framework for Implementation Research. An integrated analysis approach was used in which a priori attributes of interest were identified (Consolidated Framework for Implementation Research constructs, eg, intervention characteristics), and an inductive approach was used with regard to new themes that emerged. RESULTS A total of 58 stakeholders were interviewed (mean [SD] age, 48.38 [10.65] years; 27 men and 31 women). Stakeholders indicated that firearm safety promotion is a health system priority and reported favorable perceptions of the Firearm Safety Check approach for suicide prevention. The importance of leveraging existing infrastructures, such as electronic health record systems and brevity, were frequently noted. Distribution of firearm locks was endorsed as the most complicated component to implement. CONCLUSIONS AND RELEVANCE By including multiple service system stakeholder perspectives, these results support the development of implementation strategies to change clinician, organization, and system behaviors around firearm safety promotion in pediatric primary care as a universal suicide prevention strategy.
Collapse
Affiliation(s)
- Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Amelia E. Van Pelt
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian K. Ahmedani
- Henry Ford Health System, Center for Health Policy & Health Services Research and Behavioral Health Services, Detroit, Michigan
| | - John E. Zeber
- Center for Applied Health Research, Baylor Scott & White Health, jointly with Central Texas Veterans Health Care System, Temple
- School of Public Health, University of Massachusetts at Amherst, Amherst
| | - Joel A. Fein
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Gregory K. Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Courtney A. Gregor
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Adina Lieberman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rinad S. Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
32
|
Sorenson SB, Schut RA. Nonfatal Gun Use in Intimate Partner Violence: A Systematic Review of the Literature. TRAUMA, VIOLENCE & ABUSE 2018; 19:431-442. [PMID: 27630138 DOI: 10.1177/1524838016668589] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Guns figure prominently in the homicide of women by an intimate partner. Less is known, however, about their nonfatal use against an intimate partner. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched eight electronic databases and identified 10 original research articles that reported the prevalence of the nonfatal use of firearms against an intimate partner. Results indicate that (1) there is relatively little research on the subject of intimate partners' nonfatal gun use against women. (2) The number of U.S. women alive today who have had an intimate partner use a gun against them is substantial: About 4.5 million have had an intimate partner threaten them with a gun and nearly 1 million have been shot or shot at by an intimate partner. Whether nonfatal gun use is limited to the extreme form of abuse (battering) or whether it occurs in the context of situational violence remains to be seen. Regardless, when it comes to the likely psychological impact, it may be a distinction without a difference; because guns can be lethal quickly and with relatively little effort, displaying or threatening with a gun can create a context known as coercive control, which facilitates chronic and escalating abuse. Implications for policy, practice, and research are discussed, all of which include expanding an implicit focus on homicide to include an intimate partner's nonfatal use of a gun.
Collapse
|
33
|
Richmond TS, Foman M. Firearm Violence: A Global Priority for Nursing Science. J Nurs Scholarsh 2018; 51:229-240. [PMID: 30215887 DOI: 10.1111/jnu.12421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE This purpose of this article is to frame firearm violence as a health and public health problem, to illustrate the magnitude of the problem, to examine factors that increase the risk to be injured by a firearm, or conversely, that confer protection, and to identify relevant priority areas for nursing science. ORGANIZING CONSTRUCT Firearm violence results in physical and psychological injuries and is a global health priority. Firearm violence is categorized as intentional (interpersonal and self-inflicted) and unintentional (interpersonal and self-inflicted) and accounts for an estimated 196,000 to 220,000 nonconflict deaths annually. METHODS We reviewed the theoretical and scientific literature to analyze the magnitude and geographic distribution of firearm violence, the factors associated with firearm injury, the consequences of firearm violence, and areas where nursing science can make an impact on prevention, outcomes, and recovery. FINDINGS Firearm violence is a significant public health problem that affects the health of individuals, families, and communities. The burdens and contributors to firearm violence vary worldwide, making it important to understand the local context of this global phenomenon. Relevant areas of inquiry span primary prevention focusing on individual and environmental risk factors; and focus on managing the physical and psychological consequences postinjury; and mitigating long-term consequences of firearm violence. CONCLUSIONS Reducing the global burden of firearm violence and improving the health and safety of individuals, families, and communities provide compelling reasons to integrate this area into nursing science. CLINICAL RELEVANCE The goals of nursing are to keep people healthy and safe and to help return those injured to their optimal levels of health and well-being. Understanding the factors that come together to injure people with a firearm in various physical, social, economic, and cultural environments positions nurses to both extend the dialogue beyond pro-gun versus anti-gun and to design and carry out rigorous studies to reduce firearm violence.
Collapse
Affiliation(s)
- Therese S Richmond
- Andrea B. Laporte Professor of Nursing, Associate Dean for Research & Innovation, Biobehavioral Health Sciences Department, School of Nursing, University of Pennsylvania, Penn Injury Science Center, Philadelphia, PA, USA
| | - Matthew Foman
- Research Assistant, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.,Student, History and Sociology of Science Department, School of Arts & Sciences, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
34
|
Boggs JM, Beck A, Hubley S, Peterson EL, Hu Y, Williams LK, Prabhakar D, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Owen-Smith AA, Simon GE, Ahmedani BK. General Medical, Mental Health, and Demographic Risk Factors Associated With Suicide by Firearm Compared With Other Means. Psychiatr Serv 2018; 69:677-684. [PMID: 29446332 PMCID: PMC5984116 DOI: 10.1176/appi.ps.201700237] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mitigation of suicide risk by reducing access to lethal means, such as firearms and potentially lethal medications, is a highly recommended practice. To better understand groups of patients at risk of suicide in medical settings, the authors compared demographic and clinical risk factors between patients who died by suicide by using firearms or other means with matched patients who did not die by suicide (control group). METHODS In a case-control study in 2016 from eight health care systems within the Mental Health Research Network, 2,674 suicide cases from 2010-2013 were matched to a control group (N=267,400). The association between suicide by firearm or other means and medical record information on demographic characteristics, general medical disorders, and mental disorders was assessed. RESULTS The odds of having a mental disorder were higher among cases of suicide involving a method other than a firearm. Fourteen general medical disorders were associated with statistically significant (p<.001) greater odds of suicide by firearm, including traumatic brain injury (TBI) (odds ratio [OR]=23.53), epilepsy (OR=3.17), psychogenic pain (OR=2.82), migraine (OR=2.35), and stroke (OR=2.20). Fifteen general medical disorders were associated with statistically significant (p<.001) greater odds of suicide by other means, with particularly high odds for TBI (OR=7.74), epilepsy (OR=3.28), HIV/AIDS (OR=6.03), and migraine (OR=3.17). CONCLUSIONS Medical providers should consider targeting suicide risk screening for patients with any mental disorder, TBI, epilepsy, HIV, psychogenic pain, stroke, and migraine. When suicide risk is detected, counseling on reducing access to lethal means should include both firearms and other means for at-risk groups.
Collapse
Affiliation(s)
- Jennifer M Boggs
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Arne Beck
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Sam Hubley
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Edward L Peterson
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Yong Hu
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - L Keoki Williams
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Deepak Prabhakar
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Rebecca C Rossom
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Frances L Lynch
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Christine Y Lu
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Beth E Waitzfelder
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Ashli A Owen-Smith
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Gregory E Simon
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Brian K Ahmedani
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| |
Collapse
|
35
|
Wertz J, Azrael D, Hemenway D, Sorenson S, Miller M. Differences Between New and Long-Standing US Gun Owners: Results From a National Survey. Am J Public Health 2018; 108:871-877. [PMID: 29771618 DOI: 10.2105/ajph.2018.304412] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To quantify the proportion of current US gun owners who are new to owning firearms and compare new versus long-standing gun owners with respect to their firearms and firearm-related behaviors. METHODS We performed a cross-sectional analysis of a nationally representative probability-based online survey conducted in 2015 in the United States. We defined new gun owners as current firearm owners who acquired all of their firearms within the past 5 years, but who lived in a home without a gun at some time over the past 5 years. We defined long-standing firearm owners as all other current gun owners. RESULTS New gun owners represented 10% of all current US adult gun owners. In addition to being younger than long-standing gun owners, new gun owners were more likely to be liberal, own fewer guns, own handguns, own guns only for protection, and store guns in a safe manner. CONCLUSIONS Gun ownership is dynamic, with approximately 1 million Americans becoming new gun owners each year. Public Health Implications. Clinical guidelines should be updated to explicitly endorse re-evaluating household firearm status at regular intervals.
Collapse
Affiliation(s)
- Joseph Wertz
- Joseph Wertz, Deborah Azrael, David Hemenway, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Joseph Wertz is also with Harvard College, Harvard University, Cambridge, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Susan Sorenson is with The Evelyn Jacobs Ortner Center on Family Violence, School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Deborah Azrael
- Joseph Wertz, Deborah Azrael, David Hemenway, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Joseph Wertz is also with Harvard College, Harvard University, Cambridge, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Susan Sorenson is with The Evelyn Jacobs Ortner Center on Family Violence, School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - David Hemenway
- Joseph Wertz, Deborah Azrael, David Hemenway, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Joseph Wertz is also with Harvard College, Harvard University, Cambridge, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Susan Sorenson is with The Evelyn Jacobs Ortner Center on Family Violence, School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Susan Sorenson
- Joseph Wertz, Deborah Azrael, David Hemenway, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Joseph Wertz is also with Harvard College, Harvard University, Cambridge, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Susan Sorenson is with The Evelyn Jacobs Ortner Center on Family Violence, School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Matthew Miller
- Joseph Wertz, Deborah Azrael, David Hemenway, and Matthew Miller are with Harvard Injury Control Research Center, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Joseph Wertz is also with Harvard College, Harvard University, Cambridge, MA. Matthew Miller is also with Bouvé College of Health Sciences, Northeastern University, Boston. Susan Sorenson is with The Evelyn Jacobs Ortner Center on Family Violence, School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| |
Collapse
|
36
|
Conley MA, Higgins ET. Value from Fit with Distinct Motivational Field Environments. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2018. [DOI: 10.1080/01973533.2018.1434653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
37
|
Scott J, Azrael D, Miller M. Firearm Storage in Homes With Children With Self-Harm Risk Factors. Pediatrics 2018; 141:peds.2017-2600. [PMID: 29467279 DOI: 10.1542/peds.2017-2600] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe firearm storage practices in homes with children who have versus do not have self-harm risk factors. METHODS A cross-sectional analysis of a nationally representative probability-based online survey of US adults conducted in 2015 (n = 3949; response rate 55%). Respondents self-reported whether they lived with children and were a caretaker/health care decision-maker for a child. Household firearm ownership was ascertained for all respondents; how firearms were stored in homes with guns was asked of gun owning respondents only; all respondents were asked whether their child had a history of the following self-harm risk factors: depression, mental health conditions other than depression, or attention-deficit/hyperactivity disorder. RESULTS Household firearms were present in 43.5% (95% confidence interval [CI]: 34.4-64.7) of homes with children who had a history of self-harm risk factors (n = 52), compared with 42.3% (95% CI: 35.2-49.7) of homes in which no child had self-harm risk factors (n = 411). Among parents or caretakers with firearms, 34.9% (95 % CI: 20.2-53.2) stored all guns locked and unloaded when they had a child with a history self-harm risk factors, compared with 31.8% (95% CI: 25.9-38.3) when none of their children had such a history. CONCLUSIONS Millions of US children live in homes in which firearms are left loaded or unlocked or both. A child's history of depression, mental health conditions other than depression, or attention-deficit/hyperactivity disorder does not appear to appreciably influence caretaker decisions about whether to (1) have firearms in the home, or (2) store all household firearms in accordance with American Academy of Pediatrics recommendations (ie, locked and unloaded).
Collapse
Affiliation(s)
- John Scott
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts; and
| | - Deborah Azrael
- Harvard Injury Control Research Center, School of Public Health, Harvard University, Boston, Massachusetts
| | - Matthew Miller
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts; and .,Harvard Injury Control Research Center, School of Public Health, Harvard University, Boston, Massachusetts
| |
Collapse
|
38
|
Griffin R, Richardson JB, Kerby JD, McGwin G. A decompositional analysis of firearm-related mortality in the United States, 2001-2012. Prev Med 2018; 106:194-199. [PMID: 29109013 DOI: 10.1016/j.ypmed.2017.10.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 12/29/2022]
Abstract
Prior literature reporting increased rates of firearm-related homicide and suicide with increasing firearm availability is limited by only examining the availability of firearms, which is only one component of firearm-related mortality. The objective of the current study is to separate the rates into their respective components and determine which components contribute to mortality rate changes. To address the objective, nationally representative data from 2001 to 2012 was collected from a variety of publicly-available sources. Utilizing decompositional methodology, a negative binomial regression was used to estimate rate ratios for the association between the components and year category, and relative contributions of each component were calculated. From 2001 to 2012, the homicide and unintentional mortality rate decreased while the suicide rate increased. The suicide rate was only the firearm prevalence rate. The unintentional mortality rate was a factor of firearm prevalence, injury incidence, and case fatality rate. The homicide rate was a factor of firearm prevalence, violent crime rate, injury incidence, and case fatality rate. The current results suggest that the contributors of changes in firearm-related mortality are multi-faceted. Future studies should perform a decompositional analysis utilizing more granular data to examine whether the currently reported results are true associations or a factor of ecologic fallacy.
Collapse
Affiliation(s)
- Russell Griffin
- University of Alabama at Birmingham, Department of Epidemiology, Birmingham, AL, United States; University of Alabama at Birmingham, Department of Surgery, Division of Acute Care Surgery, Birmingham, AL, United States.
| | - Joseph B Richardson
- Department of African American Studies and Sociology, University of Maryland, College Park, MD, United States
| | - Jeffrey D Kerby
- University of Alabama at Birmingham, Department of Surgery, Division of Acute Care Surgery, Birmingham, AL, United States
| | - Gerald McGwin
- University of Alabama at Birmingham, Department of Epidemiology, Birmingham, AL, United States
| |
Collapse
|
39
|
Matthay EC, Galin J, Rudolph KE, Farkas K, Wintemute GJ, Ahern J. In-State and Interstate Associations Between Gun Shows and Firearm Deaths and Injuries: A Quasi-experimental Study. Ann Intern Med 2017; 167:837-844. [PMID: 29059689 PMCID: PMC5972533 DOI: 10.7326/m17-1792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Gun shows are an important source of firearms, but no adequately powered studies have examined whether they are associated with increases in firearm injuries. OBJECTIVE To determine whether gun shows are associated with short-term increases in local firearm injuries and whether this association differs by the state in which the gun show is held. DESIGN Quasi-experimental. SETTING California. PARTICIPANTS Persons in California within driving distance of gun shows. MEASUREMENTS Gun shows in California and Nevada between 2005 and 2013 (n = 915 shows) and rates of firearm-related deaths, emergency department visits, and inpatient hospitalizations in California. RESULTS Compared with the 2 weeks before, postshow firearm injury rates remained stable in regions near California gun shows but increased from 0.67 injuries (95% CI, 0.55 to 0.80 injuries) to 1.14 injuries (CI, 0.97 to 1.30 injuries) per 100 000 persons in regions near Nevada shows. After adjustment for seasonality and clustering, California shows were not associated with increases in local firearm injuries (rate ratio [RR], 0.99 [CI, 0.97 to 1.02]) but Nevada shows were associated with increased injuries in California (RR, 1.69 [CI, 1.16 to 2.45]). The pre-post difference was significantly higher for Nevada shows than California shows (ratio of RRs, 1.70 [CI, 1.17 to 2.47]). The Nevada association was driven by significant increases in firearm injuries from interpersonal violence (RR, 2.23 [CI, 1.01 to 4.89]) but corresponded to a small increase in absolute numbers. Nonfirearm injuries served as a negative control and were not associated with California or Nevada gun shows. Results were robust to sensitivity analyses. LIMITATION Firearm injuries were examined only in California, and gun show occurrence was not randomized. CONCLUSION Gun shows in Nevada, but not California, were associated with local, short-term increases in firearm injuries in California. Differing associations for California versus Nevada gun shows may be due to California's stricter firearm regulations. PRIMARY FUNDING SOURCE National Institutes of Health; University of California, Berkeley; and Heising-Simons Foundation.
Collapse
Affiliation(s)
- Ellicott C Matthay
- From University of California, Berkeley, School of Public Health, Berkeley, and University of California, Davis, Sacramento, California
| | - Jessica Galin
- From University of California, Berkeley, School of Public Health, Berkeley, and University of California, Davis, Sacramento, California
| | - Kara E Rudolph
- From University of California, Berkeley, School of Public Health, Berkeley, and University of California, Davis, Sacramento, California
| | - Kriszta Farkas
- From University of California, Berkeley, School of Public Health, Berkeley, and University of California, Davis, Sacramento, California
| | - Garen J Wintemute
- From University of California, Berkeley, School of Public Health, Berkeley, and University of California, Davis, Sacramento, California
| | - Jennifer Ahern
- From University of California, Berkeley, School of Public Health, Berkeley, and University of California, Davis, Sacramento, California
| |
Collapse
|
40
|
Cleveland EC, Azrael D, Simonetti JA, Miller M. Firearm ownership among American veterans: findings from the 2015 National Firearm Survey. Inj Epidemiol 2017; 4:33. [PMID: 29256160 PMCID: PMC5735043 DOI: 10.1186/s40621-017-0130-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While the majority of veteran suicides involve firearms, no contemporary data describing firearm ownership among US veterans are available. This study uses survey data to describe the prevalence of firearm ownership among a nationally representative sample of veterans, as well as veterans' reasons for firearm ownership. METHODS A cross-sectional, nationally representative web-based survey conducted in 2015. RESULTS Nearly half of all veterans own one or more firearms (44.9%, 95% CI 41.3-48.6%), with male veterans more commonly owning firearms than do female veterans (47.2%, 95% CI 43.4-51.0% versus 24.4%, 95%CI 15.6-36.1%). Most veteran firearm owners own both handguns and long guns (56.5%, 95% CI 51.1-61.8%); a majority cite protection as a primary reason for firearm ownership (63.1%, 95% CI 58.2-67.8%). CONCLUSIONS The current study is the first to provide detailed, nationally representative information about firearm ownership among U.S. veterans. Better understanding firearm ownership among veterans can usefully inform ongoing suicide prevention efforts aiming to facilitate lethal means safety among vulnerable veterans during at-risk periods.
Collapse
Affiliation(s)
- Emily C Cleveland
- Massachusetts General Hospital, Department of Emergency Medicine, Massachusetts General Hospital Massachusetts General Hospital, 5 Emerson Place, Suite 101, Boston, MA, 02114, USA.
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA, USA
| | - Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Veterans Health Administration, Denver, CO, USA
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA, USA.,Northeastern University, Bouvé College of Health Sciences, Boston, MA, USA
| |
Collapse
|
41
|
Suicide, guns, and buyback programs: An epidemiologic analysis of firearm-related deaths in Connecticut. J Trauma Acute Care Surg 2017; 83:1195-1199. [DOI: 10.1097/ta.0000000000001575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
42
|
Phillips CJ, LeardMann CA, Vyas KJ, Crum-Cianflone NF, White MR. Risk Factors Associated With Suicide Completions Among US Enlisted Marines. Am J Epidemiol 2017; 186:668-678. [PMID: 28595355 DOI: 10.1093/aje/kwx117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 10/27/2016] [Indexed: 01/23/2023] Open
Abstract
US enlisted Marines have experienced a substantial increase in suicide rates. We sought to identify risk factors for suicide completions among male Marines who entered basic training in San Diego, California, between June 2001 and October 2010. Suicides that occurred during active-duty military service were counted from June 1, 2001, through June 30, 2012. A total of 108,930 male Marines (66,286 deployers and 42,644 never deployed) were followed for 467,857 person-years of active-duty service time. Of the 790 deaths, 123 (15.6%) were suicides. In the final multivariate hazard model, preservice characteristics of not being a high-school graduate (hazard ratio (HR) = 2.17, 95% confidence interval (CI): 1.28, 3.68) and being a smoker at the time of enlistment (HR = 1.91, 95% CI: 1.32, 2.76) were significantly associated with a higher risk for suicide completion. Diagnosed with traumatic brain injury (HR = 4.09, 95% CI: 2.08, 8.05), diagnosed with depression (HR = 2.36, 95% CI: 1.22, 4.58), and received relationship counseling (HR = 3.71, 95% CI: 1.44, 9.54) during military service were significant risks for suicide death. Deployment alone was not significantly associated with a risk for suicide death (HR = 0.53, 95% CI: 0.26, 1.05).
Collapse
|
43
|
Carter PM, Cook LJ, Macy ML, Zonfrillo MR, Stanley RM, Chamberlain JM, Fein JA, Alpern ER, Cunningham R. Individual and Neighborhood Characteristics of Children Seeking Emergency Department Care for Firearm Injuries Within the PECARN Network. Acad Emerg Med 2017; 24:803-813. [PMID: 28423460 PMCID: PMC5515362 DOI: 10.1111/acem.13200] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective was to describe the characteristics of children seeking emergency care for firearm injuries within the PECARN network and assess the influence of both individual and neighborhood factors on firearm-related injury risk. METHODS This was a retrospective, multicenter cross-sectional analysis of children (<19 years old) presenting to 16 pediatric EDs (2004-2008). ICD-9-CM E-codes were used to identify and categorize firearm injuries by mechanism/intent. Neighborhood variables were derived from home address data. Multivariable analysis examined the influence of individual and neighborhood factors on firearm-related injuries compared to nonfirearm ED visits. Injury recidivism was assessed. RESULTS A total of 1,758 pediatric ED visits for firearm-related injuries were analyzed. Assault (51.4%, n = 904) and unintentional injury (33.2%, n = 584) were the most common injury mechanisms. Among children with firearm injuries, 68.3% were older adolescents (15-19 years old), 82.3% were male, 68.2% were African American, and 76.3% received public insurance/were uninsured. Extremity injuries were most common (75.9%), with 20% sustaining injuries to multiple body regions, 48.1% requiring admission and 1% ED mortality. Multivariable analysis identified firearm injury risk factors, including adolescent age (p < 0.001), male sex (p < 0.001), non-Caucasian race/ethnicity (p < 0.001), public payer/uninsured status (p < 0.001), and higher levels of neighborhood disadvantage (p < 0.001). Among children with firearm injuries, 12-month ED recidivism for any reason was 22.4%, with < 1% returning for another firearm injury. CONCLUSION Among children receiving ED treatment within the PECARN network, there are distinct demographic and neighborhood factors associated with firearm injuries. Among younger children (<10 years old), unintentional injuries predominate, while assault-type injuries were most common among older adolescents. Overall, among this PECARN patient population, male adolescents living in neighborhoods characterized by high levels of concentrated disadvantage had an elevated risk for firearm injury. Public health efforts should focus on developing and implementing initiatives addressing risk factors at both the individual and the community level, including ED-based interventions to reduce the risk for firearm injuries among high-risk pediatric populations.
Collapse
Affiliation(s)
- Patrick M. Carter
- University of Michigan, Injury Center, School of Medicine, Department of Emergency Medicine; 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109
- University of Michigan, School of Medicine, Department of Emergency Medicine; 1500 East Medical Center Drive, Ann Arbor, Michigan, 48109
- Youth Violence Prevention Center, School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
| | - Lawrence J. Cook
- University of Utah, School of Medicine, Department of Pediatrics, Division of Critical Care; 295 Chipeta Way, Salt Lake City, Utah, 84108
| | - Michelle L. Macy
- University of Michigan, Injury Center, School of Medicine, Department of Emergency Medicine; 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109
- University of Michigan, School of Medicine, Department of Emergency Medicine; Division of Pediatric Emergency Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48109
- University of Michigan, C.S. Mott Children’s Hospital, Child Health Evaluation and Research (CHEAR) Unit; 300 North Ingalls Building, Ann Arbor, Michigan, 48109
| | - Mark R. Zonfrillo
- Department of Emergency Medicine and Injury Prevention Center, Alpert Medical School of Brown University and Hasbro Children’s Hospital; 55 Claverick St, Providence, Rhode Island, 02903
| | - Rachel M. Stanley
- Nationwide Children’s Hospital, Department of Emergency Medicine; 700 Children’s Dr. Columbus, Ohio, 43205
| | - James M. Chamberlain
- Children’s National Health System, Department of Emergency Medicine and Trauma Services; 111 Michigan Ave NW, Washington, DC, 20010
| | - Joel A. Fein
- The Children’s Hospital of Philadelphia, Division of Emergency Medicine; 34 St. and Civic Center Blvd, Philadelphia, Pennsylvania, 19104
- The Children’s Hospital of Philadelphia, Center for Injury Research and Prevention; 34 St. and Civic Center Blvd, Philadelphia, Pennsylvania, 19104
| | - Elizabeth R. Alpern
- Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine; 225 E Chicago Ave, Chicago, Illinois, 60611
| | - Rebecca Cunningham
- University of Michigan, Injury Center, School of Medicine, Department of Emergency Medicine; 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109
- University of Michigan, School of Medicine, Department of Emergency Medicine; 1500 East Medical Center Drive, Ann Arbor, Michigan, 48109
- Youth Violence Prevention Center, School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
- University of Michigan, School of Public Health, Department of Health Behavior & Health Education; 1415 Washington Heights, Ann Arbor, Michigan, 48109
| |
Collapse
|
44
|
Wolk CB, Jager-Hyman S, Marcus SC, Ahmedani BK, Zeber JE, Fein JA, Brown GK, Lieberman A, Beidas RS. Developing implementation strategies for firearm safety promotion in paediatric primary care for suicide prevention in two large US health systems: a study protocol for a mixed-methods implementation study. BMJ Open 2017; 7:e014407. [PMID: 28647722 PMCID: PMC5541509 DOI: 10.1136/bmjopen-2016-014407] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 04/27/2017] [Accepted: 05/24/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The promotion of safe firearm practices, or firearms means restriction, is a promising but infrequently used suicide prevention strategy in the USA. Safety Check is an evidence-based practice for improving parental firearm safety behaviour in paediatric primary care. However, providers rarely discuss firearm safety during visits, suggesting the need to better understand barriers and facilitators to promoting this approach. This study, Adolescent Suicide Prevention In Routine clinical Encounters, aims to engender a better understanding of how to implement the three firearm components of Safety Check as a suicide prevention strategy in paediatric primary care. METHODS AND ANALYSIS The National Institute of Mental Health-funded Mental Health Research Network (MHRN), a consortium of 13 healthcare systems across the USA, affords a unique opportunity to better understand how to implement a firearm safety intervention in paediatric primary care from a system-level perspective. We will collaboratively develop implementation strategies in partnership with MHRN stakeholders. First, we will survey leadership of 82 primary care practices (ie, practices serving children, adolescents and young adults) within two MHRN systems to understand acceptability and use of the three firearm components of Safety Check (ie, screening, brief counselling around firearm safety and provision of firearm locks). Then, in collaboration with MHRN stakeholders, we will use intervention mapping and the Consolidated Framework for Implementation Research to systematically develop and evaluate a multilevel menu of implementation strategies for promoting firearm safety as a suicide prevention strategy in paediatric primary care. ETHICS AND DISSEMINATION Study procedures have been approved by the University of Pennsylvania. Henry Ford Health System and Baylor Scott & White institutional review boards (IRBs) have ceded IRB review to the University of Pennsylvania IRB. Results will be submitted for publication in peer-reviewed journals.
Collapse
Affiliation(s)
- Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian K Ahmedani
- Henry Ford Health System, Center for Health Policy and Health Services Research and Behavioral Health Services, Detroit, Michigan, USA
| | - John E Zeber
- Center for Applied Health Research, Baylor Scott & White Health, jointly with Central Texas Veterans Health Care System, Dallas, Texas, USA
| | - Joel A Fein
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gregory K Brown
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adina Lieberman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
45
|
LaVan M, LaVan H, Martin WMM. Antecedents, Behaviours, and Court Case Characteristics and Their Effects on Case Outcomes in Litigation for Persons with Schizophrenia. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2017; 24:866-887. [PMID: 31983996 PMCID: PMC6818312 DOI: 10.1080/13218719.2017.1316176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 10% random sample of 3543 cases litigated in the United States' civil and criminal courts were analysed using logistic regression to develop a model that can predict case outcomes for litigants with schizophrenia. Most predictors are related to case characteristics and not to the litigants' antecedents, behaviours or medication issues. Only the psychologist as an expert witness was found to be related to case outcome, but the concern is expressed that inadequate weight is given to expert testimony. Other significant findings include being represented by counsel, atypical medication and malingering.
Collapse
Affiliation(s)
- Melissa LaVan
- The Chicago School of Professional
Psychology, Grand Island, NE, USA
| | | | | |
Collapse
|
46
|
Essien I, Stelter M, Kalbe F, Koehler A, Mangels J, Meliß S. The shooter bias: Replicating the classic effect and introducing a novel paradigm. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2017. [DOI: 10.1016/j.jesp.2016.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
47
|
Rozel JS, Mulvey EP. The Link Between Mental Illness and Firearm Violence: Implications for Social Policy and Clinical Practice. Annu Rev Clin Psychol 2017; 13:445-469. [PMID: 28375722 DOI: 10.1146/annurev-clinpsy-021815-093459] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The United States has substantially higher levels of firearm violence than most other developed countries. Firearm violence is a significant and preventable public health crisis. Mental illness is a weak risk factor for violence despite popular misconceptions reflected in the media and policy. That said, mental health professionals play a critical role in assessing their patients for violence risk, counseling about firearm safety, and guiding the creation of rational and evidence-based public policy that can be effective in mitigating violence risk without unnecessarily stigmatizing people with mental illness. This article summarizes existing evidence about the interplay among mental illness, violence, and firearms, with particular attention paid to the role of active symptoms, addiction, victimization, and psychosocial risk factors. The social and legal context of firearm ownership is discussed as a preface to exploring practical, evidence-driven, and behaviorally informed policy recommendations for mitigating firearm violence risk.
Collapse
Affiliation(s)
- John S Rozel
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213; ,
| | - Edward P Mulvey
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213; ,
| |
Collapse
|
48
|
De Angelis J, Benz TA, Gillham P. Collective Security, Fear of Crime, and Support for Concealed Firearms on a University Campus in the Western United States. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/0734016816686660] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recently, a number of state legislatures in the United States have sought to loosen restrictions on the carrying of concealed firearms on university campuses. Often these legislative initiatives are driven by the argument that concealed firearms on campuses will deter crime. Unfortunately, little attention has been paid to variation in employee support for the carrying of concealed firearms. Moreover, little is known about the intersection between fear of crime, trust in the police, and support for concealed firearms on campus. Given that, this study draws on a survey administered to a random sample of faculty and staff at one large rural university in the Western United States ( n = 1,170). More specifically, this study examines whether fear of workplace violence and/or trust in police and local government predict/predicts support for concealed firearms on campus, even after controlling for other potential factors such as prior victimization, political orientation, and demographic background. Results indicate that fear of violence and distrust in the police/government are strongly related to support for concealed carry, though a number of other factors matter, including political orientation, social capital, and respondent demographic characteristics.
Collapse
Affiliation(s)
- Joseph De Angelis
- Department Sociology and Anthropology, University of Idaho, Moscow, ID, USA
| | - Terressa A. Benz
- Department of Sociology, Anthropology, Criminal Justice and Social Work, Oakland University, Rochester, MI, USA
| | - Patrick Gillham
- Sociology Department, Western Washington University, Bellingham, WA, USA
| |
Collapse
|
49
|
Kposowa A, Hamilton D, Wang K. Impact of Firearm Availability and Gun Regulation on State Suicide Rates. Suicide Life Threat Behav 2016; 46:678-696. [PMID: 26999372 DOI: 10.1111/sltb.12243] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/03/2016] [Indexed: 11/30/2022]
Abstract
Past studies on suicide have investigated the association of firearm ownership and suicide risk in the United States. The aim of the present study was to build on previous work by examining the impact of firearm storage practices and the strictness of firearm regulation on suicide rates at the state level. Data were compiled from primarily three sources. Suicide and firearm ownership information was obtained from the Centers for Disease Control and Prevention. Strictness of handgun regulation was derived from figures available at the Law Center to Prevent Violence, and controls were taken from the US Bureau of the Census. Mixed models were fitted to the data. Household firearm ownership was strongly associated with both suicide by all mechanisms, and firearm suicide. Storage practices had especially elevated consequences on suicide rates. Percent with loaded guns and gun readiness increased suicide rates, and strictness of gun regulation reduced suicide rates. Ready access to firearms can make a difference between life and death. Loaded and unlocked firearms within reach become risk factors for fatal outcomes from suicidal behavior. Future research might want to examine ways of obtaining more recent data on individual firearm ownership. This study proposes several policy recommendations for suicide prevention.
Collapse
Affiliation(s)
- Augustine Kposowa
- Department of Sociology, University of California Riverside, Riverside, CA, USA
| | | | - Katy Wang
- Department of Statistics, University of California Riverside, Riverside, CA, USA
| |
Collapse
|
50
|
Male suspected suicide decedents in Utah: A comparison of Veterans and nonveterans. Compr Psychiatry 2016; 69:1-10. [PMID: 27423339 DOI: 10.1016/j.comppsych.2016.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/11/2016] [Accepted: 04/23/2016] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED There has been significant debate regarding suicide risk in Veterans compared to nonveterans. However, few studies have examined similarities and differences between Veteran and nonveteran suicide decedents using a combination of next of kin psychological autopsy and data from a state Office of the Medical Examiner (OME). For the current study, next of kin of a one-year cohort of male suspected suicide decedents in Utah completed psychological autopsy interviews with trained research staff. Next of kin of 70 Veterans and 356 nonveterans completed the interviews, which included demographic, behavioral, psychosocial, and clinical variables. The psychological autopsy data then were combined with OME data for the presented analyses. Results showed that Veteran and nonveteran suicide decedents differed on multiple factors, including age at death. Specifically, male nonveteran suicide decedents were younger at age of death compared to Utah Veterans and to a national sample. Veteran decedents also were more likely to have a history of suicide attempts and more likely to have access to firearms compared to nonveterans. Other between-group differences, including Veterans being more likely to have lived alone and method of death (e.g., gunshot, hanging, etc.), were no longer statistically significant after adjustment for age at death. CONCLUSIONS these findings have significant clinical and practical importance, as they highlight the risk for suicide in younger nonveterans and older Veterans in Utah.
Collapse
|