Fatal Firearm Violence Among American Indians and Alaska Natives

There is a dearth of population-based studies regarding firearm-related deaths and years of potential life lost among American Indians and Alaska Natives (AI/AN). Using the Centers for Disease Control and Prevention's (CDC) We Based Injury Statistics Query and Reporting System (WISQARS) data for the three most recent years (2018-2020), we analyzed the demographic characteristics of AI/ANs who succumbed to firearm violence. AI/ANs averaged almost 500 firearm-related deaths per year. The majority of these deaths were observed among individuals 20-39 years of age (53%), males (84.4%), and in the West (55.3%). A plurality of these firearm-related deaths were suicides (48.9%) followed by homicides (43.5%). During the 3-year study period, the age-adjusted firearm death rate increased almost 5 times the growth of the AI/AN population. Also, a staggering 67,050 years of potential life were lost before the age of 80 years (YPLL80) during this period. Firearm suicides were responsible for the largest proportion of YPLL80s (48.5%). Traditional legal interventions [e.g., child access prevention (CAP) laws and extreme risk protection orders (ERPO)], if expanded to more states could potentially help reduce AI/AN firearm mortality. None of the 10 states with the highest firearm mortality of AI/AN have ERPOs and 8 of the 10 do not have CAP laws. Also, a renewed focus on cultural continuity and indigenous protective factors is essential to ameliorate the level of firearm violence in AI/ANs.

The muzzle to target distance -staining inside different parts of the firearm barrel

Biological traces inside firearm barrels were observed as a result of contact shots to the head. The present study was conducted to investigate the influence of the muzzle to target distance on staining inside the anterior and posterior part of firearm barrels. Ninety-nine shots were fired to so-called reference cubes (10% gelatine, 12 cm edge length, embedded paint-blood-pad) using three current handguns. Shot range was varied from contact to 50 cm distance. High-speed cameras recorded external backspatter. Endoscopic examination assessed visible staining along the barrel. Each two swabbings were gathered from the anterior and the posterior part of the barrel. The first swabs were submitted to quantitative PCR, the second ones to DNA-RNA-co-extraction. Thorough mechanical and chemical cleaning was performed to avoid any contamination which was controlled by negative zero swabs after each cleaning. In single shots up to 50 cm distance, minimal, but DNA-positive sporadic traces were detected inside the barrel in vicinity of the muzzle. Visible complex staining varying in extent was observed in the anterior barrel part for 10 cm or less distance in dependence of the calibre. The posterior part showed detectable traces only after close range shots (< 5 cm). Generally staining inside the barrel decreased from the muzzle to the rear end, which correlated with the yield of DNA. Some contact shots did not cause any staining in the posterior part of the barrel despite massive external backspatter. Blood-specific miRNA was primarily found where DNA was detected. This experience encourages to take a second swab for RNA analysis. The amount of nucleic acids in the barrel at varying muzzle to target distances is subject to large variations between individual shots and therefore appears not suitable for a reliable determination of the shot distance in a particular case on its own. Instead, shot range estimation should also take into account morphology and distribution of traces inside the barrel.

Drugs, guns, and violent crime in California

BACKGROUND

There is evidence linking use of controlled substances with perpetration of interpersonal violence. While the United States constitution protects the right to own a firearm, federal law prohibits firearm purchase and possession by persons believed to be at high risk for violence, including those who use controlled substances unlawfully.

METHODS

We report here the results of a 13-year prospective observational study on the risk of violent crime associated with a history of criminal drug charges in a cohort of 79,678 legal purchasers of handguns in California in 2001. The main outcomes were post-purchase charges for any violent crime, violent Crime Index crimes (murder, rape, robbery, aggravated assault), and firearm-related violent crimes. The main exposure of interest was a history of pre-purchase charge(s) for drug-related offenses; we examined as a secondary exposure a history of marijuana-related charges. We estimated adjusted hazard ratios (aHR) with 95 % confidence intervals (CI) using Cox proportional hazards multiple events models.

RESULTS

We found that legal handgun purchasers in California with a history of drug-related charges, even those with marijuana charges only, had triple the risk of a post-purchase violent crime charge compared to purchasers with no criminal charges (drug charges only: aHR=2.9, 95 % CI 2.2-3.8; marijuana charges only: aHR=3.3, 95 % CI 1.8-6.0). In addition, a criminal history of drug charges only vs. no criminal history was associated with increased risk of one or more violent crime charges after the first post-purchase arrest event (aHR=1.6, 95 % CI 1.2-2.3).

CONCLUSION

It is incumbent on researchers and policy makers to understand the nature and causes of this risk in order to take effective steps towards mitigation.

Firearm storage practices among military veterans in the United States: Findings from a nationally representative survey

BACKGROUND

Unsafe storage of firearms is associated with increased risk of suicide.. However, contemporary population-based data on the prevalence and correlates of firearm storage practices among veterans are limited.

METHODS

Data were from the 2022 National Health and Resilience in Veterans Study, a nationally representative sample of 2441 veterans. Analyses examined: (1) the prevalence of firearm storage practices; (2) sociodemographic, psychiatric, and clinical characteristics associated with storing firearms loaded and/or in non-secure location; and (3) associations between types of potentially traumatic events and storage practices.

RESULTS

More than half of veterans reported owning one or more personal firearms (50.9%). Among firearm owners, 52.9% reported some form of unsafe firearm storage practice (i.e., loaded and/or non-secure location), with 39.9% reporting that they stored one or more firearms loaded. After adjusting for sociodemographic characteristics, major depressive, alcohol and drug use disorders, direct trauma exposures, future suicidal intent, and traumatic brain injury were associated with storing firearms loaded and/or in a non-secure location (ORs = 1.09-7.16). Veterans with a history of specific forms of direct trauma exposure (e.g., physical assault) were more likely to store firearms unsafely.

LIMITATIONS

Cross-sectional design precludes causal inference.

CONCLUSIONS

Half of U.S. veterans who own firearms store at least one personal firearm loaded and/or in a non-secure location, with approximately four-in-ten keeping a loaded firearm in the home. These high rates underscore the importance of nationwide training initiatives to promote safe firearm storage for all service members and veterans, regardless of risk status, as well as for healthcare professionals working with veterans.

Firearm leadership: Development, analysis, and application of a novel concept to message secure storage of firearms in the military

Suicide remains a leading cause of death in the United States (U.S.) Armed Forces. Access to firearms increases the risk of death by suicide due to the high lethality of firearm-related injuries (~90% in suicide attempts) and the highly dynamic nature of suicide which includes rapid change from low- to high-risk states. Critical gaps remain in research, programming, and communication amongst scientists, Department of Defense (DoD) programmatic leaders, front-line commanders, and service members. To enhance communication and coordination, in June 2022, the first-ever national "Firearm Suicide Prevention in the Military: Messaging and Interventions Summit" was held, with discussion of Firearm Leadership, a concept that emphasizes the importance of communication about lethal means safety (LMS) among military leaders and service members. Through a discussion of scientific literature, the points identified during the Summit, as well as presenting illustrative case examples derived from suicide death reviews, we aim to provide a conceptual model for the benefits of Firearm Leadership and how some barriers can be overcome. Following the Summit, further discussions on "Firearm Leadership" led to the development of a Firearm Leadership Factsheet.

Society for Maternal-Fetal Medicine (SMFM); SMFM Health Policy and Advocacy Committee. Society for Maternal-Fetal Medicine Position Statement: Gun Violence and Pregnancy

The Society for Maternal-Fetal Medicine (SMFM) acknowledges gun violence as a public health crisis in the United States, with a significant impact on pregnant and postpartum people. We recognize the urgent need for a robust, equitable, data-driven approach to mitigate the impact of access to firearms and accompanying violence on pregnant and postpartum individuals and communities. As such, SMFM endorses the following policy principles: - SMFM calls on relevant government agencies and public funders to support and finance anti-violence and firearm safety research, public health surveillance activities, education, and other initiatives. These initiatives should acknowledge and address the connection between access to firearms and the health and safety of pregnant and postpartum people, as well as their families and communities. - SMFM strongly opposes legislation or regulations that impede or limit clinician-patient discussions about firearms. - SMFM calls for enhanced access to mental health care services for pregnant and postpartum people. - SMFM calls for additional support for individuals experiencing intimate partner violence and their families. - SMFM supports the creation of and funding for training programs for maternal-fetal medicine (MFM) subspecialists and all clinicians about firearms and domestic violence prevention. - SMFM supports laws and regulations that restrict individuals with protective or restraining orders and those with intimate partner violence or stalking convictions from purchasing and owning firearms.

Exploring Firearm Access, Carriage, and Possession among Justice-Involved Youth

Firearm carriage and possession predicts youth firearm violence victimization and perpetration. This study describes self-reported factors associated with firearm access, carriage, and possession among justice-involved youth. We conducted an exploratory, mixed-methods study. Participants were recruited from May 2022 to February 2023 from the Juvenile Justice Collaborative, a diversion program for justice-involved youth. We used online anonymous surveys to investigate exposures related to firearm access, carriage, and possession. We performed semi-structured interviews using the phenomenology framework. We used descriptive statistics to examine firearm exposures by participant demographics. We performed qualitative analyses using an iterative approach with constant comparison to identify key themes. We completed 28 surveys and 5 interviews. Most survey participants identified as male (57%) and Black (61%) with a median age of 18 years. Interview participants described the socialization and cultural normalization of firearms, most prominently among peers. Survey participants reported whether they had ever carried (25%) or possessed (21%) a firearm. Survey and interview participants endorsed protection in the context of increasing violence exposure over time as the primary motivation for firearm possession. Interview participants describe accessing firearms primarily through social networks while survey participants also reported access from strangers (25%) and licensed sellers/gun dealers (18%). In conclusion, justice-involved youth believe firearm carriage and possession may be needed for protection due to increasing violence exposure. Further investigation is necessary to determine interventions that may decrease firearm access, carriage, and possession among justice-involved youth.

Suicide Screening, Risk Assessment, and Lethal Means Counseling During Zero Suicide Implementation

OBJECTIVE

The authors measured implementation of Zero Suicide (ZS) clinical practices that support identification of suicide risk and risk mitigation, including screening, risk assessment, and lethal means counseling, across mental health specialty and primary care settings.

METHODS

Six health care systems in California, Colorado, Michigan, Oregon, and Washington participated. The sample included members ages ≥13 years from 2010 to 2019 (N=7,820,524 patients). The proportions of patients with suicidal ideation screening, suicide risk assessment, and lethal means counseling were estimated.

RESULTS

In 2019, patients were screened for suicidal ideation in 27.1% (range 5.0%-85.0%) of mental health visits and 2.5% (range 0.1%-35.0%) of primary care visits among a racially and ethnically diverse sample (44.9% White, 27.2% Hispanic, 13.4% Asian, and 7.7% Black). More patients screened positive for suicidal ideation in the mental health setting (10.2%) than in the primary care setting (3.8%). Of the patients screening positive for suicidal ideation in the mental health setting, 76.8% received a risk assessment, and 82.4% of those identified as being at high risk received lethal means counseling, compared with 43.2% and 82.4%, respectively, in primary care.

CONCLUSIONS

Six health systems that implemented ZS showed a high level of variation in the proportions of patients receiving suicide screening and risk assessment and lethal means counseling. Two opportunities emerged for further study to increase frequency of these practices: expanding screening beyond patients with regular health care visits and implementing risk assessment with lethal means counseling in the primary care setting directly after a positive suicidal ideation screening.

Effectiveness of a Suicide Prevention Lethal Means Training Program for the General Public

To evaluate the effectiveness of Conversations on Access to Lethal Means for the General Public (CALM-GP), a training for the public focusing on reducing access to lethal means during a crisis. The program adapted Counseling on Access to Lethal Means (CALM), developed for mental health practitioners and physicians. Participants completed pre/post surveys and follow-up surveys three months afterward. Measures included comfort and confidence in talking to a suicidal individual about access to lethal means, the likelihood of follow-up, and the number of lethal means conversations before and after the program. Surveys showed improvement in comfort and confidence talking about safely storing firearms and other lethal means and the likelihood of follow-up with that individual regarding access to lethal means. Results also indicated increased conversations participants had regarding suicide and lethal means at three-month follow-up. This evaluation suggests that CALM-GP is an effective suicide prevention and lethal means program for the public.

Prophylactic removal of a migratory missile from the cerebral ventricles: case report

BACKGROUND AND IMPORTANCE

Nonpowder firearm injuries to the head pose major health risks, with retained fragments potentially causing harmful sequelae that require neurosurgical intervention.

CLINICAL PRESENTATION

We report the case of 2-year-old girl who sustained an accidental gunshot wound to the head. She sustained a penetrating ballistic intracranial injury caused by a BB shot from a rifle. At presentation, she was neurologically intact with a punctate laceration on her left forehead. Head CT demonstrated a small depressed left frontal skull fracture, a small intracerebral hematoma, and a 5-mm metallic bullet fragment in the deep left frontal lobe near the frontal horn of the left lateral ventricle. She was admitted to the hospital and managed nonoperatively with levetiracetam and intravenous antibiotics, and discharged home in good condition. Follow-up CT in 1 week showed slight migration of the metallic bullet fragment to the left, placing it at the anterior horn of the lateral ventricle. Six weeks later, follow-up CT showed migration of the bullet to the temporal horn of the left lateral ventricle. Intraventricular migration of the bullet raised concern that it could move further to obstruct the foramen of Monro or cerebral aqueduct. Therefore, we removed the bullet through a small left temporal craniotomy with image guidance using a microsurgical approach through a translucent tube.

CONCLUSION

The authors discuss the rationale and technique for removing a nonpowder firearm bullet that has migrated within the cerebral ventricles.

Firearm Access and Suicide Rates: An Unambiguously Robust Association

Firearms account for approximately half of all suicide deaths within the United States each year. Recently, Lane and Kleck published pieces reporting conflicting results regarding the relationship between firearm access and suicide rates. In this commentary, I aim to contextualize the findings within the broader literature and to provide clarity for readers aiming to navigate the findings of the two studies. Ultimately, I conclude that the results of Lane more accurately represent the nature of the relationship and align with the extant literature on the topic.

Modeling the Relationship Between Firearm Restrictions, Medicaid Expansion, and Political Partisanship with Pediatric Firearm Mortality Costs

INTRODUCTION

Firearms are now the leading cause of pediatric mortality in the U.S., but few studies have investigated the economic impact of these deaths. Thus, this study determined whether multiple different gun-related measures, political partisanship and Medicaid expansion were related to the costs of pediatric gun deaths.

METHODS

Each states' medical costs, years of potential life lost (YPLL), and value of statistical life (VSL) lost due to pediatric gun deaths were extracted from the WISQARS database from 2015 to 2020. Seven firearm laws or restrictiveness measures (assault weapons bans, child access prevention laws, firearm registration and permit to purchase requirements, safe storage laws, Giffords Law Center ranking, and the number of firearm provisions), the Cook Partisan Voting Index (PVI), and Medicaid expansion status were determined across states. Unadjusted analyses compared each measure and (1) medical costs, (2) VSL, and (3) YPLL for each state. These were repeated using adjusted analyses, controlling for poverty, educational attainment, poor mental health, and race.

RESULTS

Of the 9 variables assessed, unadjusted analyses revealed that 8 variables were significantly associated with increased medical costs, all 9 were associated with higher VSL and 8 were associated with higher YPLL due to pediatric firearm-related mortality. Multivariable analyses revealed that 7 variables were associated with medical costs, 7 were associated with VSL and 6 were associated with YPLL.

CONCLUSION

States with fewer gun laws and those which have not adopted Medicaid expansion were more likely to experience a higher economic burden due to pediatric gun deaths. Quantifying the costs of these deaths can demonstrate the social toll of gun violence to policymakers and the general public.

LEVEL OF EVIDENCE

III.

New alginate-gelatine method for casting of staining inside firearm barrels

Contact shots to the head often leave behind biological traces inside firearm barrels, a phenomenon of great forensic interest. Until now, the visualization and preservation of these traces presented a significant challenge, lacking a reliable method. This study addresses this gap by searching for a suitable method to extract the traces within a casting. Using alginate or gelatine as suitable materials, the results were hampered by serious adhesion issues and their extraction out of the firearm barrel was impeded. Finally, the combination of 11% gelatine with 1% alginate, introduced into the barrel around a 'central spine', succeeded to consistently produce replicable castings. Experimental contact shots displayed a distinct staining gradient from the muzzle to the rear of the barrel, as revealed through endoscopy and proved in the macroscopic casting. The technique proved effective for various common handgun barrels and successfully preserved blood and gunshot residue (GSR) patterns within the barrel. This method offers the dual benefits of visually mapping staining patterns and securing localized samples for targeted molecular genetic analysis in forensic investigations.

Characteristics of ocular injuries associated with mortality in patients admitted with major trauma

BACKGROUND

Few ocular trauma studies have addressed mortality outcomes. We sought to determine characteristics of mortality-related ocular trauma admissions and compared them with non-fatal injuries.

METHODS

A retrospective study was conducted using de-identified data of patients admitted with major trauma from the National Trauma Data Bank (2008-2014). Patients with ocular injury were identified using ICD- 9CM codes. Demographics, intention and mechanism, types of ocular and head injuries, and injury severity were documented. Mortality was determined using post-admission disposition. Statistical analysis using student t-test, chi-square, and odds ratios (OR) calculations were performed with STATA-17 software. Significance was set at P < 0.05.

RESULTS

Of 316,485 patients admitted with ocular trauma, 12,233 (3.86%) were mortality related. Expired patients were older than survivors: mean (SD) of 50.1(25.5) vs. 41.5(22.8) years. White (OR = 1.32; P < 0.001), ≥ 65years old (OR = 2.25; P < 0.001), and male (OR = 1.05; P = 0.029) patients were most likely to expire than their counterparts. Common mechanisms of injury in survivors were falls (25.3%), motor vehicle traffic-occupant, MVTO (21.8%) and struck by/against (18.1%) and for fatal injuries, falls (29.7%), MVTO (21.9%) and firearms (11.5%). Traumatic brain injury (TBI) was documented in 88.2% of mortality-related admissions. Very severe injury severity scores (ISS > 24) (OR = 19.19; P < 0.001) and severe Glasgow Coma Score (GCS < 8) (OR = 19.22; P < 0.001) were most associated with mortality than survival. Firearms were most associated with very severe ISS (OR = 3.73; P < 0.001), severe GCS (OR = 4.68; P < 0.001) and mortality (OR = 5.21; P < 0.001) than other mechanisms. Patients with cut/pierce injuries had the greatest odds of survival (OR = 13.48; P < 0.001). Optic nerve/visual pathways injuries (3.1%) had the highest association with very severe ISS (OR = 2.51; P < 0.001), severe GCS (OR = 3.64; P < 0.001) and mortality (OR = 2.58; P < 0.001) than other ocular injuries. Black patients with very severe ISS (OR = 32.14; P < 0.001) and severe GCS (OR = 31.89; P < 0.001) were more likely to expire than other race/ethnicities with similar injury severity.

CONCLUSIONS

Mortality-related admissions were older, male, and mostly of White race than ocular trauma admissions of survivors. Firearms were the deadliest mechanism. TBI was commonly associated and patients with optic nerve/pathway injuries, very severe ISS and severe GCS had higher mortality rates. Characteristics and demographic variations identified in this study may be useful in developing focused measures aimed at preventing trauma-related deaths.

Examining the role of firearm involvement in repeat intimate partner violence assaults

BACKGROUND

Intimate partner violence (IPV) remains a pervasive and complex issue with significant social and public health implications. The nexus of firearms and intimate partner violence (IPV) is an especially dangerous one. However, little is known about how firearm involvement can influence the risk of repeat IPV assaults.

METHODS

We use data from 346 male perpetrated IPV incidents reported to the Detroit Police Department between December 2016 and April 2017 to examine the role of firearm involvement in IPV recidivism during a 5 and half year follow up period. Employing a conditional gap-time frailty model that accommodates heterogeneity among individuals through a frailty term, we analyze time to multiple IPV assaults that occur over the follow up period. We identify various pathways through which firearms impact the likelihood of subsequent IPV incidents, including intimidation, threats, and use of firearms, while controlling for observable perpetrator characteristics to understand the explicit roles of firearms.

RESULTS

Firearm involvement at the index assault was not associated with IPV recidivism. However, involvement of firearms in past IPV assaults significantly increased the risk of subsequent physical IPV. The discrepancy is likely arising from a high degree of censoring among individuals who were armed with a firearm during the index assault.

CONCLUSION

Our research reveals a nuanced relationship between firearm involvement and IPV recidivism, shedding light on the multifaceted dynamics at play. By elucidating the intricate dynamics at the intersection of firearms and intimate partner violence, our study underscores the need for targeted policy interventions and preventative measures aimed at reducing IPV recidivism.

National community disparities in prehospital penetrating trauma adjusted for income, 2020-2021

INTRODUCTION

While Black individuals experienced disproportionately increased firearm violence and deaths during the COVID-19 pandemic, less is known about community level disparities. We sought to evaluate national community race and ethnicity differences in 2020 and 2021 rates of penetrating trauma.

METHODS

We linked the 2018-2021 National Emergency Medical Services Information System databases to ZIP Code demographics. We stratified encounters into majority race/ethnicity communities (>50% White, Black, or Hispanic/Latino). We used logistic regression to compare penetrating trauma for each community in 2020 and 2021 to a combined 2018-2019 historical baseline. Majority Black and majority Hispanic/Latino communities were compared to majority White communities for each year. Analyses were adjusted for household income.

RESULTS

We included 87,504,097 encounters (259,449 penetrating traumas). All communities had increased odds of trauma in 2020 when compared to 2018-2019, but this increase was largest for Black communities (aOR 1.4, [1.3-1.4]; White communities - aOR 1.2, [1.2-1.3]; Hispanic/Latino communities - aOR 1.1. [1.1-1.2]). There was a similar trend of increased penetrating trauma in 2021 for Black (aOR 1.2, [1.2-1.3]); White (aOR 1.2, [1.1-1.2]); Hispanic/Latino (aOR 1.1, [1.1-1.1]). Comparing penetrating trauma in each year to White communities, Black communities had higher odds of trauma in all years (2018/2019 - aOR 3.0, [3.0-3.1]; 2020 - aOR 3.3, [3.3-3.4]; 2021 - aOR 3.3, [3.2-3.2]). Hispanic/Latino also had more trauma each year but to a lesser degree (2018/2019 - aOR 2.0, [2.0-2.0]; 2020 - aOR 1.8, [1.8-1.9]; 2021 - aOR 1.9, [1.8-1.9]).

CONCLUSION

Black communities were most impacted by increased penetrating trauma rates in 2020 and 2021 even after adjusting for income.

Individual and cumulative firearm violence exposure: Implications for sleep among Black and American Indian/Alaska Native adults

PURPOSE

We investigated the relationship between various forms of firearm violence exposure and sleep problems among nationally representative samples of Black (N = 3015) and American Indian and Alaska Native (AI/AN) (N = 527) adults, focusing on difficulties falling asleep, staying asleep, and waking too early. Survey data were collected in April and May 2023.

METHODS

We employed negative binomial regression models to analyze the associations between the different types of firearm violence exposure and sleep problems. We further examined associations between cumulative firearm violence exposure and sleep outcomes.

RESULTS

A substantial proportion of Black (59%) and AI/AN (56%) adults reported experiencing some form of firearm violence exposure. Being threatened with a firearm emerged as a consistent factor associated with sleep problems for both racial groups. Witnessing or hearing about shootings was linked to sleep problems in the Black sample, while cumulative firearm violence exposure was associated with all sleep problems in both groups.

CONCLUSIONS

Individual and cumulative firearm violence exposure is associated with increased sleep problems among Black and AI/AN adults.

Predicting early complications in patients with spinal gunshot wounds: A multicenter study

Introduction

There is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage.

Research question

we aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds.

Material and methods

This is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression.

Results

Results: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68-7.30), dirty wound (3.32, 1.50-7.34), GCS ≤8 (3.56, 1.17-10.79), hemodynamic instability (2.29, 1.07-4.88), and multiple bullets (1.97, 1.05-3.67).

Discussion and conclusion

Spinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.

A Study of Households with Children and Firearms in Baltimore, Maryland

Firearm injuries are the leading cause of death among children and adolescents in the US. Safe storage of firearms in the home is one of the most effective ways of preventing firearm injuries in children. This feasibility study was conducted in both the pediatric and general Emergency Departments of a large urban academic medical center in a community with high rates of firearm injuries in children. The objective was to pilot a survey seeking to describe sociodemographic characteristics, firearm specific risk factors, and firearm storage practices of households with children in the community. One hundred participants completed a survey containing items regarding participant demographics, household features, firearm ownership, firearm characteristics, and storage practices. Descriptive statistics were used to define sociodemographic characteristics of the enrolled population, comparing those with firearms to those without, and to describe firearms and storage practices of firearm owners in households with children. Of 100 participants, 30 lived in households with firearms and children. Most firearms in homes with children were stored locked and unloaded most of the time; however, 30% of participants with firearms and children in the home reported not consistently storing a firearm locked and unloaded. The most common reason given for not storing a firearm in the safest manner possible was that storing a firearm locked and unloaded would make it difficult to access quickly. Engaging families with children in discussions around firearm prevention during Emergency Department visits is feasible and may have implications for future efforts to promote safe firearm storage practices.

Fragmenting projectiles: a case report and literature review of the G2 Radically Invasive Projectile

Innovations in projectile design present unique challenges for trauma surgeons when treating gunshot victims. The G2 Radically Invasive Projectile (G2 Research, Winder, Georgia, USA) (G2RIP) is a frangible, rapidly expanding bullet resulting in a distinct pattern of injury consisting of diffuse hemorrhage with multicavity trauma as well as unique radiographic features of the projectile. To efficiently manage patients injured by the G2RIP, trauma surgeons must be aware of these distinct characteristics, and of previous patterns in effective management such as liberal damage control and extensive use of CT. Understanding previous presentation and management of patients injured by the G2RIP can aid in improving patient care in the trauma center.

Avocational exposure associations with ALS risk, survival, and phenotype: A Michigan-based case-control study

INTRODUCTION

Environmental exposures strongly influence ALS risk and identification is needed to reduce ALS burden. Participation in hobbies and exercise may alter ALS risk and phenotype, warranting an assessment to understand their contribution to the ALS exposome.

METHODS

Participants with ALS and healthy controls were recruited from University of Michigan and self-completed a survey to ascertain hobbies, exercise, and avocational exposures. Exposure variables were associated with ALS risk, survival, onset segment, and onset age.

RESULTS

ALS (n = 400) and control (n = 287) participants self-reported avocational activities. Cases were slightly older (median age 63.0 vs. 61.1 years, p = 0.019) and had a lower educational attainment (p < 0.001) compared to controls; otherwise, demographics were well balanced. Risks associating with ALS after multiple comparison correction included golfing (odds ratio (OR) 3.48, padjusted = 0.004), recreational dancing (OR 2.00, padjusted = 0.040), performing gardening or yard work (OR 1.71, padjusted = 0.040) five years prior to ALS and personal (OR 1.76, padjusted = 0.047) or family (OR 2.21, padjusted = 0.040) participation in woodworking, and personal participation in hunting and shooting (OR 1.89, padjusted = 0.040). No exposures associated with ALS survival and onset. Those reporting swimming (3.86 years, padjusted = 0.016) and weightlifting (3.83 years, padjusted = 0.020) exercise 5 years prior to ALS onset had an earlier onset age.

DISCUSSION

The identified exposures in this study may represent important modifiable ALS factors that influence ALS phenotype. Thus, exposures related to hobbies and exercise should be captured in studies examining the ALS exposome.

Examining media reports of pediatric unintentional firearm injury deaths for prevention messaging concerning secured storage of firearms: U.S., 2021-2022

BACKGROUND

Media outlets that report on firearm injuries and deaths may provide an important role in emphasizing safe storage practices, particularly when unintentional firearm injuries and deaths occur among young children. There has been a scarcity of research on aspects of media reports on injuries, particularly concerning prevention messaging. The objective of the present study was to examine prevention messaging on the safe storage of firearms among media outlets when reporting on unintentional firearm injury deaths among children aged 0-11.

METHODS

The Gun Violence Archive collects information from media sources regarding firearm injuries and deaths. We analyzed data from 2021 to 2022 to analyze prevention messaging incorporated into the media reports. We then examined if media reporting of events that occurred in States with child access prevention (CAP) laws had a higher likelihood of including prevention messaging compared to those events occurring in States without CAP laws.

RESULTS

There were 223 deaths reported that were attributed to unintentional firearm discharge among children aged 0-11. Prevention messages were delivered in 61 of the 223 incidents. Specific messages which included the word "lock" when referring to firearm storage were included in 21.9% of all incidents. An analysis examining State CAP laws and the presence of any prevention message per event did not yield any discernable relationship.

CONCLUSION

Inclusion of prevention messaging stating that firearms should be stored locked and unloaded when reporting on unintentional firearm injury deaths among children is lacking. When specific prevention messaging was included, the source was often law enforcement. Public health officials may play an important role in educating the journalistic and law enforcement communities about the inclusion of safe storage messages when reporting on firearm deaths.

A Systematic Review of Lethal Means Safety Counseling Interventions: Impacts on Safety Behaviors and Self-Directed Violence

For lethal means safety counseling interventions (LMSC) to reduce population-level suicide rates, interventions must be deployed across many settings and populations. We conducted a systematic search in six databases to review the current state of LMSC interventions across study designs, settings, messengers, populations, and injury prevention levels (e.g., universal). Eligibility criteria were: any individual or group receiving a LMSC intervention involving a human-to-human component aiming to influence adult behaviors related to lethal suicide methods, and outcome assessment of storage behaviors and/or suicidal self-directed violence (SDV). Risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool. A descriptive synthesis approach was used for analysis. Twenty-two studies were included that reported medication and/or firearm storage behaviors and/or SDV following LMSC. Fourteen of the 19 studies assessing behavioral change reported a significant improvement in safe storage behaviors, and all studies measuring acceptability reported that participants found the interventions favorable. Quality of evidence was limited. No studies were rated low risk of bias, and 77% were rated high risk of bias. There was substantial heterogeneity in the settings, populations, injury prevention levels, delivery methods, and intervention elements. Many included studies focused on caregivers of pediatric populations, and few studies assessed SDV outcomes. Higher quality trials conducted across a variety of settings, particularly those focusing on adults at risk of suicide, are needed. There was no funding for this review, and it was preregistered on the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42021230668).

Spinal gunshot wounds: A retrospective, multicenter, cohort study

INTRODUCTION AND OBJECTIVE

To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America.

MATERIAL AND METHODS

Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment.

RESULTS

Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in 320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (P = 0.004), canal compromise (P < 0.001), dirty wounds (P < 0.001), bullet or bone fragment remains in the spinal canal (P < 0.001) and injury pattern (P < 0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise.

CONCLUSIONS

In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Social determinants of health in pediatric trauma: Associations with injury mechanisms and outcomes in the context of the COVID-19 pandemic

BACKGROUND

Relationships between social determinants of health and pediatric trauma mechanisms and outcomes are unclear in context of COVID-19.

METHODS

Children <16 years old injured between 2016 and 2021 from ten pediatric trauma centers in Florida were included. Patients were stratified by high vs. low Social Vulnerability Index (SVI). Injury mechanisms studied were child abuse, ATV/golf carts, and firearms. Mechanism incidence trends and mortality were evaluated by interrupted time series and multivariable logistic regression.

RESULTS

Of 19,319 children, 68% and 32% had high and low SVI, respectively. Child abuse increased across SVI strata and did not change with COVID. ATV/golf cart injuries increased after COVID among children with low SVI. Firearm injuries increased after COVID among children with high SVI. Mortality was predicted by injury mechanism, but was not independently associated with SVI, race, or COVID.

CONCLUSION

Social vulnerability influences pediatric trauma mechanisms and COVID effects. Child abuse and firearm injuries should be targeted for prevention.

Nationwide Analysis of Firearm Injury Versus Other Penetrating Trauma: It's Not All the Same Caliber

INTRODUCTION

Ballistic injuries cause both a temporary and permanent cavitation event, making them far more destructive and complex than other penetrating trauma. We hypothesized that global injury scoring and physiologic parameters would fail to capture the lethality of gunshot wounds (GSW) compared to other penetrating mechanisms.

METHODS

The 2019 American College of Surgeons Trauma Quality Programs participant use file was queried for the mortality rate for GSW and other penetrating mechanisms. A binomial logistic regression model ascertained the effects of sex, age, hypotension, tachycardia, mechanism, Glasgow Coma Scale, ISS, and volume of blood transfusion on the likelihood of mortality. Subgroup analyses examined isolated injuries by body regions.

RESULTS

Among 95,458 cases (82% male), GSW comprised 46.4% of penetrating traumas. GSW was associated with longer hospital length of stay (4 [2-9] versus 3 [2-5] days), longer intensive care unit length of stay (3 [2-6] versus 2 [2-4] days), and more ventilator days (2 [1-4] versus 2 [1-3]) compared to stab wounds, all P < 0.001. The model determined that GSW was linked to increased odds of mortality compared to stab wounds (odds ratio 4.19, 95% confidence interval 3.55-4.93). GSW was an independent risk factor for acute kidney injury, acute respiratory distress syndrome, venous thromboembolism, sepsis, and surgical site infection.

CONCLUSIONS

Injury scoring systems based on anatomical or physiological derangements fail to capture the lethality of GSW compared to other mechanisms of penetrating injury. Adjustments in risk stratification and reporting are necessary to reflect the proportion of GSW seen at each trauma center. Improved classification may help providers develop quality processes of care. This information may also help shape public discourse on this highly lethal mechanism.

Firearm Mortality of Non-Hispanic Black Americans by Law Enforcement, 2011-2020

Law enforcement officers in the U.S. are more likely to use lethal force against non-Hispanic Black citizens than on their non-Hispanic White counterparts. The purpose of this study was to assess estimates of the national prevalence of fatal firearm violence by law enforcement officers (LEOs) against non-Hispanic Black Americans. The Web-Based Injury Statistics Query and Reporting System (WISQARS) from the Centers for Disease Control and Prevention (CDC) were analyzed using descriptive statistics and joinpoint regression from 2011 to 2020. During the decade (2011-2020) LEOs fatally shot 5,073 citizens and 1,170 were non-Hispanic Black (23%). The vast majority (96%) were males and two-thirds (66%) of those killed were ages 20-39 years. The region with the highest number of LEO fatal shootings was the Western U.S. Firearm deaths of non-Hispanic Blacks were the dominant (82%) method of LEO-induced deaths. Non-Hispanic Black Americans experience LEO firearm-related injuries and deaths at a much higher rate than their non-Hispanic White counterparts. In the context of the racial disparities among people who die following LEO-related gunshot wounds, changes to police training systems and an examination of implicit biases among LEOs should be investigated as the next step in reducing the use of lethal force practices.

A Randomized Control Trial of a Digital Health Tool for Safer Firearm and Medication Storage for Patients with Suicide Risk

Most patients with suicide risk do not receive recommendations to reduce access to lethal means due to a variety of barriers (e.g., lack of provider time, training). Determine if highly efficient population-based EHR messaging to visit the Lock to Live (L2L) decision aid impacts patient-reported storage behaviors. Randomized trial. Integrated health care system serving Denver, CO. Served by primary care or mental health specialty clinic in the 75-99.5th risk percentile on a suicide attempt or death prediction model. Lock to Live (L2L) is a web-based decision aid that incorporates patients' values into recommendations for safe storage of lethal means, including firearms and medications. Anonymous survey that determined readiness to change: pre-contemplative (do not believe in safe storage), contemplative (believe in safe storage but not doing it), preparation (planning storage changes) or action (safely storing). There were 21,131 patients randomized over a 6-month period with a 27% survey response rate. Many (44%) had access to a firearm, but most of these (81%) did not use any safe firearm storage behaviors. Intervention patients were more likely to be categorized as preparation or action compared to controls for firearm storage (OR = 1.30 (1.07-1.58)). When examining action alone, there were no group differences. There were no statistically significant differences for any medication storage behaviors. Selection bias in those who responded to survey. Efficiently sending an EHR invitation message to visit L2L encouraged patients with suicide risk to consider safer firearm storage practices, but a stronger intervention is needed to change storage behaviors. Future studies should evaluate whether combining EHR messaging with provider nudges (e.g., brief clinician counseling) changes storage behavior.ClinicalTrials.gov: NCT05288517.

Research needs related to firearm rights restoration

BACKGROUND

In the USA, firearms are commonly involved in many incidents of serious interpersonal harm. Federal law prohibits the purchase and possession of firearms by certain high-risk groups including those with prior felony or domestic violence misdemeanor convictions. Evidence supports the effectiveness of these prohibitions, but little is known about how often prohibited persons later seek to have their firearm rights restored.

MAIN BODY

For this commentary, we systematically searched the empirical literature for information about who requests firearm rights restoration in the USA, how often it is granted, and what its consequences are. We found a dearth of empirical literature on this topic.

CONCLUSION

We call for attention to this gap in the research. There is a need to build an evidence base that can help inform state policy and courtroom practices regarding the eligibility, appropriateness, and risk for subsequent harm following firearm rights restoration among persons who are prohibited based on a criminal conviction history.

Suicide-related behavior and firearm access among perpetrators of domestic violence subject to domestic violence protection orders

Perpetrators of domestic violence (DV) may be a population at elevated risk of suicide. Domestic violence protection orders (DVPOs) can include the removal of firearms from the individual subjected to the order (i.e., the respondent) to protect the victim-survivor. While removal of firearms in a DVPO is designed to protect the victim-survivor; it may also prevent suicide of the respondent by reducing access to lethal means. Therefore, we examined the association of respondent suicide-related behaviors with firearm possession and weapon use in DV among a sample of granted DVPO petitions in King County, Washington (WA), United States from 2014 to 2020 (n = 2,537). We compared prevalence ratios (PR) of respondent firearm possession and use of firearms or weapons to threaten or harm by suicide-related behavior. Overall, respondent suicide-related behavior was commonly reported by petitioners (46 %). Approximately 30 % of respondents possessed firearms. This was similar between respondents with and without a history of suicide-related behavior (PR: 1.03; 95 % CI: 0.91-1.17). Respondents with a history of suicide-related behavior were 1.33 times more likely to have used firearms or weapons to threaten/harm in DV compared to those without a history of suicide-related behavior (44.1 % vs. 33.8 %; 95 % CI: 1.20-1.47). In conclusion, both firearm possession and suicide-related behaviors were common among DVPO respondents. History of suicide-related behavior may be a marker for firearm-related harm to the victim-survivor. Evaluations of DVPO firearm dispossession should consider both firearm-related injury of the victim-survivor and suicide of the respondent.

Childhood Exposure to Firearm Violence in Chicago and Its Impact on Mental Health

OBJECTIVE

To describe how often Chicago children are exposed to firearm violence, the types of exposure, and the parent-reported impact of these exposures on child mental health symptoms.

METHODS

Data were collected in May-July 2022 using the Voices of Child Health in Chicago Parent Panel Survey, administered to parents with children aged 2-17 years from all 77 Chicago neighborhoods. Firearm violence exposure was characterized as indirect (hearing gunshots or knowing someone who was shot) or direct (witnessing a shooting, being threatened with a firearm, being shot at but not injured, or being shot and injured). Parents indicated if children in their household had any of the following mental health symptoms associated with firearm violence exposure: fear, anxiety, sadness, isolation, difficulty concentrating, difficulty in school, or aggression. Chi-squared tests and multivariable logistic regression models were used for statistical analysis.

RESULTS

Responses were received from 989 Chicago parents. More than one third (37%) of children were exposed to firearm violence with an indirect exposure prevalence of 32% and a direct exposure prevalence of 10%. Mental health symptoms associated with firearm violence exposure were reported for 20% of children. Mental health symptoms were reported for 7% of children without firearm violence exposure compared to 31% with indirect exposure (aOR 6.2, 95% CI: 3.7, 10.6) and 68% with direct exposure (aOR 36.1, 95% CI: 16.6, 78.6) CONCLUSIONS: Chicago children with indirect and direct exposure to firearm violence had more parent-reported mental health symptoms than unexposed children. Trauma informed care approaches to mitigate the negative mental health effects of both direct and indirect firearm violence exposure are critical.

Loneliness and firearm acquisition among low-income U.S. veterans: Findings from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study

RATIONALE

There are theoretical reasons to expect loneliness related to firearm purchasing. For instance, loneliness might amplify social isolation and feelings of insecurity, anxiety, perceived danger, and need for self-reliance. Purchasing a firearm might be seen as a way to bolster one's security and gain a sense of control when faced with potential threats, yet there is a lack of research assessing this possibility.

OBJECTIVE

This study aimed to examine the relationship between loneliness and purchasing a firearm among a sample of low-income U.S. military veterans.

METHODS

Data are from a national survey of 1,004 low-income U.S. veterans collected in December 2022 and January 2023. Firth logistic regression-a rare event logistic regression model to address small-sample bias stemming from rare outcomes through a penalized likelihood approach-was used to estimate the adjusted association between loneliness and purchasing a firearm in the past year.

RESULTS

Approximately 5.4% reported the purchase of a new firearm in the past year, and respondents reported an average loneliness score of 1.82 (standard deviation = 1.96; range = 0-6). Results of Firth Logit regression analyses found that net of control variables for demographic, socioeconomic, and household characteristics, loneliness was positively associated with purchasing a firearm in the past year (OR = 1.167, 95% CI = 1.006, 1.352).

CONCLUSION

The findings indicate that loneliness among U.S. military veterans is associated with firearm purchasing. Considering the risks posed by both loneliness and firearm ownership for veteran suicide, the findings suggest the need for greater focus and synergistic strategies to address loneliness and safe firearm practices among U.S. veterans.

Empowering law enforcement officers to engage effectively with individuals in crisis

As first responders with a duty to protect the safety of civilians, law enforcement officers are required to carry firearms. Over the course of a career, officers are exposed to multiple traumatic events and are required to make rapid decisions regarding safety. In the last few years, the use of deadly force by law enforcement officers has become a public concern. Persons with untreated mental illness have a comparatively higher risk than most for deadly outcomes in crisis situations. The purpose of this manuscript is to describe policies and programs that have been developed and implemented by teams that include psychiatric mental health nurse practitioners to help law enforcement officers recognize and interact effectively with persons in crisis. The same programs help officers understand the effects of severe stress and trauma on emotional, behavioral, and cognitive functioning, and provide support, encouragement, and access for officers who need help.

Descriptive Epidemiology of Fatal Law Enforcement Interactions with Teenagers, 2010-2020

There is a dearth of population studies regarding law enforcement officers (LEOs) use of fatal force against teenagers. The purpose of this cross-sectional study was to characterize the teens most likely to be killed, the methods used to fatally injure teenagers, the geographic distribution of the killings, and the years of potential life lost before the age of 80 years (YPLL80) due to LEO interactions. Data from the Web-based Injury Statistics Query and Reporting System (WISQARS) from the Center for Disease Control and Prevention (CDC) were analyzed for the years 2010-2020. LEOs killed 330 teenagers; most were males (94.2%) and 6 of 7 teens (84.5%) were shot. The teens killed were disproportionately older teens ages 18-19 years (64.2%) and non-Hispanic Blacks (45.8%) who were usually killed in metropolitan areas (90.0%). The rate of teenage killings by LEOs significantly increased (267%) over the time frame studied. A total of 20,575 YPLL80 were lost and they significantly increased over time (263%). Mitigation of teenagers killed by LEOs will require transforming policing through policy changes (e.g. hiring and training) over an extended period of time. Also, the public needs education, (e.g. funding, interactions) regarding policing.

Firearm-related suicides, homicides, and homicide-suicides involving security officers in two East African Countries: a press media review

BACKGROUND

Firearm violence is a growing public health problem causing death globally. With easy accessibility to firearms, suicides, homicides, and homicide-suicides have increased among security officers, especially in developing countries affected by long-standing civil wars/political insurgencies. No study has explored firearm violence in East African countries. This study describes the press media reporting of suicides, homicides, and homicide-suicides among security officers in two East African countries (Uganda and Kenya).

METHODS

Due to the absence of suicide databases among East African countries, the present study reviewed press media reports. We utilized content analysis of suicides, homicides, and homicide-suicides reports among security forces. Relevant media reports between January-2020 and May-2023 were searched. Using ANOVA and chi-square tests, we tested for statistical differences in characteristics between victims and perpetrators.

RESULTS

Among the 56 perpetrated reports, most of them were homicides 44.64% (n = 25/56), 30.36% (n = 17/56) were homicide-suicides, and 25% (n = 14/56) were suicides. Perpetrators' age ranged from 21 to 47 years, majority being males [53/56 (94.64%)]. Victims were 58, mostly Ugandans [41/58 (73.21%)] with a mean age of 33.5 ± 8.81 years. Among the three main outcomes, statistically significant difference existed by country (χ2 = 23.88, p < 0.001), and perpetrators' age (F = 8.59, p = 0.005). There was a significant difference between perpetrators and the number of victims lost by age of victims (F = 10.37, p = 0.002). Among victims, type of security of perpetrator and citizenship of victims (χ2 = 24.18, p < 0.001) showed statistical difference with Ugandans having more victims to army officers while Kenyans to police officers. Brief incident descriptions pointed towards relationship dysfunctions, alcohol/substance abuse, intentional harm, and financial disagreements, as the potential causes. Only two perpetrators were reported to have mental health-related conditions.

CONCLUSION

This study shows that media reported firearms-related suicides, homicides, and homicide-suicides among security forces commonly involve males. Perpetrators in Uganda are mainly army officers while in Kenya the perpetrators are mostly police officers. Mental health conditions were not frequently reported among perpetrators. We recommend strengthening and enforcing gun regulation policies among security officers to curb this growing problem in these countries. Routine screening of mental health problems to enable early interventions is recommended among security officers.

Older Adults' Preferences Regarding Firearm Locking Device Use: Results of a National Survey

OBJECTIVES

Use of firearm locking devices may reduce the risk of suicide and injury among older adults. This study describes older adults' preferences when choosing a firearm locking device.

METHODS

We conducted a secondary analysis of a nationally representative survey of US adult firearm owners (N = 2,152). We compared older adults (≥65y) with relatively younger adults (<65y), stratified by self-reported gender.

RESULTS

The top three factors cited as impacting firearm locking device selection included speed (53.6%) and ease of firearm access from device (52.4%), and cost of the device (28.7%). These top factors were comparable for all adults across genders. A larger proportion of older vs younger males reported that a primary preference was whether the device allows the firearm to remain loaded with ammunition; smaller proportions of older vs younger males reported strength of device (device durability) and costs.

CONCLUSIONS

Preference among older adults, particularly older males, for locking devices that maintain the firearms easy to access - especially, loaded with ammunition - might impact firearm injury prevention efforts for this high-risk group.

CLINICAL IMPLICATIONS

For harm reduction, use of any firearm locking device may reduce the risk of firearm injury or death. Clinicians are encouraged to explore reasons for locking device selection within motivational interviewing frameworks.

Safer Behind Bars? Comparing In-Custody Deaths Prior to and During Incarceration

INTRODUCTION

This project aims to characterize trauma-associated deaths of the American incarcerated population through legal intervention (LI) or death by law enforcement officials while in custody before and during incarceration. We determined the preceding events leading to violent death, including initiation of medical care, use of restraints and force, and demographics of the victims.

METHODS

We used National Violent Death Reporting System data from the years 2003-2019 to identify deaths that occurred while in custody or incarcerated, including discriminate and narrative data. Event information included weapon type, location of death, incident type, incarceration status, use of restraints, and prone positioning.

RESULTS

There were 86 victims who died from LI included in the analysis. Most events occurred after incarceration. All victims in our cohort were male, and race was an associated factor for death by LI. Only 16% of victims had an education level above high school/general educational development. Death by firearm compared to other weapons was significantly more common in the in-custody but not yet incarcerated group (83% versus 42%, P ≤ 0.0001). Other associated factors included a history of mental health, physical confrontations, the belief that the victim had a weapon, and being restrained in prone positioning.

CONCLUSIONS

Our study shows that racial minority victims are disproportionately affected by LI deaths. Firearms and restraint type were important factors in LI deaths. Our findings suggest that violence prevention in the justice system should focus on prevention and de-escalation across setting with specific attention to use of force and inmate access to the weapons of police, guards, and other law and justice system workers. More transparent quality data is sorely needed to adequately define and address this problem.

Assessing the relationship between gun ownership and fear of mass shootings

RATIONALE

Gun sales spike after mass shooting incidents. As firearm presence is associated with numerous health and safety risks, it is imperative to understand what catalyzes gun ownership. Despite evidence that Americans' fear of mass shootings is increasing at a pace that exceeds their likelihood of victimization, the relationship between fear of mass shootings and gun ownership has received minimal attention.

OBJECTIVE

The current study examines group differences in fear of mass shootings and openness to gun ownership. Specifically, it is hypothesized that (1) fear of mass shootings will increase openness to future firearm ownership among non-owners, (2) gun owners will be more afraid of mass shootings than non-owners, and (3) protective owners will be more afraid than non-protective owners.

METHODS

This paper uses Wave 26 of Pew Research Center's nationally representative American Trends Panel (n = 1968).

RESULTS

Binary logistic regression analyses indicate that among non-gun-owners, fear of mass shootings decreases openness to ownership. Ordinal logistic regression analyses indicate that while fear of mass shootings does not differ between gun owners and non-owners, protective gun owners are more afraid than non-protective owners.

CONCLUSIONS

Combined with prior research, these findings suggest that protective gun owners, non-protective gun owners, and non-owners have distinct views of the relationship between guns and mass shootings and are motivated to acquire firearms by different processes. Additional longitudinal work is needed to confirm these findings and clarify the role of causal attributions.

An assessment of a non-destructive magneto-optical imaging technique for the recovery of laser engraved marks from steel plates and firearm components

The International Tracing Instrument (ITI) is a document adopted by United Nations Member States in 2005, which outlines challenges faced in the tracing of illicit weapons and offers suggestions to increase the success of tracing operations. A key provision of the ITI states that serial numbers must be recoverable if obliterated. This research, therefore, investigates two methods of recovering laser engraved marks on steel, due to the increase in firearms manufacturing relying on lasers to apply critical markings. This work uses 20 steel plates (CR4 grade), 6 AK-pattern rifle top covers, and a steel pistol slide to investigate the potential for visualising laser engraved marks. All samples had marks applied using a BWM-30F Fibre laser marking machine, in addition to any original manufacture's stamped marks on the pistol. All marks were removed using a grinding belt (plates) and a Dremel® rotary tool (slide and top covers) to average depths of 1200 µm (stamped) and 240 µm (laser engraved). Recovery of the marks was attempted using two techniques to compare the two techniques in their ability to recover laser engraved marks; Regula Forensics® Eddy Current Recovery kit, followed by traditional Fry's reagent. Both recovery techniques recovered 100 % (n = 6) of the stamped characters on the pistol slide, and 0 % (n = 509) of the laser engraved characters on the pistol, top covers and steel plates. Recommendations are made for forensic firearms examiners to avoid attempting the recovery of laser engraved marks using Fry's reagent to preserve the integrity of evidence. It is also suggested that manufacturers avoid laser engraving unique identifying marks on firearms, and to use more permanent methods, such as stamping, to remain compliant with politically binding documents such as the ITI.

Firearm availability and police shootings of citizens: a city level analysis of fatal and injurious shootings in California and Florida

BACKGROUND

A growing body of research has found a link between firearm availability and police shootings of citizens across place. The problem, however, is that the previous studies on the topic tend to suffer from several limitations: a near exclusive focus on citizen fatalities, units of analysis at the state or county levels, and a variety of proxy measures tapping into community-level firearm access. The current study set out to address these issues by examining the relationship between different forms of firearm availability and both fatal and nonfatal injurious police shootings of citizens at the city level.

METHODS

More specifically, it merged The Trace's "Missing Pieces" measures of guns reported lost and stolen to police as well as licensed firearms dealers across jurisdictions from the Bureau of Alcohol, Tobacco, Firearms, and Explosives as proxies for firearm availability with data on police shootings of citizens in California and Florida from California's URSUS system and the Tampa Bay Times' "Why Cops Shoot" database, respectively. Negative binomial regression analyses were performed on a sample of 253 cities across the two states and a sub-sample of cities with licensed firearms dealers.

RESULTS

Findings uncovered a small positive association between rates of federally licensed guns stores and the number citizens shot by police as well as police shooting incidents while controlling for several community-level measures (e.g., concentrated disadvantage, gun homicide rates). Rates of guns lost or reported stolen were generally not significantly associated with the outcome measures in the multivariate models.

CONCLUSIONS

Firearm availability is a significant correlate of police shootings. Pooled counts of both citizens shot by police and police shooting incidents are heightened in jurisdictions with higher rates of licensed gun dealers, which may be due to the fact that all firearms sold in the USA first make their way to the public through these mechanisms. Such licensed gun dealers must be appropriately monitored and audited to reduce illicit behavior and prevent firearms from making their way into secondary markets. Addressing access to firearms can be meaningful for a host of gun-related morbidity and mortality outcomes, including police shootings of citizens.

Misclassification of firearm-related violent crime in criminal legal system records: challenges and opportunities

BACKGROUND

Criminal legal system data are one source for measuring some types of firearm-related harms, including those that do not necessarily result in injury or death, but measurement can be hampered by imprecise criminal code statutes. We quantified the degree of misclassification in Washington state criminal codes for measuring firearm-related crime.

FINDINGS

In this study of individuals aged 18 years and older who were convicted of a misdemeanor in Washington Superior Courts from 1/1/2015 through 12/31/2019, we compared firearm-related charges as measured with criminal codes and with manual review of probable cause documents, considered the gold standard. The sample included 5,390 criminal cases. Of these, 77 (1.4%) were firearm-related as measured with criminal codes and 437 (8.1%) were firearm-related as measured via manual record review. In the sample overall, the sensitivity of criminal codes was 17.6% (95% CI 14.2-21.5%), and negative predictive value (NPV) was 93.2% (95% CI 92.5-93.9%). Sensitivity and NPV were higher for cases with exclusively non-violent charges. For all cases and for cases with any violent crime charge, firearm-related crimes described in probable cause documents most often involved explicit verbal threats, firearm possession, and pointing a firearm at or touching a firearm to someone; almost 10% of all cases involved shooting/discharging a firearm. For cases with exclusively non-violent charges, the most common firearm-related crime was unlawful possession.

CONCLUSIONS

Criminal records can be used for large-scale policy-relevant studies of firearm-related harms, but this study suggests Washington state criminal codes substantially undercount firearm-related crime, especially firearm-related violent crime.

Heightened threat perceptions and reduced stability in anxiety and fear among U.S. adults who carry handguns

Firearm carrying is often motivated to provide safety and is correlated with increased anxiety related to elevated perceptions of the world as a dangerous place. No studies have investigated affective states among firearm owners as they occur in their natural environments. This study used ecological momentary assessment (EMA) to examine cognitive-affective states among firearm owners who carry handguns outside their home (n = 35), firearm owners who do not carry (n = 47), and non-firearm owners (n = 62). Participants completed a self-report questionnaire at baseline followed by EMA surveys of mood state with the Positive and Negative Affect Scale (PANAS) 6 times per day for 28 consecutive days. Carry handgun owners reported significantly higher threat perceptions, measured with the negative cognitions about the world subscale of the shortened Posttraumatic Cognitions Inventory (PTCI), than no-carry handgun owners (Mdiff=2.0, 95% CI=0.8-2.0, d=0.45, p = .001) and non-owners (Mdiff=1.8, 95% CI=0.6-2.9, d=0.42, p = .003). Groups did not significantly differ in mean momentary mood ratings assessed via EMA but stability in high-arousal negative arousal was significantly reduced among carry handgun owners (F(2, 150)= 3.7, p = .026). Results suggest firearm owners who carry handguns view the world as especially dangerous, are more likely to experience shifts in anxiety and fear, and take longer to recover from periods of elevated anxiety and fear.

Lethal Force Usage by Law Enforcement Officers Against Hispanics, 2011-2020

Most research on lethal force by law enforcement officers (LEOs) has focused on firearm deaths by LEOs among certain racial groups (e.g., African Americans). Specifically, not much is known about LEOs-induced lethal injuries among Hispanics. The purpose of this study was to characterize LEOs induced fatal injuries, the methods used, among various demographic groups of Hispanics, and the years of potential life lost before the age of 80 years due to lethal force by LEOs. Data from the Web-Based Injury Statistics Query and Reporting System (WISQARS) were analyzed for the years 2011-2020. LEOs killed 1,158 Hispanics; most were males (96.2%) with the majority being shot (89.9%). Two-thirds (66.9%) of those killed were Hispanics 20-39 years of age and from the Western U.S. These Hispanic deaths resulted in 53,320 YPLLs. Males and those ages 20-39 years lost the most YPLLs. The rate of fatal encounters with LEOs for Hispanics grew by 44.4% over the decade, with the highest rate in 2020. Mitigation of unnecessary Hispanic deaths by LEOs needs to include changes in law enforcement agency policies, hiring practices for LEOs, improved data collection for LEOs use of lethal force, improved mental healthcare and training for LEOs, use of less lethal strategies for citizen control by law enforcement, deference education for all young adults, and long-term changes in social forces that have created and maintained disenfranchised communities of color.

Temporal trends and geographic variations in mortality rates from tobacco and firearms in the United States

We explored temporal trends and geographic variations in United States of America (US) mortality rates from smoking and firearms from 1999 to 2019. To do so, we used the publicly available Centers for Disease Control and Prevention (CDC) Wide Ranging Online Data for Epidemiologic Research (WONDER) with Multiple Cause of Death files from 1999 to 2019. Using age-specific rates and ArcGIS Pro Advanced software for Optimized Hot Spot Analyses from Esri, we generated maps of statistically significant spatial clusters with 90-99% confidence intervals with the Getis-Ord Gi* statistic for mortality from smoking-related causes and firearms. These data show temporal trends and geographic variations in mortality from smoking and firearms in the US. Smoking and firearm-related mortality from assault and suicide increased throughout the US and clustered in the Southeast. Firearm-related suicide also clustered in the continental West and Alaska. These descriptive data generate many hypotheses which are testable in analytic epidemiologic studies designed a priori to do so. The trends suggest smoking and firearm-related causes pose particular challenges to the Southeast and firearms also to the West and Alaska. These data may aid clinicians and public health authorities to implement evidence-based smoking avoidance and cessation programs as well as address firearm mortality, with particular attention to the areas of highest risks. As has been the case with cigarettes, individual behavior changes as well as societal changes are likely to be needed to achieve decreases in premature mortality.

A shotgun-induced nonunion humeral fracture treated by Masquelet technique and arthrodesis: a case report

Introduction and importance

The Masquelet technique remains one of the procedures with low rates of failure and infection. The use of this technique in humeral defects is still rare.

Case presentation

A 38-year-old male patient with an open humeral comminuted fracture induced by shotgun injury was referred to our hospital. The Masquelet technique was chosen as the best option with a lower risk of infection and the lower expenses at this stage due to the second time of open reduction and internal fixation and bone graft failure, low patient compliance, and the increasing size of the defect due to bone absorption. An arthrodesis procedure was performed 5 days after the second Masquelet stage as restoring the elbow joint's range of motion was impossible.

Clinical discussion

The Masquelet technique, is a two-step surgical procedure to manage pseudoarthroses and bone defects. Various surgical options are available for performing this procedure. There are several reasons behind the rising popularity of this technique during recent years. Some of these reasons include the reproducibility of this technique, as well as requiring less time, not being technically challenging, and having fewer neurovascular complications.

Conclusion

This case was one of the limited examples of successful implementation of the Masquelete procedure on severe traumatic injuries of the upper limb with bone defects providing more evidence on the safety and efficacy of this technique in similar conditions.

Adverse childhood experiences, child behavioral health needs, and family characteristics associated with the presence of a firearm in the home: a survey of parents in Chicago

BACKGROUND

Firearm violence is the leading cause of pediatric mortality in the USA. The presence of a firearm in the home poses an immense risk to children with increased rates of suicide and unintentional injury by firearm. Recent literature has not explored child ACEs and child behavioral health needs with the presence of a firearm in the home. The objective of this study was to explore an association between these factors, parent health, family experience with firearm violence, and demographics, and the presence of a firearm in the home.

RESULTS

Overall, 382 of 1,436 (weighted to 22.0%) responding parents reported the presence of a firearm in the home. In an adjusted model, the odds ratio of firearm presence increased incrementally with a child's increasing exposure to ACEs. Compared to a child in the household exposed to no ACEs, a child in the household exposed to two or more ACEs was associated with a 5.16 times higher odds of firearm presence in the home (95% confidence interval (CI) 2.92-9.10). Similarly, a child in the household who had used behavioral health services was associated with a 2.10 times higher odds of firearm presence in the home (95% CI 1.35-3.26), compared to a child in the household who had not. Presence of firearm in the home was also associated with higher household income, younger parent age (under 35 years), and male parent gender.

CONCLUSIONS

Chicago parents have higher odds of reporting the presence of a firearm in the home when living in a household with a child exposed to ACEs and with behavioral health needs. These findings could inform future public health interventions and targeted safe storage messaging to prevent pediatric firearm injury in the home.

Spinal gunshot wounds: A retrospective, multicenter, cohort study

INTRODUCTION AND OBJECTIVE

To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America.

MATERIAL AND METHODS

Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment.

RESULTS

Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in n=320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (n=79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (p=0.004), canal compromise (p<0.001), dirty wounds (p<0.001), bullet or bone fragment remains in the spinal canal (p<0.001) and injury pattern (p<0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise.

CONCLUSIONS

In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Firearm locking device preferences among firearm owners in the USA: a systematic review

BACKGROUND

Preventing firearm-involved injuries is a critical public health priority. Firearm locking devices can prevent firearm injuries, such as suicide and unintentional shootings, as well as theft. Various firearm locking devices exist; however, little is known about firearm owners' preferred locking devices for secure firearm storage. In this systematic review, we examined existing literature on preferred locking devices for secure storage of personal firearms among United States (US) firearm owners with the purpose of understanding practical implications and needs for future research.

METHODS

We searched 8 major databases, as well as the grey literature, for English-language sources published on or before January 24, 2023, that empirically examined firearm locking device preferences. Following PRISMA guidelines, coders independently screened and reviewed 797 sources using pre-determined criteria. Overall, 38 records met inclusion criteria and were included in this review.

RESULTS

The majority of studies measure and report on participant use of various types of locking devices, but few go on to measure preference between device options and the attributes and features that may contribute to an individual's preference. Included studies suggest that a preference for larger devices, such as lockboxes and gun safes, may exist among US firearm owners.

CONCLUSIONS

Review of included studies suggests that current prevention efforts may not be aligned with firearm owners' preferences. Additionally, findings from this systematic review emphasize the need for additional methodological rigorous research to understand firearm locking device preferences. Expanded knowledge in this area will result in actionable data and foundational best practices for programming that encourages behavior change concerning secure storage of personal firearms to prevent injury and death.

Physical Health Problems as a Suicide Precipitant: Associations With Other Risk Factors and Suicide Methods in Three Age Groups of Older Decedents

Background and Objectives

Physical health problems are a significant late-life suicide precipitant. This study's purpose was to examine differences in (i) other suicide precipitants and psychiatric/substance use problems, and (ii) suicide methods (firearms, hanging/suffocation, and poisoning) in 3 age groups (55-64, 65-74, and 75+) of older suicide decedents who had physical health problems as a suicide precipitant.

Research Design and Methods

Data came from the 2017-2019 U.S. National Violent Death Reporting System (N = 34,912; 27,761 males [79.5%] and 7,151 females [20.5%]). Generalized linear models for a Poisson distribution with a log link were used to examine the study questions.

Results

Physical health problems were a suicide precipitant for 25.8%, 41.9%, and 57.7% of the 55-64, 65-74, and 75+ age groups, respectively, and were associated with a higher likelihood of having had depressed mood (IRR = 1.38, 95% CI: 1.33-1.43) and other substance use problems (IRR = 1.22, 95% CI: 1.13-1.31). Interaction effects showed that when job/finance/housing problems, depressed mood, or any psychiatric disorders were co-present with physical health problems, the age group differences in the predicted rates of physical health problems were diminished. Physical health problems were also positively associated with firearm and poisoning use, but negatively associated with hanging/suffocation. Interaction effects indicated that the predicted rates of firearm and poisoning use significantly increased among those aged 55-64 with than without physical health problems.

Discussion and Implications

In all 3 age groups of older suicide decedents, physical health problems were the predominant suicide precipitant, and those with physical health problems had elevated depressed mood. Assessment of suicide risk, affordable and accessible health, and mental health services, restriction of access to lethal suicide methods, and policy-based suicide prevention approaches for older adults with physical health problems are needed.

Safe at home: prevention of pediatric unintentional injuries

BACKGROUND

Unintentional injuries are the leading cause of death in children in the United States. Studies have shown that parent adherence to safety guidelines is improved when education is provided in conjunction with safety equipment.

METHODS

This study surveyed parents about specific injury prevention behaviors regarding medication and firearm storage and provided education and safety equipment for safe practice of these behaviors. The project took place in a pediatric emergency department (PED) and partnered with the hospital foundation and the school of medicine. Inclusion criteria were families visiting a freestanding PED in a tertiary care center. Participants completed a survey conducted by a medical student approximately 5 min in length. The student then provided each family with a medication lock box (if children ≤ 5 years old lived in the home), firearm cable lock, and education for safe storage of medications and firearms in the home.

RESULTS

The medical student researcher spent a total of 20 h in the PED from June to August 2021. 106 families were approached to participate in the study, of which 99 agreed to participate (93.4%). A total of 199 children were reached with ages ranging from less than 1 year old to 18 years old. A total of 73 medication lockboxes and 95 firearm locks were distributed. The majority (79.8%) of survey participants were the mother of the patient and 97.0% of participants lived with the patient > 50% of the time. For medication storage, 12.1% of families store medications locked and 71.7% reported never receiving medication storage education from a healthcare professional. Regarding firearms, 65.2% of participants who reported having at least 1 firearm in the home stored firearms locked and unloaded with various methods of storage. 77.8% of firearm owners reported storing ammunition in a separate location from the firearm. Of all participants surveyed, 82.8% reported never receiving firearm storage education from a healthcare professional.

CONCLUSIONS

The pediatric ED is an excellent setting for injury prevention and education. Many families are not storing medications and firearms safely, demonstrating a clear opportunity to increase knowledge in families with young children.