From gunstore to smoking gun: tracking guns that kill children in North Carolina.

PubMed

Campbell, Brendan T; Radisch, Deborah L; Phillips, J Duncan; von Allmen, Daniel

2004-12-01

This study reviews the epidemiology of pediatric firearm deaths in North Carolina and estimates the time from the retail sale of guns to their involvement in pediatric firearm deaths. The authors reviewed autopsy reports for all children 0 to 14 years of age that died of firearm-related injuries in North Carolina from January 1999 through December 2002. Data obtained included demographic information, firearm type, and manner of death. Data from the Bureau of Alcohol, Tobacco and Firearms, which traced guns involved in crimes and determined the time elapsed from purchase to their involvement in a crime (ie, time-to-crime were also reviewed). During the study period, 40 children died of firearm injuries. Mean age was 7.6 years. Handguns were responsible for the majority of deaths (59%) followed by shotguns (27%), rifles (10%), and undetermined cause (10%). Most deaths were homicides (67%) followed by unintentional death (18%), suicide (13%), and undetermined cause (2%). Most crime guns (76%) were purchased legally, and many (40%) had a time-to-crime of less than 3 years. Legally purchased firearms pose a significant threat to children in North Carolina. A more restrictive approach to the sale of handguns is a logical approach to reducing pediatric firearm-related deaths in the United States.

Toward a taxonomy of the unintentional discharge of firearms in law enforcement.

PubMed

O'Neill, John; O'Neill, Dawn A; Lewinski, William J

2017-03-01

An unintentional discharge (UD) is an activation of the trigger mechanism that results in an unplanned discharge that is outside of the firearm's prescribed use. UDs can result in injury or death, yet have been understudied in scientific literature. Pre-existing (1974-2015) UD reports (N = 137) from seven law enforcement agencies in the United States of America were analyzed by context, officer behavior, type of firearm, and injuries. Over 50% of UDs occurred in contexts with low threat potential while engaged in routine firearm tasks. The remaining UDs occurred in contexts with elevated to high threat potential during muscle co-activation, unfamiliar firearm tasks, contact with inanimate objects, and a medical condition. An antecedent-behavior-consequence (A-B-C) taxonomy as well as a standardized reporting form, based on the current findings and the existing literature, are offered as tools for identifying the conditions under which UDs may be likely to occur. Copyright © 2016 Elsevier Ltd. All rights reserved.

Violence related injuries, deaths and disabilities in the capital of Honduras.

PubMed

Yacoub, Sophie; Arellano, Sergio; Padgett-Moncada, Dennis

2006-05-01

Honduras has the second highest incidence of violence in the Americas. The aim of this study is to explore the number and mechanism of fatal injuries, non-fatal injuries and the sequelae of these injuries due to violence. This is compared with unintentional injuries, in the capital of Honduras for 2001, with a view to better-targeted prevention. Data for non-fatal injuries was retrospectively obtained from medical records of all admissions from the public Emergency Department in Tegucigalpa for 2001. Data on fatal injuries were obtained from the national forensic department. All injuries were reviewed for intention, mechanism and age group. There were 1631 (rate 138/100,000) fatal injuries recorded for 2001 in Tegucigalpa. Of these, 1149 (70.4%) were due to violence, compared to 355 (21.8%) due to unintentional injuries and 127 (7.8%) of unknown intent. Homicides accounted for 1044 (64%), suicides 105 (6.4%) and unintentional deaths 355 (22%). Firearms were the leading cause of death in the homicide group (84.3%). In addition 1592 (rate 235/100,000) non-fatal injuries were documented for people 15 years and above, with 1228 (77.1%) caused by violence, of which 640 (52.1%) were caused by firearms. The age group 15-24 years had the highest rates of fatal and non-fatal injuries due to violence. Twenty percent had permanent sequelae as a result of their injuries. Firearm injuries had the highest proportion of sequelae (28.8%). Violence in Tegucigalpa is a major cause of injury resulting in substantial morbidity, mortality and disability, particularly in young individuals. Firearms are the most common form of violence related injury mechanism and carry the highest associated mortality and permanent disability. Prevention programs are urgently needed to address this devastating problem.

Firearm Deaths in America: Can We Learn From 462,000 Lives Lost?

PubMed

Resnick, Shelby; Smith, Randi N; Beard, Jessica H; Holena, Daniel; Reilly, Patrick M; Schwab, C William; Seamon, Mark J

2017-09-01

We sought to determine whether state firearm legislation correlated with firearm-related fatality rates (FFR) during a 15-year period. The politicized and controversial topic of firearm legislation has been grossly understudied when the relative impact of American firearm violence is considered. Scientific evidence regarding gun legislation effectiveness remains scant. Demographic and intent data (1999-2013) were collected from the Centers for Disease Control and Prevention's Web-Based Injury Statistics Query and Reporting System database and compared by state firearm legislation rankings with respect to FFR. State scorecards were obtained from firearm-restrictive (Brady Campaign/Law Center against Gun Violence [BC/LC]) and less-restrictive (National Rifle Association) groups. FFR were compared between restrictive and least-restrictive states during 3 periods (1999-2003, 2004-2008, 2009-2013). During 1999 to 2013, 462,043 Americans were killed by firearms. Overall FFR did not change during the 3 periods (10.89 ± 3.99/100,000; 10.71 ± 3.93/100,000; 11.14 ± 3.91/100,000; P = 0.87). Within each period, least-restrictive states had greater unintentional, pediatric, and adult suicide, White and overall FFR than restrictive states (all P < 0.05). Conversely, no correlation was seen, during any of the 3 time periods, with either homicide or Black FFR-population subsets accounting for 41.7% of firearm deaths. Restrictive firearm legislation is associated with decreased pediatric, unintentional, suicide, and overall FFR, but homicide and Black FFR appear unaffected. Future funding and research should be directed at both identifying the most effective aspects of firearm legislation and creating legislation that equally protects every segment of the American population.

Law, Ethics, and Conversations between Physicians and Patients about Firearms in the Home.

PubMed

McCourt, Alexander D; Vernick, Jon S

2018-01-01

Firearms in the home pose a risk to household members, including homicide, suicide, and unintentional deaths. Medical societies urge clinicians to counsel patients about those risks as part of sound medical practice. Depending on the circumstances, clinicians might recommend safe firearm storage, temporary removal of the firearm from the home, or other measures. Certain state firearm laws, however, might present legal and ethical challenges for physicians who counsel patients about guns in the home. Specifically, we discuss state background check laws for gun transfers, safe gun storage laws, and laws forbidding physicians from engaging in certain firearm-related conversations with their patients. Medical professionals should be aware of these and other state gun laws but should offer anticipatory guidance when clinically appropriate. © 2018 American Medical Association. All Rights Reserved.

77 FR 74484 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-14

... surveillance of school-associated homicides and suicides. The system relies on existing public records and... the United States died violent deaths due to suicide, homicide, and unintentional firearm injuries... suicide occurs in or around school, it becomes a matter of particularly intense public interest and...

On the Alert: Preparing for Medical Emergencies in Schools

ERIC Educational Resources Information Center

Mahoney, Dan

2012-01-01

Medical emergencies can happen in any school at any time. They can be the result of preexisting health problems, accidents, violence, unintentional actions, natural disasters, and toxins. Premature deaths in schools from sudden cardiac arrest, blunt trauma to the chest, firearm injuries, asthma, head injuries, drug overdose, allergic reactions,…

Childhood Maltreatment, Public Service System Contact, and Preventable Death in Young Adulthood.

PubMed

Jonson-Reid, Melissa; Drake, Brett; Kohl, Patricia L

2017-02-01

Data from a longitudinal cohort study of low-income children reported for maltreatment matched to similarly poor nonreported children were used to examine intentional and unintentional injury deaths in young adulthood. The goal was to examine the unique contribution of maltreatment history and identify other potential systems for preventive efforts. Maltreatment reports were associated with increased risk of injury-related death per 6-month intervals (hazard ratio [HR] = 1.09, p < .05). Young adults with histories of both status offenses and delinquent offenses were at greater risk for later death (HR = 2.24, p < .05) as were those with histories of emergency room (ER) treatment for intentional injury prior to age 18 years (HR =3.95, p < .05). More than 50% of the deaths were firearm-related; nearly all firearm deaths occurred among Black youth. Implications for prevention within at-risk populations are discussed.

Preventing gun injuries in children.

PubMed

Crossen, Eric J; Lewis, Brenna; Hoffman, Benjamin D

2015-02-01

Firearms are involved in the injury and death of a large number of children each year from both intentional and unintentional causes. Gun ownership in homes with children is common, and pediatricians should incorporate evidence-based means to discuss firearms and protect children from gun-related injuries and violence. Safe storage of guns, including unloaded guns locked and stored separately from ammunition, can decrease risks to children, and effective tools are available that pediatricians can use in clinical settings to help decrease children's access to firearms. Furthermore, several community-based interventions led by pediatricians have effectively reduced firearm-related injury risks to children. Educational programs that focus on children's behavior around guns have not proven effective. © American Academy of Pediatrics, 2015. All rights reserved.

County Poverty Concentration and Disparities in Unintentional Injury Deaths: A Fourteen-Year Analysis of 1.6 Million U.S. Fatalities

PubMed Central

Karb, Rebecca A.; Subramanian, S. V.; Fleegler, Eric W.

2016-01-01

Unintentional injury is the fourth leading cause of death in the United States, and mortality due to injury has risen over the past decade. The social determinants behind these rising trends have not been well documented. This study examines the relationship between county-level poverty and unintentional injury mortality in the United States from 1999–2012. Complete annual compressed mortality and population data for 1999–2012 were obtained from the National Center for Health Statistics and linked with census yearly county poverty measures. The outcomes examined were unintentional injury fatalities, overall and by six specific mechanisms: motor vehicle collisions, falls, accidental discharge of firearms, drowning, exposure to smoke or fire, and unintentional poisoning. Age-adjusted mortality rates and time trends for county poverty categories were calculated, and multivariate negative binomial regression was used to determine changes over time in both the relative risk of living in high poverty concentration areas and the population attributable fraction. Age-adjusted mortality rates for counties with > 20% poverty were 66% higher mortality in 1999 compared with counties with < 5% poverty (45.25 vs. 27.24 per 100,000; 95% CI for rate difference 15.57,20.46), and that gap widened in 2012 to 79% (44.54 vs. 24.93; 95% CI for rate difference 17.13,22.09). The relative risk of living in the highest poverty counties has increased for all injury mechanisms with the exception of accidental discharge of firearms. The population attributable fraction for all unintentional injuries rose from 0.22 (95% CI 0.13,0.30) in 1999 to 0.35 (95% CI 0.22,0.45) in 2012. This is the first study that uses comprehensive mortality data to document the associations between county poverty and injury mortality rates for the entire US population over a 14 year period. This study suggests that injury reduction interventions should focus on areas of high or increasing poverty. PMID:27144919

County Poverty Concentration and Disparities in Unintentional Injury Deaths: A Fourteen-Year Analysis of 1.6 Million U.S. Fatalities.

PubMed

Karb, Rebecca A; Subramanian, S V; Fleegler, Eric W

2016-01-01

Unintentional injury is the fourth leading cause of death in the United States, and mortality due to injury has risen over the past decade. The social determinants behind these rising trends have not been well documented. This study examines the relationship between county-level poverty and unintentional injury mortality in the United States from 1999-2012. Complete annual compressed mortality and population data for 1999-2012 were obtained from the National Center for Health Statistics and linked with census yearly county poverty measures. The outcomes examined were unintentional injury fatalities, overall and by six specific mechanisms: motor vehicle collisions, falls, accidental discharge of firearms, drowning, exposure to smoke or fire, and unintentional poisoning. Age-adjusted mortality rates and time trends for county poverty categories were calculated, and multivariate negative binomial regression was used to determine changes over time in both the relative risk of living in high poverty concentration areas and the population attributable fraction. Age-adjusted mortality rates for counties with > 20% poverty were 66% higher mortality in 1999 compared with counties with < 5% poverty (45.25 vs. 27.24 per 100,000; 95% CI for rate difference 15.57,20.46), and that gap widened in 2012 to 79% (44.54 vs. 24.93; 95% CI for rate difference 17.13,22.09). The relative risk of living in the highest poverty counties has increased for all injury mechanisms with the exception of accidental discharge of firearms. The population attributable fraction for all unintentional injuries rose from 0.22 (95% CI 0.13,0.30) in 1999 to 0.35 (95% CI 0.22,0.45) in 2012. This is the first study that uses comprehensive mortality data to document the associations between county poverty and injury mortality rates for the entire US population over a 14 year period. This study suggests that injury reduction interventions should focus on areas of high or increasing poverty.

Occupational injury mortality in New Mexico.

PubMed

Fullerton, L; Olson, L; Crandall, C; Sklar, D; Zumwalt, R

1995-10-01

To examine specific risks for occupational injury deaths in New Mexico. Retrospective review of state medical investigator reports from 1980 through 1991 with regard to industry, agent of death, gender, ethnicity, location, and alcohol and other drug involvement. New Mexico residents who were fatally injured while on the job. We identified 613 deaths: 87.1% unintentional, 10.6% homicides, and 2.3% suicides. Industries with the most fatalities were construction (11.8%), oil/gas (10.6%), and farming (8.6%). The primary agents of death were motor vehicles (41.7%), firearms (10.1%), and falling objects (10.0%). Almost all (95.6%) of the decedents were male. However, females were overrepresented among homicide deaths (P < .0001). Most unintentional injuries occurred in rural areas (69.1%), whereas most homicides (73.4%) and suicides (71.4%) occurred in urban areas. Drug or alcohol use was evident in 19.4% of cases. New Mexico has a high rate of occupational injury death, which appears to be associated with rural location and use of motor vehicles and alcohol.

Rural population survey of behavioral and demographic risk factors for loaded firearms

PubMed Central

Nordstrom, D; Zwerling, C; Stromquist, A; Burmeister, L; Merchant, J

2001-01-01

Objectives—In the United States, firearm deaths are almost as frequent as motor vehicle deaths. Firearm unintentional and suicide death rates are raised in rural areas. This study examines firearm prevalence and storage practices in three different types of rural households. Methods—Adults from a stratified random sample of 983 households in a rural Iowa county were interviewed. The χ2 test of independence was used to assess association between loaded, unlocked firearms and seven behavioral and demographic risk factors. Results—Nearly 67% of respondents reported firearms in their households. Nearly 7% of households had a loaded, unlocked gun. Prevalence of firearms at home was higher while prevalence of loaded, unlocked guns was lower than reported in other surveys. Prevalence of loaded, unlocked guns in farm households, 10.5%, was about twice the level in town households, 5.5% (χ2 test, p=0.033). Having taken a gun safety course was associated with more than double the prevalence of a loaded, unlocked gun, 13.5% v 5.1% (χ2 test, p=0.001). The prevalence of loaded, unlocked guns in households with a handgun, 19.3%, was four and one half times higher than in households with a long gun only, 4.2% (χ2 test, p=0.001). Households with someone with a lifetime prevalence of alcohol abuse or dependence were about twice as likely as other households, 13.0% v 6.6% (χ2 test, p=0.004), to report having loaded, unlocked firearms. Conclusions—Anyone interested in promoting safe storage of firearms in rural homes should consider these observations. PMID:11428557

Children and firearms in Turkish homes.

PubMed

Hizel, S; Ozcebe, H; Sanli, C; Albayrak, M; Uner, S

2008-01-01

Unintentional firearm injuries are an important cause of preventable deaths and disabilities among children. Keeping firearms at home and letting children to see or touch them increases the risk of injury. This cross-sectional study was conducted to estimate the extent of the firearm problem in an Anatolian province in Turkey. A random sample of families were approached and were asked to answer a series of questions completed by research assistants. In 974 randomly selected households, there were 2129 children aged less than 18 years, 11.1% of the fathers have a job in the firearms industry or in the security sector, and 12.3% of the households kept a firearm at home. Only 25.6% of the firearms were kept in a safe place, and 29.3% of the firearms and ammunition were kept separately. Overall, 70.9% of the children whose parents have firearms saw the firearm and 27.2% had handled it. Results of this study pointed to the urgent need for preventive measures for the physical separation of guns from children. The establishment of effective firearms safety programmes requires an understanding of the culture and routine behaviours of the target population.

Comparison of Rates of Firearm and Nonfirearm Homicide and Suicide in Black and White Non-Hispanic Men, by U.S. State.

PubMed

Riddell, Corinne A; Harper, Sam; Cerdá, Magdalena; Kaufman, Jay S

2018-05-15

The extent to which differences in homicide and suicide rates in black versus white men vary by U.S. state is unknown. To compare the rates of firearm and nonfirearm homicide and suicide in black and white non-Hispanic men by U.S. state and to examine whether these deaths are associated with state prevalence of gun ownership. Surveillance study. 50 states and the District of Columbia, 2008 to 2016. Cause-of-death data were abstracted by using the Centers for Disease Control and Prevention's WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Non-Hispanic black and non-Hispanic white males, all ages. Absolute rates of and rate differences in firearm and nonfirearm homicide and suicide in black and white men. During the 9-year study period, 84 113 homicides and 251 772 suicides occurred. Black-white differences in rates of firearm homicide and suicide varied widely across states. Relative to white men, black men had between 9 and 57 additional firearm homicides per 100 000 per year, with black men in Missouri, Michigan, Illinois, Indiana, and Pennsylvania having more than 40 additional firearm homicides per 100 000 per year. White men had between 2 fewer and 16 more firearm suicides per 100 000 per year, with the largest inequalities observed in southern and western states and the smallest in the District of Columbia and densely populated northeastern states. Some homicides and suicides may have been misclassified as deaths due to unintentional injury. Survey data on state household gun ownership were collected in 2004 and may have shifted during the past decade. The large state-to-state variation in firearm homicide and suicide rates, as well as the racial inequalities in these numbers, highlights states where policies may be most beneficial in reducing homicide and suicide deaths and the racial disparities in their rates. McGill University and the National Institutes of Health.

Unintended shootings in a large metropolitan area: an incident-based analysis.

PubMed

Ismach, Richard B; Reza, Avid; Ary, Roy; Sampson, Tomoko Rie; Bartolomeos, Kidist; Kellermann, Arthur L

2003-01-01

We determine the proportion of unintended shootings that might be prevented by promoting safe storage, safe handling, and/or safer firearm designs. A regional firearm injury surveillance system was used to identify fatal and nonfatal unintentional shootings in a 5-county metropolitan area. Case reports were reviewed, and the causes of each shooting were independently classified by 4 members of the research team. A consensus conference was held to resolve disagreements. Between May 1, 1996, and June 30, 2000, 216 cases of unintentional firearm injury were identified, 3.8% of the shootings documented during the study period. Six (2.8%) were fatal. The majority of victims were between 15 and 34 years of age. One fourth (54) of the shootings involved victims younger than 18 years. Handguns were involved in 87% of the incidents. Enough information was available to characterize the incident in 122 (57%) cases. All but 6 fell into 1 or more of 3 broad categories of causation: Child access (14%), mishandling (74%), and/or deficiencies in firearm design (32%). Many unintentional shootings could be prevented by promoting safe storage of guns in the home, promoting safe handling of firearms, and requiring that all new handguns incorporate basic safety features.

Mortality in American Hip-Hop and Rap Recording Artists, 1987-2014.

PubMed

Lawson, Carl J

2015-12-01

The deaths of American hip-hop and rap recording artists often receive considerable media attention. However, these artists' deaths have not been examined as a distinct group like the deaths of rock, classical, jazz, and pop music artists. This is a seminal epidemiological analysis on the deaths of an understudied group, American hip-hop and rap music recording artists. Media reports were analyzed of the deaths of American hip-hop and rap music recording artists that occurred from January 1, 1987 to December 31, 2014. The decedents' age, sex, race, cause of death, stage names, and city and state of death were recorded for analysis. The most commonly reported cause of death was homicide. The 280 deaths were categorized as homicide (55%), unintentional injury (13%), cardiovascular (7%), undetermined/undisclosed (7%), cancer (6%), other (5%), suicide (4%), and infectious disease (3%). The mean reported age at death was 30 yrs (range 15-75) and the median was 29 yrs; 97% were male and 92% were black. All but one of the homicides were committed with firearms. Homicide was the most commonly reported cause of death. Public health focus and guidance for hip-hop and rap recording artists should mirror that for African-American men and adolescent males ages 15-54 yrs, for whom the leading causes of death are homicide, unintentional injury, and heart disease. Given the preponderance of homicide deaths in this analysis, premature mortality reduction efforts should focus on violence prevention and conflict mitigation.

Firearm-associated Fractures in Children and Adolescents: Trends in the United States 2003-2012.

PubMed

Blumberg, Todd J; DeFrancesco, Christopher J; Miller, Daniel J; Pandya, Nirav K; Flynn, John M; Baldwin, Keith D

2018-05-02

Firearm-associated injuries are the second leading cause of death in children in the United States. Fractures are common comorbid injuries in young patients with firearm-associated injuries. The purpose of this study was to define the burden of firearm-associated fractures (FAFs) in children and adolescents in the United States. We analyzed the 2003-2012 Kids' Inpatient Database. Patients were grouped into 4 age groups: 0 to 4, 5 to 9, 10 to 14, and 15 to 20 years old. Sample observations with both an external cause of injury code indicating gunshot injury and a diagnosis code indicating orthopaedic fracture (extremity, pelvis, or spine) were identified as cases of FAF. Sex, age, race, cause of injury, and fracture-related operating room procedures were catalogued. Population-level incidence was calculated for each year studied. From 2003 to 2012, the incidence of FAF in patients 20 years and below of age increased from 73 to 96 cases per 100,000 admissions (P=0.009). The 0 to 4 age group saw the largest increase in injury frequency (141%, P=0.08). There was a 4-fold increase in the rate of unintentional injury in this subgroup. The most common age group affected by FAFs was 15 to 20 year olds. Minorities and male individuals were disproportionately affected. Assault and unintentional causes were the most common reasons for injury. The frequency of FAF in patients 20 years and below of age increased over the study period, with almost 1 case per 1000 admissions in 2012. The finding that certain subpopulations are disproportionately affected reflects the complex sociologic factors influencing gun violence in the United States. Level III-retrospective cohort study.

Surveillance for Violent Deaths —
National Violent Death Reporting System, 18 States, 2014

PubMed Central

Jack, Shane P.D.; Lyons, Bridget H.; Betz, Carter J.; Petrosky, Emiko

2018-01-01

Problem/Condition In 2014, approximately 59,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC’s National Violent Death Reporting System (NVDRS) regarding violent deaths from 18 U.S. states for 2014. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. Reporting Period Covered 2014. Description of System NVDRS collects data from participating states regarding violent deaths. Data are obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 18 states that collected statewide data for 2014 (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) into a single incident. Results For 2014, a total of 22,098 fatal incidents involving 22,618 deaths were captured by NVDRS in the 18 states included in this report. The majority of deaths were suicides (65.6%), followed by homicides (22.5%), deaths of undetermined intent (10.0%), deaths involving legal intervention (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (<1%). The term “legal intervention” is a classification incorporated into the International Classification of Diseases, Tenth Revision (ICD-10) and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement. Suicides occurred at higher rates among males, non-Hispanic American Indian/Alaska Natives (AI/AN), non-Hispanic whites, persons aged 45–54 years, and males aged ≥75 years. Suicides were preceded primarily by a mental health, intimate partner, substance abuse, or physical health problem or a crisis during the previous or upcoming 2 weeks. Homicide rates were higher among males and persons aged <1 year and 15–44 years; rates were highest among non-Hispanic black and AI/AN males. Homicides primarily were precipitated by arguments and interpersonal conflicts, occurrence in conjunction with another crime, or related to intimate partner violence (particularly for females). When the relationship between a homicide victim and a suspected perpetrator was known, it was most often either an acquaintance/friend or an intimate partner. Legal intervention death rates were highest among males and persons aged 20–44 years; rates were highest among non-Hispanic black males and Hispanic males. Precipitating factors for the majority of legal intervention deaths were alleged criminal activity in progress, the victim reportedly using a weapon in the incident, a mental health or substance abuse problem, an argument or conflict, or a recent crisis. Deaths of undetermined intent occurred more frequently among males, particularly non-Hispanic black and AI/AN males, and persons aged 30–54 years. Substance abuse, mental health problems, physical health problems, and a recent crisis were the most common circumstances preceding deaths of undetermined intent. Unintentional firearm deaths were more frequent among males, non-Hispanic whites, and persons aged 10–24 years; these deaths most often occurred while the shooter was playing with a firearm and were most often precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded. Interpretation This report provides a detailed summary of data from NVDRS for 2014. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected persons aged <65 years, males, and certain minority populations. The primary precipitating factors for homicides and suicides were intimate partner problems, interpersonal conflicts, mental health and substance abuse problems, and recent crises. Public Health Action NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths. For example, North Carolina VDRS data were used to improve case ascertainment of pregnancy-associated suicides, Wisconsin VDRS data were used to develop the statewide suicide prevention strategy, and Colorado VDRS data were used to develop programs and prevention strategies for suicide among veterans. The continued development and expansion of NVDRS to include all U.S. states, territories, and the District of Columbia are essential to public health efforts to reduce the impact of violence. PMID:29389917

Surveillance for Violent Deaths -
National Violent Death Reporting System, 18 States, 2014.

PubMed

Fowler, Katherine A; Jack, Shane P D; Lyons, Bridget H; Betz, Carter J; Petrosky, Emiko

2018-02-02

In 2014, approximately 59,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 18 U.S. states for 2014. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. 2014. NVDRS collects data from participating states regarding violent deaths. Data are obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 18 states that collected statewide data for 2014 (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) into a single incident. For 2014, a total of 22,098 fatal incidents involving 22,618 deaths were captured by NVDRS in the 18 states included in this report. The majority of deaths were suicides (65.6%), followed by homicides (22.5%), deaths of undetermined intent (10.0%), deaths involving legal intervention (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (<1%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision (ICD-10) and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement. Suicides occurred at higher rates among males, non-Hispanic American Indian/Alaska Natives (AI/AN), non-Hispanic whites, persons aged 45-54 years, and males aged ≥75 years. Suicides were preceded primarily by a mental health, intimate partner, substance abuse, or physical health problem or a crisis during the previous or upcoming 2 weeks. Homicide rates were higher among males and persons aged <1 year and 15-44 years; rates were highest among non-Hispanic black and AI/AN males. Homicides primarily were precipitated by arguments and interpersonal conflicts, occurrence in conjunction with another crime, or related to intimate partner violence (particularly for females). When the relationship between a homicide victim and a suspected perpetrator was known, it was most often either an acquaintance/friend or an intimate partner. Legal intervention death rates were highest among males and persons aged 20-44 years; rates were highest among non-Hispanic black males and Hispanic males. Precipitating factors for the majority of legal intervention deaths were alleged criminal activity in progress, the victim reportedly using a weapon in the incident, a mental health or substance abuse problem, an argument or conflict, or a recent crisis. Deaths of undetermined intent occurred more frequently among males, particularly non-Hispanic black and AI/AN males, and persons aged 30-54 years. Substance abuse, mental health problems, physical health problems, and a recent crisis were the most common circumstances preceding deaths of undetermined intent. Unintentional firearm deaths were more frequent among males, non-Hispanic whites, and persons aged 10-24 years; these deaths most often occurred while the shooter was playing with a firearm and were most often precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded. This report provides a detailed summary of data from NVDRS for 2014. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected persons aged <65 years, males, and certain minority populations. The primary precipitating factors for homicides and suicides were intimate partner problems, interpersonal conflicts, mental health and substance abuse problems, and recent crises. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths. For example, North Carolina VDRS data were used to improve case ascertainment of pregnancy-associated suicides, Wisconsin VDRS data were used to develop the statewide suicide prevention strategy, and Colorado VDRS data were used to develop programs and prevention strategies for suicide among veterans. The continued development and expansion of NVDRS to include all U.S. states, territories, and the District of Columbia are essential to public health efforts to reduce the impact of violence.

National estimates of non-fatal firearm related injuries other than gunshot wounds

PubMed Central

Hootman, J; Annest, J; Mercy, J; Ryan, G; Hargarten, S

2000-01-01

Objective—To characterize non-fatal firearm related injuries other than gunshot wounds (non-GSWs) treated in hospital emergency departments in the United States that occur during routine gun handling and recreational use as well as violence related use of a firearm. Methods—Cases were identified through the National Electronic Injury Surveillance System (NEISS). During the study period, 1 January 1993 through 31 December 1996, NEISS consisted of a nationally representative sample of 91 hospitals in the United States having at least six beds and providing 24 hour emergency services. Results—An estimated 65 374, or an average of 16 300 per year, non-fatal, non-GSWs were treated in American hospital emergency departments during the four year study period. Fifty seven per cent of all the non-fatal, non-GSWs were violence related, most of which involved being struck by a firearm. The majority of unintentional non-fatal, non-GSWs were self inflicted and occurred during routine gun handling or recreational use of a firearm; 43% of these injuries resulted from gun recoils. Conclusions—Non-fatal, non-GSWs make a notable contribution to the public health burden of firearm related injuries. Firearm related injury prevention programs should focus on not only the reduction of gunshot wounds but also the reduction of unintentional and violence related non-GSWs. PMID:11144625

School-associated violent deaths in the United States, 1994-1999.

PubMed

Anderson, M; Kaufman, J; Simon, T R; Barrios, L; Paulozzi, L; Ryan, G; Hammond, R; Modzeleski, W; Feucht, T; Potter, L

2001-12-05

Despite the public alarm following a series of high-profile school shootings that occurred in the United States during the late 1990s, little is known about the actual incidence and characteristics of school-associated violent deaths. To describe recent trends and features of school-associated violent deaths in the United States. Population-based surveillance study of data collected from media databases, state and local agencies, and police and school officials for July 1, 1994, through June 30, 1999. A case was defined as a homicide, suicide, legal intervention, or unintentional firearm-related death of a student or nonstudent in which the fatal injury occurred (1) on the campus of a public or private elementary or secondary school, (2) while the victim was on the way to or from such a school, or (3) while the victim was attending or traveling to or from an official school-sponsored event. National estimates of risk of school-associated violent death; national trends in school-associated violent deaths; common features of these events; and potential risk factors for perpetration and victimization. Between 1994 and 1999, 220 events resulting in 253 deaths were identified; 202 events involved 1 death and 18 involved multiple deaths (median, 2 deaths per multiple-victim event). Of the 220 events, 172 were homicides, 30 were suicides, 11 were homicide-suicides, 5 were legal intervention deaths, and 2 were unintentional firearm-related deaths. Students accounted for 172 (68.0%) of these deaths, resulting in an estimated average annual incidence of 0.068 per 100 000 students. Between 1992 and 1999, the rate of single-victim student homicides decreased significantly (P =.03); however, homicide rates for students killed in multiple-victim events increased (P =.047). Most events occurred around the start of the school day, the lunch period, or the end of the school day. For 120 (54.5%) of the incidents, respondents reported that a note, threat, or other action potentially indicating risk for violence occurred prior to the event. Homicide offenders were more likely than homicide victims to have expressed some form of suicidal behavior prior to the event (odds ratio [OR], 6.96; 95% confidence interval [CI], 1.96-24.65) and been bullied by their peers (OR, 2.57; 95% CI, 1.12-5.92). Although school-associated violent deaths remain rare events, they have occurred often enough to allow for the detection of patterns and the identification of potential risk factors. This information may help schools respond to this problem.

Surveillance for Violent Deaths - National Violent Death Reporting System, 17 States, 2013.

PubMed

Lyons, Bridget H; Fowler, Katherine A; Jack, Shane P D; Betz, Carter J; Blair, Janet M

2016-08-19

In 2013, more than 57,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 17 U.S. states for 2013. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. 2013. NVDRS collects data from participating states regarding violent deaths obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 17 states that collected statewide data for 2013 (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, North Carolina, New Jersey, New Mexico, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) from a single incident. For 2013, a total of 18,765 fatal incidents involving 19,251 deaths were captured by NVDRS in the 17 states included in this report. The majority (66.2%) of deaths were suicides, followed by homicides (23.2%), deaths of undetermined intent (8.8%), deaths involving legal intervention (1.2%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (<1%). (The term legal intervention is a classification incorporated into the International Classification of Diseases, Tenth Revision [ICD-10] and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Suicides occurred at higher rates among males, non-Hispanic whites, American Indian/Alaska Natives, persons aged 45-64 years, and males aged ≥75 years. Suicides were preceded primarily by a mental health, intimate partner, or physical health problem or a crisis during the previous or upcoming 2 weeks. Homicide rates were higher among males and persons aged 15-44 years; rates were highest among non-Hispanic black males. Homicides primarily were precipitated by arguments and interpersonal conflicts, occurrence in conjunction with another crime, or were related to intimate partner violence (particularly for females). A known relationship between a homicide victim and a suspected perpetrator was most likely either that of an acquaintance or friend or an intimate partner. Legal intervention death rates were highest among males and persons aged 20-24 years and 30-34 years; rates were highest among non-Hispanic black males. Precipitating factors for the majority of legal intervention deaths were another crime, a mental health problem, or a recent crisis. Deaths of undetermined intent occurred at the highest rates among males and persons aged <1 year and 45-54 years. Substance abuse and mental or physical health problems were the most common circumstances preceding deaths of undetermined intent. Unintentional firearm death rates were higher among males, non-Hispanic whites, and persons aged persons aged 15-19 and 55-64 years; these deaths were most often precipitated by a person unintentionally pulling the trigger while playing with a firearm or while hunting. This report provides a detailed summary of data from NVDRS for 2013. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected persons aged <65 years, males, and certain minority populations. For homicides and suicides, intimate partner problems, interpersonal conflicts, mental health problems, and recent crises were primary precipitating factors. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths. For example, Utah Violent Death Reporting System (VDRS) data were used to develop policies that support children of intimate partner homicide victims, Colorado VDRS data to develop a web-based suicide prevention program targeting middle-aged men, and Rhode Island VDRS data to help guide suicide prevention efforts at workplaces. The continued development and expansion of NVDRS to include all U.S. states, territories, and the District of Columbia are essential to public health efforts to reduce the impact of violence.

FastStats: Accidents or Unintentional Injuries

MedlinePlus

... 17 [PDF – 676 KB] Mortality All unintentional injury deaths Number of deaths: 146,571 Deaths per 100, ... 6 Cause of death rank: 4 Unintentional fall deaths Number of deaths: 33,381 Deaths per 100, ...

Causes of unintentional deaths from carbon monoxide poisonings in California.

PubMed Central

Girman, J R; Chang, Y L; Hayward, S B; Liu, K S

1998-01-01

The purpose of this study was to determine the annual number and incidence of unintentional deaths from carbon monoxide (CO) poisonings in California and to identify specific factors that caused or contributed to the deaths. Unintentional CO deaths in California over a ten-year period (1979 to 1988) were identified from the database of the California Master Mortality File and coroners' investigation reports. Factors associated with unintentional CO deaths were determined based on the information from the investigation reports. The annual number of unintentional CO deaths varied from 27 to 58 over the ten years examined, with an average annual death incidence of 1.7 x 10(-6). Death rates were high among males and African-Americans. Alcohol appeared to be a factor in 31% of the cases. The types of combustion sources associated with unintentional CO deaths were: heating or cooking appliances; motor vehicles; charcoal grills and hibachis; small engines; and camping equipment. Factors associated with unintentional CO deaths interact in a complex way. To reduce the rate of unintentional CO deaths effectively, joint efforts involving several prevention methods are suggested. PMID:9549414

The National Violent Death Reporting System: overview and future directions.

PubMed

Blair, Janet M; Fowler, Katherine A; Jack, Shane P D; Crosby, Alexander E

2016-04-01

To describe the National Violent Death Reporting System (NVDRS). This is a surveillance system for monitoring the occurrence of homicides, suicides, unintentional firearm deaths, deaths of undetermined intent, and deaths from legal intervention (excluding legal executions) in the US. This report provides information about the history, scope, data variables, processes, utility, limitations, and future directions of the NVDRS. The NVDRS currently operates in 32 states, with the goal of future expansion to all 50 states, the District of Columbia, and US territories. The system uses existing primary data sources (death certificates, coroner/medical examiner reports, and law enforcement reports), and links them together to provide a comprehensive picture of the circumstances surrounding violent deaths. This report provides an overview of the NVDRS including a description of the system, discussion of its expanded capability, the use of new technologies as the system has evolved, how the data are being used for violence prevention efforts, and future directions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Prevention of firearm injuries with gun safety devices and safe storage: an Eastern Association for the Surgery of Trauma systematic review.

PubMed

Violano, Pina; Bonne, Stephanie; Duncan, Thomas; Pappas, Peter; Christmas, A Britton; Dennis, Andrew; Goldberg, Stephanie; Greene, Wendy; Hirsh, Michael; Shillinglaw, William; Robinson, Bryce; Crandall, Marie

2018-03-08

Over 50,000 homicides and suicides occur each year. An estimated half of all U.S. households are believed to have a firearm present, making them one of the most ubiquitous consumer products. Our goal was to determine if the manner of storage of a firearm in a home could potentially make a difference in the outcomes of intentional and unintentional injuries involving a firearm; specifically addressing the use of gun safes and devices that block/disable firearm function (trigger locks, cable locks, etc.). A comprehensive review of the literature was performed. We used GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology to assess the breadth and quality of the data specific to our PICO (Population, Intervention, Comparator, Outcomes) questions. A total of 176 studies were initially identified, then 120 more added after a subsequent, literature review with 97 removed as duplicates. One hundred and ninety-one case reports, case series, and reviews were removed because they did not focus on prevention or did not address our comparators of interest. This left a total of two studies which merited inclusion for PICO #1, should gun locks be used to prevent firearm injuries and six studies which merited inclusion for PICO #2, should safe storage for guns be used to prevent firearm injuries. PICO 1: We conditionally recommend that gun locks be used to prevent unintentional firearm injury.PICO 2: Because of the large effect size and the reasonable quality of available evidence with safe storage of firearms, we recommend safe storage prevent firearm-related injuries. Systematic review, level III.

Gun buyback programs: a venue to eliminate unwanted guns in the community.

PubMed

Violano, Pina; Driscoll, Cassandra; Chaudhary, Neil K; Schuster, Kevin M; Davis, Kimberly A; Borer, Esther; Winters, Jane K; Hirsh, Michael P

2014-09-01

The United States has a high rate of death due to firearms, and gun buyback programs may mitigate these high death rates. Understanding the demographics, motivation, and geographic region of participants may improve program efficacy. Three Injury Free Coalition for Kids gun buyback programs, in collaboration with the local police, were studied: Phoenix, Arizona; Worcester, Massachusetts; and New Haven, Connecticut. Participants were defined as those who relinquished a firearm. A self-administered, anonymous, paper survey elicited information from participants regarding demographic data, formal training on the use of the firearm, how the firearm was acquired, potential child access, knowledge of others injured by a firearm, whether the firearm was stored unlocked, factors motivating the surrender of the firearm, and other factors. Survey results were entered into a composite database and analyzed for differences in location, race, sex, and other factors. Participants (n = 301) were predominantly male (73.5%), white (80.9%), and older than 55 years (59.0%). They lived an average of 19.0 miles from the event by zip codes and had an average median household income of $65,731. More than half (54.5%) did not purchase the firearm, acquiring it through inheritance, gift, or random find. Most (74.8%) had previous firearms training and were relinquishing for safety reasons (68.3%). Those relinquishing firearms for safety reasons were less likely to have purchased the firearm (odds ratio [OR], 2.46, p <0.05), less likely to have any formal training (OR, 5.92; p < 0.01), and less likely to keep the firearm locked (OR, 3.50; p < 0.01). Women were less likely to have purchased the firearm (OR, 0.50; p < 0.05). Fifty-three percent of those turning in firearms reported having at least one more firearm at home; designated themselves to be white, compared with all other groups combined (OR, 2.55; p < 0.05); more likely to report locking the firearm (OR, 0.11; p < 0.001); more interested in receiving a gun lock (OR, 0.15; p < 0.001); and more likely to know others who also own firearms (OR, 0.17; p < 0.001). In at least one of the cities participating in this study, as many as 30 percent of the weapons used in gun-wielding criminal acts were burglarized from the home of legal gun owners that had failed to secure them properly. The gun buyback program is solely one prong of a multipronged approach in reducing firearm-based interpersonal violence. Additional research is necessary to determine effective methods to target individuals who would have the greatest impact on gun violence if they relinquished their weapons. Through the forging of relationships and enhancement of firearm knowledge among medical, law enforcement, judicial, and school communities, the prevention of intentional and unintentional firearm-related injuries will be able to be managed more effectively.

Forensic firearm identification of semiautomatic handguns using laser formed microstamping elements

NASA Astrophysics Data System (ADS)

Lizotte, Todd E.; Ohar, Orest

2008-08-01

For well over one hundred years the science of Firearm and Tool Mark Identification has relied on the theory that unintentional random tooling marks generated during the manufacture of a firearm onto its interior surfaces are unique to each individual firearm.[1][2] Forensic Firearm and Tool Mark Examiners have had to rely on the analysis of these randomly formed unintentional striations, or scratches and dings, transferred onto ammunition components from firearms used to commit crimes, as a way of developing clues and evidence. Such transfers take place during the cycle of fire and ejection of the cartridge from the firearm during the commission of a crime. The typical striations on the cartridge casings are caused by tooling marks that are randomly formed during the machining of interior surfaces of the manufactured firearm and by other firearm components that come in contact with the cycling ammunition. Components like the firing pin, extractor and ejector, impact the surfaces of the cartridges as they are fed, fired and ejected from the firearm. When found at a crime scene, these striae constitute ballistic evidence when effectively analyzed by a Forensic Firearm and Tool Mark Examiner. Examiners categorize these striations looking for matches to be made between the components that created the marks and the recovered firearm. Reality is that nearly 50% of firearms used in violent crimes are not recovered at a crime scene, requiring the analysis to be processed and logged into evidence files or imaged into reference image databases for future comparison whenever a firearm might be recovered. This paper will present a unique law enforcement technology, embedded into firearms for tracking the sources of illegally trafficked firearms, called Microstamping. Microstamping is a laser based micromachining process that forms microscopic "intentional structures and marks" on components within a firearm. Thus when the firearm is fired, these microstamp structures transfer an identifying tracking code onto the expended cartridge ejected from the firearm. Microstamped structures are laser micromachined alpha numeric and encoded geometric tracking numbers, linked to the serial number of the firearm. Ballistic testing data will be presented covering microstamp transfer quality, transfer rates and survivability/durability. Further information will provide an overview on how microstamping information can be utilized by law enforcement to combat illegal firearm trafficking.

Can Statewide Emergency Department, Hospital Discharge, and Violent Death Reporting System Data Be Used to Monitor Burden of Firearm-Related Injury and Death in Rhode Island?

PubMed

Jiang, Yongwen; Ranney, Megan L; Sullivan, Brian; Hilliard, Dennis; Viner-Brown, Samara; Alexander-Scott, Nicole

2018-03-07

National data on the epidemiology of firearm injuries and circumstances of firearm deaths are difficult to obtain and often are nonreliable. Since firearm injury and death rates and causes can vary substantially between states, it is critical to consider state-specific data sources. In this study, we illustrate how states can systematically examine demographic characteristics, firearm information, type of wound, toxicology tests, precipitating circumstances, and costs to provide a comprehensive picture of firearm injuries and deaths using data sets from a single state with relatively low rates of firearm injury and death. Cross-sectional study. Firearm-related injury data for the period 2005-2014 were obtained from the Rhode Island emergency department and hospital discharge data sets; death data for the same period were obtained from the Rhode Island Violent Death Reporting System. Descriptive statistics were used. Healthcare Cost and Utilization Project cost-to-charge ratios were used to convert total hospital charges to costs. Most firearm-related emergency department visits (55.8%) and hospital discharges (79.2%) in Rhode Island were from assaults; however, most firearm-related deaths were suicides (60.1%). The annual cost of firearm-related hospitalizations was more than $830 000. Most decedents who died because of firearms tested positive for illicit substances. Nearly a quarter (23.5%) of firearm-related homicides were due to a conflict between the decedent and suspect. More than half (59%) of firearm suicide decedents were reported to have had current mental or physical problems prior to death. Understanding the state-specific magnitude and patterns (who, where, factors, etc) of firearm injury and death may help inform local injury prevention efforts. States with similar data sets may want to adopt our analyses. Surveillance of firearm-related injury and death is essential. Dissemination of surveillance findings to key stakeholders is critical in improving firearm injury prevention. States that are not part of the National Violent Death Reporting System (NVDRS) could work with their other data sources to obtain a better picture of violent injuries and deaths to make the best use of resources.

Characteristics of self-inflicted drug overdose deaths in North Carolina.

PubMed

Austin, Anna E; Proescholdbell, Scott K; Creppage, Kathleen E; Asbun, Alex

2017-12-01

Drug overdose mortality is a major public health concern in the United States, with prescription opioids contributing substantially to recent increases in drug overdose deaths. Compared to unintentional drug overdose deaths, relatively little data describes intentional self-inflicted drug overdose deaths (i.e., suicide by drug overdose). The aim of this study was to examine the characteristics of self-inflicted drug overdose deaths, overall and in comparison to unintentional drug overdose deaths. We linked vital statistics, prescription drug monitoring program, and toxicology data for self-inflicted and unintentional drug overdose deaths among North Carolina residents in 2012. Most self-inflicted (79.2%) and unintentional (75.6%) drug overdose decedents had a prescription for a controlled substance within one year of death. Toxicology results revealed that antidepressants contributed to a significantly higher percent of self-inflicted compared to unintentional drug overdose deaths (45.0% vs. 8.1%). Among deaths in which commonly prescribed opioids (oxycodone, hydrocodone) or benzodiazepines (alprazolam, clonazepam) contributed to death, a significantly higher percent of self-inflicted drug overdose decedents had a prescription for the substance within 30days of death compared to unintentional drug overdose decedents. The results highlight the use of prescription opioids, benzodiazepines, and antidepressants among self-inflicted drug overdose decedents. Importantly, the results indicate that self-inflicted drug overdose decedents were more likely than unintentional drug overdose decedents to have potential contact with the health care system in the weeks preceding death, offering an opportunity for professionals to identify and intervene on risk factors or signs of distress and potential for self-harm. Copyright © 2017 Elsevier B.V. All rights reserved.

Individual and Neighborhood Characteristics of Children Seeking Emergency Department Care for Firearm Injuries Within the PECARN Network.

PubMed

Carter, Patrick M; Cook, Lawrence J; Macy, Michelle L; Zonfrillo, Mark R; Stanley, Rachel M; Chamberlain, James M; Fein, Joel A; Alpern, Elizabeth R; Cunningham, Rebecca M

2017-07-01

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. 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. 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. 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. © 2017 by the Society for Academic Emergency Medicine.

Source of firearms used by students in school-associated violent deaths--United States, 1992-1999.

PubMed

2003-03-07

During July 1, 1992-June 30, 1999, a total of 323 school-associated violent death events occurred in the United States, resulting in 358 deaths. To guide prevention efforts, CDC examined school-associated firearm violent death events committed by students in elementary and secondary schools in the United States and determined the sources of the firearms used in these events. The findings indicate that, among the incidents for which data are available, the majority of the firearms used in these events were obtained from perpetrators' homes or from friends or relatives. The safe storage of firearms is critically important and should be continued. In addition, other strategies that might prevent firearm-related injuries and deaths among students, such as safety and design changes for firearms, should be evaluated.

State background checks for gun purchase and firearm deaths: an exploratory study.

PubMed

Sen, Bisakha; Panjamapirom, Anantachai

2012-10-01

This study examines the relationship between the types of background-information check required by states prior to firearm purchases, and firearm homicide and suicide deaths. Negative binomial models are used to analyze state-level data for homicides and suicides in the U.S. from 1996 to 2005. Data on types of background information are retrieved from the Surveys of State Procedures Related to Firearm Sales, and the violent death data are from the WISQARS. Several other state level factors were controlled for. More background checks are associated with fewer homicide (IRR:0.93, 95% CI:0.91-0.96) and suicide (IRR:0.98, 95% CI:0.96-1.00) deaths. Firearm homicide deaths are lower when states have checks for restraining orders (IRR:0.87, 95% CI:0.79-0.95) and fugitive status (IRR:0.79, 95% CI:0.72-0.88). Firearm suicide deaths are lower when states have background checks for mental illness (IRR:0.96, 95% CI:0.92-0.99), fugitive status (IRR:0.95, 95% CI:0.90-0.99) and misdemeanors (IRR:0.95, 95% CI:0.92-1.00). It does not appear that reductions in firearm deaths are offset by increases in non-firearm violent deaths. More extensive background checks prior to gun purchase are mostly associated with reductions in firearm homicide and suicide deaths. Several study limitations are acknowledged, and further research is called for to ascertain causality. Copyright © 2012 Elsevier Inc. All rights reserved.

A longitudinal ecological study of household firearm ownership and firearm-related deaths in the United States from 1999 through 2014: A specific focus on gender, race, and geographic variables.

PubMed

Geier, David A; Kern, Janet K; Geier, Mark R

2017-06-01

Firearms have a longstanding tradition in the United States (US) and are viewed by many with iconic stature with regards to safety and personal freedom. Unfortunately, from a public health point of view, firearm-related deaths (FRDs) in the US have reached a crisis point with an estimated > 31,000 deaths and 74,000 nonfatal injuries resulting from firearms each year. This longitudinal ecological study analyzed variations in FRDs following firearm assaults (FAs) and law enforcement incidents involving a firearm (LEIF) in comparison to variations in household firearm ownership (HFO) among different geographic and demographic groups in the US from 1999 to 2014. The Underlying Cause of Death database was examined on the CDC Wonder online interface. Records coded with ICD-10 codes: FA (X93 - assault by handgun discharge, X94 - assault by rifle, shotgun, and larger firearm discharge, or X95 - assault by other and unspecified firearm discharge) and LEIF (Y35.0) were examined, and the prevalence of HFO was determined using the well-established proxy of the percentage of suicides committed with a firearm. Gender, ethnicity, Census Division, and urbanization significantly impacted the death rates from FA and LEIF. Significant direct correlations between variations in HFO and death rates from FAs and LEIF were observed. Understanding the significant impacts of gender, race, Census Division, and urbanization status may help shape future public health policy to promote increased firearm safety.

Firearms injury prevention and gun control in Canada.

PubMed

Chapdelaine, A; Maurice, P

1996-11-01

Firearms cause more than three deaths daily in Canada. The rate of mortality from gunshot wounds varies among provinces and territories, ranging from 5.7 to 21.2 per 100,000 people. Most deaths from gunshot wounds occur in the home, with more occurring in rural areas than in cities, and are inflicted with legally acquired hunting guns. The cost of the consequences of the improper use of firearms in Canada has been estimated at $6.6 billion per year. There is a correlation between access to guns and risk of death. The mere presence of a firearm in a home increases the risk of suicide, homicide and "accidental" death. It is estimated that, in one third of all households in Quebec that have a firearm, it is not safely, or even legally, stored. To prevent deaths and injuries from firearms, education is not enough. Environmental, technological and legislative measures are also needed. In this spirit, the Quebec Public Health Network has taken a position supporting better controls on access to firearms, including the licensing and registration of all firearms and their ownership, to prevent deaths and injuries. The network believes that licensing and registration will reduce the problems related to firearms by making owners accountable for the use of their firearms, improving public safety, helping to control the import and circulation of firearms, reinforcing research and education, and reducing access to firearms in homes. Licensing and registration do not interfere with legitimate firearm use, their cost is acceptable in light of the advantages they provide, and they are desired by most Canadians.

Firearms injury prevention and gun control in Canada.

PubMed Central

Chapdelaine, A; Maurice, P

1996-01-01

Firearms cause more than three deaths daily in Canada. The rate of mortality from gunshot wounds varies among provinces and territories, ranging from 5.7 to 21.2 per 100,000 people. Most deaths from gunshot wounds occur in the home, with more occurring in rural areas than in cities, and are inflicted with legally acquired hunting guns. The cost of the consequences of the improper use of firearms in Canada has been estimated at $6.6 billion per year. There is a correlation between access to guns and risk of death. The mere presence of a firearm in a home increases the risk of suicide, homicide and "accidental" death. It is estimated that, in one third of all households in Quebec that have a firearm, it is not safely, or even legally, stored. To prevent deaths and injuries from firearms, education is not enough. Environmental, technological and legislative measures are also needed. In this spirit, the Quebec Public Health Network has taken a position supporting better controls on access to firearms, including the licensing and registration of all firearms and their ownership, to prevent deaths and injuries. The network believes that licensing and registration will reduce the problems related to firearms by making owners accountable for the use of their firearms, improving public safety, helping to control the import and circulation of firearms, reinforcing research and education, and reducing access to firearms in homes. Licensing and registration do not interfere with legitimate firearm use, their cost is acceptable in light of the advantages they provide, and they are desired by most Canadians. PMID:8911295

Drugs, guns and cars: how far we have come to improve safety in the United States; yet we still have far to go.

PubMed

Dodington, James; Violano, Pina; Baum, Carl R; Bechtel, Kirsten

2017-01-01

Significant breakthroughs in the field of injury prevention and childhood safety have occurred during the past half-century. For example, the Poison Prevention Packaging Act of 1970 and the institution of child passenger safety laws are responsible for a significant reduction in injuries among children and adolescents. This review will focus on the following three topics because of their significant contribution to pediatric injury morbidity, especially among adolescents, and their promise for further effective prevention research. Opioid overdoses by adolescents and young adults are increasing; however, the use of naloxone by bystanders represents a life-saving development in opioid overdose prevention that deserves further investigation. Youth firearm injury remains a major cause of death and disability in adolescents. Despite a lack of robust injury prevention research on the topic, the development of novel approaches to access and examine firearm injury data is leading to exploration of public health approaches to reduce these injuries. Finally, despite legislative and educational efforts surrounding child passenger safety and graduated driver license laws, motor vehicle crashes are still a leading cause of injury for both children and adolescents; however, research on these laws holds the opportunity for significant reduction in injuries. Focused efforts to reduce unintentional injuries from opiate overdoses, firearms and motor vehicle crashes may produce a breakthrough in the field of injury prevention similar to that of the Poison Prevention Packaging Act.

State Firearm Legislation and Nonfatal Firearm Injuries.

PubMed

Simonetti, Joseph A; Rowhani-Rahbar, Ali; Mills, Brianna; Young, Bessie; Rivara, Frederick P

2015-08-01

We investigated whether stricter state-level firearm legislation was associated with lower hospital discharge rates for nonfatal firearm injuries. We estimated discharge rates for hospitalized and emergency department-treated nonfatal firearm injuries in 18 states in 2010 and used negative binomial regression to determine whether strength of state firearm legislation was independently associated with total nonfatal firearm injury discharge rates. We identified 26 744 discharges for nonfatal firearm injuries. The overall age-adjusted discharge rate was 19.0 per 100 000 person-years (state range = 3.3-36.6), including 7.9 and 11.1 discharges per 100 000 for hospitalized and emergency department-treated injuries, respectively. In models adjusting for differences in state sociodemographic characteristics and economic conditions, states in the strictest tertile of legislative strength had lower discharge rates for total (incidence rate ratio [IRR] = 0.60; 95% confidence interval [CI] = 0.44, 0.82), assault-related (IRR = 0.58; 95% CI = 0.34, 0.99), self-inflicted (IRR = 0.18; 95% CI = 0.14, 0.24), and unintentional (IRR = 0.53; 95% CI = 0.34, 0.84) nonfatal firearm injuries. There is significant variation in state-level hospital discharge rates for nonfatal firearm injuries, and stricter state firearm legislation is associated with lower discharge rates for such injuries.

State Firearm Legislation and Nonfatal Firearm Injuries

PubMed Central

Rowhani-Rahbar, Ali; Mills, Brianna; Young, Bessie; Rivara, Frederick P.

2015-01-01

Objectives. We investigated whether stricter state-level firearm legislation was associated with lower hospital discharge rates for nonfatal firearm injuries. Methods. We estimated discharge rates for hospitalized and emergency department–treated nonfatal firearm injuries in 18 states in 2010 and used negative binomial regression to determine whether strength of state firearm legislation was independently associated with total nonfatal firearm injury discharge rates. Results. We identified 26 744 discharges for nonfatal firearm injuries. The overall age-adjusted discharge rate was 19.0 per 100 000 person-years (state range = 3.3–36.6), including 7.9 and 11.1 discharges per 100 000 for hospitalized and emergency department–treated injuries, respectively. In models adjusting for differences in state sociodemographic characteristics and economic conditions, states in the strictest tertile of legislative strength had lower discharge rates for total (incidence rate ratio [IRR] = 0.60; 95% confidence interval [CI] = 0.44, 0.82), assault-related (IRR = 0.58; 95% CI = 0.34, 0.99), self-inflicted (IRR = 0.18; 95% CI = 0.14, 0.24), and unintentional (IRR = 0.53; 95% CI = 0.34, 0.84) nonfatal firearm injuries. Conclusions. There is significant variation in state-level hospital discharge rates for nonfatal firearm injuries, and stricter state firearm legislation is associated with lower discharge rates for such injuries. PMID:26066935

Association Between Gun Law Reforms and Intentional Firearm Deaths in Australia, 1979-2013.

PubMed

Chapman, Simon; Alpers, Philip; Jones, Michael

2016-07-19

Rapid-fire weapons are often used by perpetrators in mass shooting incidents. In 1996 Australia introduced major gun law reforms that included a ban on semiautomatic rifles and pump-action shotguns and rifles and also initiated a program for buyback of firearms. To determine whether enactment of the 1996 gun laws and buyback program were followed by changes in the incidence of mass firearm homicides and total firearm deaths. Observational study using Australian government statistics on deaths caused by firearms (1979-2013) and news reports of mass shootings in Australia (1979-May 2016). Changes in intentional firearm death rates were analyzed with negative binomial regression, and data on firearm-related mass killings were compared. Implementation of major national gun law reforms. Changes in mass fatal shooting incidents (defined as ≥5 victims, not including the perpetrator) and in trends of rates of total firearm deaths, firearm homicides and suicides, and total homicides and suicides per 100,000 population. From 1979-1996 (before gun law reforms), 13 fatal mass shootings occurred in Australia, whereas from 1997 through May 2016 (after gun law reforms), no fatal mass shootings occurred. There was also significant change in the preexisting downward trends for rates of total firearm deaths prior to vs after gun law reform. From 1979-1996, the mean rate of total firearm deaths was 3.6 (95% CI, 3.3-3.9) per 100,000 population (average decline of 3% per year; annual trend, 0.970; 95% CI, 0.963-0.976), whereas from 1997-2013 (after gun law reforms), the mean rate of total firearm deaths was 1.2 (95% CI, 1.0-1.4) per 100,000 population (average decline of 4.9% per year; annual trend, 0.951; 95% CI, 0.940-0.962), with a ratio of trends in annual death rates of 0.981 (95% CI, 0.968-0.993). There was a statistically significant acceleration in the preexisting downward trend for firearm suicide (ratio of trends, 0.981; 95% CI, 0.970-0.993), but this was not statistically significant for firearm homicide (ratio of trends, 0.975; 95% CI, 0.949-1.001). From 1979-1996, the mean annual rate of total nonfirearm suicide and homicide deaths was 10.6 (95% CI, 10.0-11.2) per 100,000 population (average increase of 2.1% per year; annual trend, 1.021; 95% CI, 1.016-1.026), whereas from 1997-2013, the mean annual rate was 11.8 (95% CI, 11.3-12.3) per 100,000 (average decline of 1.4% per year; annual trend, 0.986; 95% CI, 0.980-0.993), with a ratio of trends of 0.966 (95% CI, 0.958-0.973). There was no evidence of substitution of other lethal methods for suicides or homicides. Following enactment of gun law reforms in Australia in 1996, there were no mass firearm killings through May 2016. There was a more rapid decline in firearm deaths between 1997 and 2013 compared with before 1997 but also a decline in total nonfirearm suicide and homicide deaths of a greater magnitude. Because of this, it is not possible to determine whether the change in firearm deaths can be attributed to the gun law reforms.

27 CFR 479.42 - Changes through death of owner.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Changes through death of owner. 479.42 Section 479.42 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

27 CFR 479.42 - Changes through death of owner.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Changes through death of owner. 479.42 Section 479.42 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

27 CFR 479.42 - Changes through death of owner.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Changes through death of owner. 479.42 Section 479.42 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

27 CFR 479.42 - Changes through death of owner.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Changes through death of owner. 479.42 Section 479.42 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

FastStats: Child Health

MedlinePlus

... 7 [PDF – 2.7 MB] Leading causes of death Children aged 1-4 years Accidents (unintentional injuries) ... unintentional injuries) Cancer Intentional self-harm (suicide) Source: Deaths: Final Data for 2015, table 6 [PDF – 2. ...

Unintentional injury mortality among indigenous communities of Taiwan: trends from 2002 to 2013 and evaluation of a community-based intervention.

PubMed

Pan, Stephen W; Chong, Hiu Ha; Kao, Hui-Chuan

2017-11-27

Indigenous communities in Taiwan shoulder a disproportionate burden of unintentional injury fatalities. We compare unintentional injury mortality rate trends among Taiwan's indigenous communities and the general population from 2002 to 2013, and evaluate potential impact of a community-based injury prevention programme on indigenous unintentional injury death rates. Standardised and crude unintentional injury mortality rates were obtained from Taiwan government reports. Segmented linear regression was used to estimate and compare unintentional injury mortality rate trends before and after the intervention. Between 2002 and 2013, unintentional injury mortality rates among Taiwan's indigenous population significantly declined by about 4.5 deaths per 100 000 each year (p<0.0001). During that time, the unintentional injury mortality rate ratio between indigenous Taiwanese and the general population significantly decreased by approximately 1% each successive year (p=0.02). However, we were unable to detect evidence that the 'Healthy and Safe Tribe' programme was associated with a statistically significant decrease in the unintentional injury mortality rate trend among indigenous persons (p=0.81). Taiwanese indigenous communities remain at significantly higher risk of unintentional injury death, though the gap may be slowly narrowing. We found no evidence that the 'Healthy and Safe Tribe' indigenous injury-prevention programme significantly contributed to the nationwide decline in unintentional injury mortality among indigenous Taiwanese communities from 2009 to 2013. Future interventions to address the disproportionate burden of unintentional injury fatalities among indigenous Taiwanese should consider interventions with wider coverage of the indigenous population, and complementing grass roots led community-based interventions with structural policy interventions as well. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Fatal injuries in the slums of Nairobi and their risk factors: results from a matched case-control study.

PubMed

Ziraba, Abdhalah Kasiira; Kyobutungi, Catherine; Zulu, Eliya Msiyaphazi

2011-06-01

Injuries contribute significantly to the rising morbidity and mortality attributable to non-communicable diseases in the developing world. Unfortunately, active injury surveillance is lacking in many developing countries, including Kenya. This study aims to describe and identify causes of and risk factors for fatal injuries in two slums in Nairobi city using a demographic surveillance system framework. The causes of death are determined using verbal autopsies. We used a nested case-control study design with all deaths from injuries between 2003 and 2005 as cases. Two controls were randomly selected from the non-injury deaths over the same period and individually matched to each case on age and sex. We used conditional logistic regression modeling to identity individual- and community-level factors associated with fatal injuries. Intentional injuries accounted for about 51% and unintentional injuries accounted for 49% of all injuries. Homicides accounted for 91% of intentional injuries and 47% of all injury-related deaths. Firearms (23%) and road traffic crashes (22%) were the leading single causes of deaths due to injuries. About 15% of injuries were due to substance intoxication, particularly alcohol, which in this community comes from illicit brews and is at times contaminated with methanol. Results suggest that in the pervasively unsafe and insecure environment that characterizes the urban slums, ethnicity, residence, and area level factors contribute significantly to the risk of injury-related mortality.

To Improve Homicide Firearm Information Reporting - Rhode Island State Crime Laboratory.

PubMed

Jiang, Yongwen; Lyons, Dennis; Northup, Jane B; Hilliard, Dennis; Foss, Karen; Young, Shannon; Viner-Brown, Samara

2018-05-01

Information on homicide firearms can be used to help state and local communities understand the problems of violence and decrease injuries and deaths. However, it is difficult to collect these data. To our knowledge, in the public health arena, the National Violent Death Reporting System (NVDRS) is the only system that collects detailed firearm information. The Rhode Island State Crime Laboratory (RISCL) can provide detailed information about the firearms and cartridge cases\\bullets involved in firearm deaths. With help from the RISCL, the firearm information related to homicides in Rhode Island has improved dramatically. In 2015, information on caliber/gauge increased by 80%, the firearm type by 50%, the make by 50%, and the model by 20%. By documenting the process of using information from the RISCL, it is hoped that this process can be used as a model by other states when reporting on violent deaths. [Full article available at http://rimed.org/rimedicaljournal-2018-05.asp].

Firearm legislation and firearm-related fatalities in the United States.

PubMed

Fleegler, Eric W; Lee, Lois K; Monuteaux, Michael C; Hemenway, David; Mannix, Rebekah

2013-05-13

Over 30,000 people die annually in the United States from injuries caused by firearms. Although most firearm laws are enacted by states, whether the laws are associated with rates of firearm deaths is uncertain. To evaluate whether more firearm laws in a state are associated with fewer firearm fatalities. Using an ecological and cross-sectional method, we retrospectively analyzed all firearm-related deaths reported to the Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System from 2007 through 2010. We used state-level firearm legislation across 5 categories of laws to create a "legislative strength score," and measured the association of the score with state mortality rates using a clustered Poisson regression. States were divided into quartiles based on their score. Fifty US states. Populations of all US states. The outcome measures were state-level firearm-related fatalities per 100,000 individuals per year overall, for suicide, and for homicide. In various models, we controlled for age, sex, race/ethnicity, poverty, unemployment, college education, population density, nonfirearm violence-related deaths, and household firearm ownership. Over the 4-year study period, there were 121,084 firearm fatalities. The average state-based firearm fatality rates varied from a high of 17.9 (Louisiana) to a low of 2.9 (Hawaii) per 100,000 individuals per year. Annual firearm legislative strength scores ranged from 0 (Utah) to 24 (Massachusetts) of 28 possible points. States in the highest quartile of legislative strength (scores of ≥9) had a lower overall firearm fatality rate than those in the lowest quartile (scores of ≤2) (absolute rate difference, 6.64 deaths/100,000/y; age-adjusted incident rate ratio [IRR], 0.58; 95% CI, 0.37-0.92). Compared with the quartile of states with the fewest laws, the quartile with the most laws had a lower firearm suicide rate (absolute rate difference, 6.25 deaths/100,000/y; IRR, 0.63; 95% CI, 0.48-0.83) and a lower firearm homicide rate (absolute rate difference, 0.40 deaths/100,000/y; IRR, 0.60; 95% CI, 0.38-0.95). A higher number of firearm laws in a state are associated with a lower rate of firearm fatalities in the state, overall and for suicides and homicides individually. As our study could not determine cause-and-effect relationships, further studies are necessary to define the nature of this association.

Who Are the Owners of Firearms Used in Adolescent Suicides?

ERIC Educational Resources Information Center

Johnson, Renee M.; Barber, Catherine; Azrael, Deborah; Clark, David E.; Hemenway, David

2010-01-01

In this brief report, the source of firearms used in adolescent suicides was examined using data from the National Violent Injury Statistics System, the pilot to the CDC's National Violent Death Reporting System, a uniform reporting system for violent and firearm-related deaths. Data represent the 63 firearm suicides among youth (less than 18 yrs)…

Stats of the States

MedlinePlus

... rates for fatal drug poisonings. Death Rates from Firearm Injuries: United States, 2013 - The latest state-based age-adjusted death rates for firearm-related fatalities. Death Rates from Homicide: United States, ...

Evaluation of a community-based safe firearm and ammunition storage intervention.

PubMed

Simonetti, Joseph A; Rowhani-Rahbar, Ali; King, Cassie; Bennett, Elizabeth; Rivara, Frederick P

2018-06-01

Safe firearm storage practices are associated with a lower risk of unintentional and self-inflicted firearm injuries among household members, though many firearms remain unlocked and/or loaded. Conduct a preliminary evaluation of a community-based firearm safety intervention and assess participants' preferences for firearm locking devices and their comfort with potential firearm safety counsellors. Baseline event and follow-up surveys among adult participants to assess changes in firearm storage practices, including whether all household firearms were stored locked, all were unloaded, all ammunition was locked, and a composite measure assessing whether all firearms were locked and unloaded and all ammunition was stored locked. A total of 206 out of 415 participants completed both surveys and were included. Nearly 9 in 10 respondents preferred the firearm lock box rather than a trigger lock. At follow-up, a significantly greater proportion reported that all household firearms were locked (+13.7%) and unloaded (+8.5%) and a non-significantly greater proportion reported that all ammunition was locked (+6.3%). A significantly greater proportion reported practising all three safe firearm and ammunition storage practices at follow-up (+12.6%). A majority reported they would be comfortable or very comfortable discussing firearm safety with various safety counsellors, though women were less likely to do so than men. This intervention that included distribution of a free, participant-selected locking device improved safe firearm storage practices among participants. Differences in participant preferences for devices and safety counsellors suggest that a 'one size fits all' approach may be inadequate in affecting population-level storage practices. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Variability of child access prevention laws and pediatric firearm injuries.

PubMed

Hamilton, Emma C; Miller, Charles C; Cox, Charles S; Lally, Kevin P; Austin, Mary T

2018-04-01

State-level child access prevention (CAP) laws impose criminal liability on adults who negligently allow children access to firearms. The CAP laws can be further divided into strong CAP laws which impose criminal liability for negligently stored firearms and weak CAP laws that prohibit adults from intentionally, knowingly, and/or recklessly providing firearms to a minor. We hypothesized that strong CAP laws would be associated with a greater reduction in pediatric firearm injuries than weak CAP laws. We constructed a cross-sectional national study using the Healthcare Cost and Utilization Project-Kids Inpatient Database from 2006 and 2009 using weighted counts of firearm-related admissions among children younger than 18 years. Poisson regression was used to estimate the association of CAP laws with pediatric firearm injuries. After adjusting for race, sex, age, and socioeconomic income quartile, strong CAP laws were associated with a significant reduction in all (incidence rate ratio, 0.70; 95% confidence interval, 0.52-0.93), self-inflicted (incidence rate ratio, 0.46; 95% confidence interval, 0.26-0.79), and unintentional (incidence rate ratio, 0.56; 95% confidence interval, 0.43-0.74) pediatric firearm injuries. Weak CAP laws, which only impose liability for reckless endangerment, were associated with an increased risk of all pediatric firearm injuries. The association of CAP laws on hospitalizations for pediatric firearm injuries differed greatly depending on whether a state had adopted a strong CAP law or a weak CAP law. Implementation of strong CAP laws by each state, which require safe storage of firearms, has the potential to significantly reduce pediatric firearm injuries. Prognostic and epidemiology study, level III.

Surveillance for violent deaths--National Violent Death Reporting System, 16 states, 2005.

PubMed

Karch, Debra L; Lubell, Keri M; Friday, Jennifer; Patel, Nimesh; Williams, Dionne D

2008-04-11

An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 U.S. states for 2005. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. 2005. NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS began operation in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004 and four (California, Kentucky, New Mexico, and Utah) in 2005, for a total of 17 states. This report includes data from 16 states; data from California are not included in this report because NVDRS has been implemented only in a limited number of California cities and counties rather than statewide as in other states. For 2005, a total of 15,495 fatal incidents involving 15,962 violent deaths occurred in the 16 NVDRS states included in this report. The majority (56.1%) of deaths were suicides, followed by homicides and deaths involving legal interventions (29.6%), violent deaths of undetermined intent (13.3%), and unintentional firearm deaths (0.7%). Fatal injury rates varied by sex, race/ethnicity, age group, and method of injury. Rates were substantially higher for males than for females and for American Indians/Alaska Natives (AI/ANs) and blacks than for whites and Hispanics. Rates were highest for persons aged 20-24 years. For method of injury, the three highest rates were reported for firearms, poisonings, and hanging/strangulation/suffocation. Suicides occurred at higher rates among males, AI/ANs, whites, and older persons and most often involved the use of firearms in the home. Suicides were precipitated primarily by mental illness, intimate partner or physical health problems, or a crisis during the previous 2 weeks. Homicides occurred at higher rates among males and young adult blacks and most often involved the use of firearms in the home or on a street/highway. Homicides were precipitated primarily by an argument over something other than money or property or in conjunction with another crime. Similar variation was reported among the other manners of death and special situations or populations highlighted in this report. This report provides the first detailed summary of data concerning violent deaths collected by NVDRS. The results indicate that deaths resulting from self-inflicted or interpersonal violence occur to a varying extent among males and females of every age group and racial/ethnic population. Key factors affecting rates of violent fatal injuries include sex, age group, method of injury, location of injury, and precipitating circumstances (e.g., mental health and substance abuse). Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary. Accurate, timely, and comprehensive surveillance data are necessary for the occurrence of violent deaths in the United States to be understood better and ultimately prevented. NVDRS data can be used to track the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths and injuries at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states using NVDRS, with an ultimate goal of full national representation.

Firearm fatalities in Western Sydney 1994-2003.

PubMed

Jeffery, A; Hulewicz, B; Langlois, N; Little, D; Ellis, P

2007-12-01

This study reviews firearm-related deaths (homicidal, suicidal and accidental) from 1994 to 2003 in the Western Sidney area, Australia, serviced by the Westmead Department of Forensic Medicine, in order to document the features of the cases and to assess the effect of the introduction of the NSW Firearms Act in 1996. There were 211 fatalities involving firearms (1.8% of all of the Coroner's cases for the period); firearm deaths were classified as homicide (75), suicide (134) or accidental (2). There was a clear peak of homicide deaths by firearm in the 20-29 age group, whereas the suicide peak was broad, spanning the ages 20-69 years. More suicides occurred at home than homicides and a higher proportion of suicides were by rifle than homicides, which favoured hand guns. Entry wounds in suicides mostly involved the head, with the chest being the commonest entry site in homicides. The only statistically significant trend was for an increase in the number of firearm-related suicides in males, comparing the number of deaths pre- and post-firearm law introduction. The study includes reports of two suicides by unusual weapons: a home-made pipe gun and a spear gun.

An analysis of firearms-related deaths between 1993-2010: a retrospective study.

PubMed

Toygar, Mehmet; Türker, Türker; Eroğlu, Murat; Kaldırım, Umit; Poyrazoğlu, Yavuz; Eyi, Yusuf Emrah; Durusu, Murat; Eryılmaz, Mehmet

2013-11-01

Firearm injuries (FI) are the most common cause of death among military personnel. In this study, postmortem examination and autopsy records of deaths resulting from firearm injuries recorded in the Department of Forensic Medicine of Gulhane Military Medical Academy between 1993-2010 were examined retrospectively. We evaluated the characteristics of 153 firearm deaths accounting for 36.6% of all medical-legal autopsies. The cases included 152 men (99.3%) and 1 woman (0.7%). The mean age of the cases was 23.1 years (±4.7; range, 20-43 years). The manner of death was determined in all cases with 41.8% of cases identified as suicide and 39.9% as homicide. The most common sites of firearm entrance wounds were the head and neck region (n=109, 71.2%), the chest (n=26, 17%), or the abdomen (n=14, 9.2%). The type of firearm was not clear in most cases. In conclusion, complete forensic and medical records will facilitate the rapid and accurate conclusion of the legal process and will enhance future retrospective studies.

[Time trend study of firearm mortality in Argentina, 1980-2012].

PubMed

Spinelli, Hugo; Santoro, Adrián; Guevel, Carlos; Alazraqui, Marcio

2015-06-01

This work analyzes the impact of firearm mortality between 1980 and 2012 in Argentina. For this purpose a descriptive epidemiological time trend study was carried out including the following variables: sex, age group, intentionality and jurisdiction. Data was obtained from the Office of Health Statistics and Information of the Argentine Ministry of Health. A total of 87,671 deaths due to firearms were discovered, of which 85.7% occurred in men. The highest mortality rate due to firearms corresponded to the year 2002, reaching 21.2 deaths per 100,000 inhabitants. The age group concentrating the largest number of deaths due to firearms was that of 20-29 years, accounting for 25.6% of all deaths. The highest adjusted rates corresponded to the years 2000-2002, with values of 10.0 to 11.6 deaths per 100,000 inhabitants. This time period coincides with the institutional-economic crisis the country experienced. The province of Buenos Aires was the place of residence of 49.1% of the deceased. In the discussion, political-economic and ideological-cultural dimensions of the relations among firearms, violence, science and society are considered.

Trends in firearm-related deaths in the Transkei region of South Africa.

PubMed

Meel, Banwari

2007-03-01

Firearms tends to be seen today as instrumental in injuries and deaths, including suicide. South Africa's gun law allows firearms to be licensed and legal, so in general they are not illegal weapons, even though many used in violence are illegal. This is a prime area in which multisectorial collaboration is needed in a country like South Africa. The purpose of this study is to determine the incidence of firearm-related deaths and to understand the underlying causative factors. This is a record review of 10,860 medicolegal autopsies conducted between 1993 and 2004 at Umtata General Hospital. Between 1993 and 2004, there were 10,860 autopsies performed of those who died as a result of trauma and others in Umtata General Hospital. The average gunshot-related deaths during this period are 48.4 per 100,000 of the population per year. The rate has increased from 27 per 100,000 in 1993 to 42 per 100,000 in 2004. It was climbed to its peak to 67.8 per 100,000 in 2001. Firearm-related deaths account for 29% of all traumatic deaths. Males (82%) outnumber females 4.6:1 in fatalities due to firearms. There is an increasing trend in females. About 50% were in the 21- to 40-year age group. Interpersonal violence, poverty, and use of drugs and alcohol are common underlying factors. There is a high incidence of firearm-related deaths in Transkei, which is in support of stricter gun control.

Firearms injuries and deaths: a critical public health issue. American Medical Association Council on Scientific Affairs.

PubMed Central

1989-01-01

The prevention of firearm deaths and injuries is one of the most complex and controversial issues facing the public health profession in recent years. Laws have been enacted to control or discourage private gun ownership, and especially to eliminate guns from the hands of criminals, but the laws' effects in reducing crime and firearm-related injuries and deaths have been disappointing. Gunshot wounds are the 12th leading cause of death in the United States and more than half of all suicides are committed with guns. There are virtually no reliable data on the number of nonfatal firearm injuries. One of the most troubling aspects of handgun violence is that children often are the victims. Educational efforts have been attempted to promote the safer use of firearms, but they have not led to a significant reduction in the number of fatalities, since most firearm incidents are intended to do harm. PMID:2495544

Homicidal deaths by firearms in Peshawar: an autopsy study.

PubMed

Hussain, Zahid; Shah, Mian Mujahid; Afridi, Hakim Khan; Arif, Muhammad

2006-01-01

Medico legal autopsies can be valuable sources of information about the distribution of causes of reported deaths, particularly in homicidal cases. The present study provides information regarding the homicidal deaths due to firearm injuries in the district of Peshawar, NWFP, Pakistan. This descriptive study was conducted over the period of the year 2004. Data were collected from the autopsy records of the Department of Forensic Medicine, Khyber Medical College Peshawar and included all reported unnatural deaths from urban and rural areas of district Peshawar on whom autopsies were conducted in the department. Homicidal deaths constituted 77.7% (492/633) of all autopsies for the year 2004. Of 492 homicidal deaths, a vast majority of 452 (91.87%) were caused by firearm injuries. Among these, the male to female ratio was 5.5:1. The most common firearm weapon (418/452, 92.5%) were high velocity rifled weapons (Kalashnikov, rifles, pistols), followed by low velocity rifled weapons (18/452, 3.98%) and shotguns (16/452, 3.54%). A total of 956 injuries were found in various body areas, giving an average of over two injuries per person. The head, face and neck sustained the highest injuries (257, 26.9%), followed by the chest (248, 25.9%) and abdomen (149, 15.6%); the extremities, buttocks and genitalia together sustained 302 (31.6%) injuries. The vast majority of reported homicides in Peshawar are caused by firearm injuries, which bring up issues related to possession of firearms and changes in cultural attitudes towards use of firearms, if a decrease in firearm-related homicides is desired.

Surveillance for violent deaths--National Violent Death Reporting System, 16 states, 2009.

PubMed

Karch, Debra L; Logan, Joseph; McDaniel, Dawn; Parks, Sharyn; Patel, Nimesh

2012-09-14

An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 U.S. states for 2009. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. 2009. NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS data collection began in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004, four (California, Kentucky, New Mexico, and Utah) in 2005, and two (Ohio and Michigan) in 2010, for a total of 19 states. This report includes data from 16 states that collected statewide data in 2009. California is excluded because data were collected in only four counties. Ohio and Michigan are excluded because data collection did not begin until 2010. For 2009, a total of 15,981 fatal incidents involving 16,418 deaths were captured by NVDRS in the 16 states included in this report. The majority (60.6%) of deaths were suicides, followed by homicides and deaths involving legal intervention (i.e., deaths caused by police and other persons with legal authority to use deadly force, excluding legal executions) (24.7%), deaths of undetermined intent (14.2%), and unintentional firearm deaths (0.5%). Suicides occurred at higher rates among males, non-Hispanic whites, American Indians/Alaska Natives, and persons aged 45-54 years. Suicides occurred most often in a house or apartment and involved the use of firearms. Suicides were preceded primarily by mental health, intimate partner, or physical health problems or by a crisis during the previous 2 weeks. Homicides occurred at higher rates among males and persons aged 20-24 years; rates were highest among non-Hispanic black males. The majority of homicides involved the use of a firearm and occurred in a house or apartment or on a street/highway. Homicides were preceded primarily by arguments and interpersonal conflicts or in conjunction with another crime. Characteristics associated with other manners of death, circumstances preceding death, and special populations also are highlighted in this report. This report provides a detailed summary of data from NVDRS for 2009. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected adults aged <55 years, males, and certain racial/ethnic minority populations. For homicides and suicides, relationship problems, interpersonal conflicts, mental health problems, and recent crises were among the primary factors that might have precipitated the fatal injuries. Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary. For the occurrence of violent deaths in the United States to be better understood and ultimately prevented, accurate, timely, and comprehensive surveillance data are necessary. NVDRS data can be used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Additional efforts are needed to increase the number of states participating in NVDRS, with an ultimate goal of full national representation.

Surveillance for violent deaths--national violent death reporting system, 16 States, 2006.

PubMed

Karch, Debra L; Dahlberg, Linda L; Patel, Nimesh; Davis, Terry W; Logan, Joseph E; Hill, Holly A; Ortega, Lavonne

2009-03-20

An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 U.S. states for 2006. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. 2006. NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS began operation in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004 and four (California, Kentucky, New Mexico, and Utah) in 2005, for a total of 17 states. This report includes data from 16 states that collected statewide data; data from California are not included in this report because NVDRS has been implemented only in a limited number of California cities and counties rather than statewide. For 2006, a total of 15,007 fatal incidents involving 15,395 violent deaths occurred in the 16 NVDRS states included in this report. The majority (55.9%) of deaths were suicides, followed by homicides and deaths involving legal intervention (e.g. a suspect is killed by a law enforcement officer in the line of duty)(28.2%), violent deaths of undetermined intent (15.1%), and unintentional firearm deaths (0.7%). Suicides occurred at higher rates among males, American Indians/Alaska Natives (AI/ANs), non-Hispanic whites, and persons aged 45--54 years and occurred most often in a house or apartment and involved the use of firearms. Suicides were precipitated primarily by mental-health, intimate-partner, or physical-health problems or by a crisis during the preceding 2 weeks. Homicides occurred at higher rates among males and persons aged 20--24 years; rates were highest among non-Hispanic black males. The majority of homicides involved the use of a firearm and occurred in a house or apartment or on a street/highway. Homicides were precipitated primarily by arguments and interpersonal conflicts or in conjunction with another crime. Other manners of death and special situations or populations also are highlighted in this report. This report provides a detailed summary of data concerning violent deaths collected by NVDRS for 2006. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence affected adults aged 20--54 years, males, and certain minority populations disproportionately. For many types of violent death, relationship problems, interpersonal conflicts, mental-health problems, and recent crises were among the primary precipitating factors. Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary. For the occurrence of violent deaths in the United States to be better understood and ultimately prevented, accurate, timely, and comprehensive surveillance data are necessary. NVDRS data can be used to track the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states participating in NVDRS, with an ultimate goal of full national representation.

Presence of minor and major mental health impairment in adolescence and death from suicide and unintentional injuries/accidents in men: a national longitudinal cohort study.

PubMed

Fadum, Elin Anita; Fønnebø, Vinjar; Borud, Einar Kristian

2017-01-01

To examine the association between minor and major mental health impairment in late adolescence and death from suicide and unintentional injuries/accidents in men. In Norway, all men attend a compulsory military medical and psychological examination. We included 558 949 men aged 17-19 years at the time of military examination in 1980-1999 and followed them up for death from suicide and unintentional injuries/accidents until the end of 2013. We used Cox proportional hazard models to examine the association between the presence of minor and major mental health impairments at examination and death from suicide and unintentional injuries/accidents. Compared to men with no mental health impairment, those with minor mental health impairment was associated with an increased risk of death from suicide (adjusted HR (HR adj )=1.63, 95% CI 1.39 to 1.92), transport accidents (HR adj =1.33, 95% CI 1.09 to 1.63), accidental poisoning (HR adj =2.27, 95% CI 1.79 to 2.88) and other unintentional injuries/accidents (HR adj =1.54, 95% CI 1.17 to 2.02). In men with major mental health impairment, the risk of death from suicide and accidental poisoning was elevated two times (HR adj =2.29, 95% CI 1.85 to 2.85) and three times (HR adj =3.53, 95% CI 2.61 to 4.79), respectively. We found an increased risk of death from suicide and unintentional injuries/accidents in men who had minor and major mental health impairment at age 17-19 years. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Firearm Deaths among Children and Youth.

ERIC Educational Resources Information Center

O'Donnell, Clifford R.

1995-01-01

Examines the long- and short-term policy alternatives in reducing firearm deaths of children. The article advocates the need for multiple steps that include educational efforts such as conflict resolution; safety devices, such as trigger locks; security policies for schools to protect students; and gun access laws to reduce firearm acquisitions by…

Child and adolescent suicide deaths in New Mexico, 1990-1994.

PubMed

Werenko, D D; Olson, L M; Fullerton-Gleason, L; Lynch, A W; Zumwalt, R E; Sklar, D P

2000-01-01

The suicide death rate in New Mexico is consistently higher than the national rate. Among adolescents, suicide is the third leading cause of death nationally, but in New Mexico it is the second leading cause of death. This study describes the pattern of adolescent suicide deaths in New Mexico. We conducted a retrospective review of all medical examiner autopsies for adolescent suicides (ages 20 years and younger) in New Mexico from 1990-1994. Records were reviewed for demographics and possible contributing factors such as depression, previous attempts, and alcohol and drug use. We identified 184 suicide deaths among children and adolescents ages 9-20 years for an overall rate of 12.9 per 100,000. Our rates for ages 5-9 years (0.2), 10-14 years (3.8), and 15-19 years (22.3) are over twice the U. S. rates. Suicide deaths resulted primarily from firearms (67%), hanging (16%), poisoning (6%), inhalation (4%), and other methods (7%). Method varied by ethnicity (p = .01) and gender (p = .03); males and non-Hispanic Whites were overrepresented among firearm deaths. Firearm ownership was known in 60 (48%) of the firearm deaths. Of these, 53% of the firearms belonged to a family member, 25% to the decedent, and 22% to a friend. Over one-third of decedents (41%) experienced mental disorders, primarily depressed mood and clinical depression. Previous suicide attempts were noted for 15% of the decedents. Some 50% of the decedents had alcohol or drugs present at the time of death; among American Indians/Alaska Natives, 74% had drugs or alcohol present (p = .003). Targeted interventions are needed to reduce adolescent suicide in New Mexico. We suggest raising awareness about acute and chronic contributing factors to suicide; training physicians to look for behavioral manifestations of depression; and involving physicians, teachers, and youth activity leaders in efforts to limit firearm accessibility, such as advising parents to remove firearms from their households.

Firearm-related hospitalization and risk for subsequent violent injury, death, or crime perpetration: a cohort study.

PubMed

Rowhani-Rahbar, Ali; Zatzick, Douglas; Wang, Jin; Mills, Brianna M; Simonetti, Joseph A; Fan, Mary D; Rivara, Frederick P

2015-04-07

Risk for violent victimization or crime perpetration after firearm-related hospitalization (FRH) must be determined to inform the need for future interventions. To compare the risk for subsequent violent injury, death, or crime perpetration among patients with an FRH, those hospitalized for noninjury reasons, and the general population. Retrospective cohort study. All hospitals in Washington. Patients with an FRH and a random sample of those with a non-injury-related hospitalization in 2006 to 2007 (index hospitalization). Primary outcomes included subsequent FRH, firearm-related death, and the combined outcome of firearm- or violence-related arrest ascertained through 2011. Among patients with an index FRH (n = 613), rates of subsequent FRH, firearm-related death, and firearm- or violence-related arrest were 329 (95% CI, 142 to 649), 100 (CI, 21 to 293), and 4221 (CI, 3352 to 5246) per 100 000 person-years, respectively. Compared with the general population, standardized incidence ratios among patients with an index FRH were 30.1 (CI, 14.9 to 61.0) for a subsequent FRH and 7.3 (CI, 2.4 to 22.9) for firearm-related death. In survival analyses that accounted for competing risks, patients with an index FRH were at greater risk for subsequent FRH (subhazard ratio [sHR], 21.2 [CI, 7.0 to 64.0]), firearm-related death (sHR, 4.3 [CI, 1.3 to 14.1]), and firearm- or violence-related arrest (sHR, 2.7 [CI, 2.0 to 3.5]) than those with a non-injury-related index hospitalization. Lack of information on whether patients continued to reside in Washington during follow-up may have introduced outcome misclassification. Hospitalization for a firearm-related injury is associated with a heightened risk for subsequent violent victimization or crime perpetration. Further research at the intersection of clinical care, the criminal justice system, and public health to evaluate the effectiveness of interventions delivered to survivors of firearm-related injury is warranted. Seattle City Council and University of Washington Royalty Research Fund.

Surveillance for violent deaths--National Violent Death Reporting System, 16 States, 2007.

PubMed

Karch, Debra L; Dahlberg, Linda L; Patel, Nimesh

2010-05-14

An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 states for 2007. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. 2007. NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS began operation in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004, four (California, Kentucky, New Mexico, and Utah) in 2005, and two states (Ohio and Michigan) were funded to begin data collection in 2010, totaling 19 states. This report includes data from 16 states that collected statewide data in 2007. California data are not included in this report because NVDRS data are collected only in a limited number of California cities and counties rather than statewide. Ohio and Michigan are excluded because they did not begin data collection until 2010. For 2007, a total of 15,882 fatal incidents involving 16,319 deaths occurred in the 16 NVDRS states included in this report. The majority (56.6%) of deaths was suicides, followed by homicides and deaths involving legal intervention (i.e., deaths caused by police and other persons with legal authority to use deadly force, excluding legal executions) (28.0%), deaths of undetermined intent (14.7%), and unintentional firearm deaths (0.7%). Suicides occurred at higher rates among males, American Indians/Alaska Natives, non-Hispanic whites, and persons aged 45--54 years. Suicides occurred most often in a house or apartment and involved the use of firearms. Suicides were precipitated primarily by mental-health, intimate-partner, or physical-health problems, or by a crisis during the preceding 2 weeks. Homicides occurred at higher rates among males and persons aged 20--24 years; rates were highest among non-Hispanic black males. The majority of homicides involved the use of a firearm and occurred in a house or apartment or on a street/highway. Homicides were precipitated primarily by arguments and interpersonal conflicts or in conjunction with another crime. Other manners of death and special situations or populations also are highlighted in this report. This report provides a detailed summary of data from NVDRS for 2007. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected adults aged <55 years, males, and certain minority populations. For homicides and suicides, relationship problems, interpersonal conflicts, mental-health problems, and recent crises were among the primary precipitating factors. Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary. For the occurrence of violent deaths in the United States to be better understood and ultimately prevented, accurate, timely, and comprehensive surveillance data are necessary. NVDRS data can be used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states participating in NVDRS, with an ultimate goal of full national representation.

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy.

PubMed

Garstang, Joanna; Ellis, Catherine; Griffiths, Frances; Sidebotham, Peter

2016-12-01

A comprehensive child death review (CDR) program was introduced in England and Wales in 2008, but as yet data have only been analyzed at a local level, limiting the learning from deaths. The aim of this study is to describe the profile of causes and risk factors for sudden unexpected death in infancy (SUDI) as determined by the new CDR program. This was a descriptive outcome study using data from child death overview panel Form C for SUDI cases dying during 2010-2012 in the West Midlands region of England. The main outcome measures were: cause of death, risk factors and potential preventability of death, and determination of deaths probably due to unintentional asphyxia. Data were obtained for 65/70 (93 %) SUDI cases. 20/65 (31 %) deaths were initially categorized as due to medical causes; 21/65 (32 %) as SIDS; and 24/65 (37 %) as undetermined. Reanalysis suggested that 2/21 SIDS and 7/24 undetermined deaths were probably due to unintentional asphyxia, with 6 of these involving co-sleeping and excessive parental alcohol consumption. Deaths classified as "undetermined" had significantly higher total family and environmental risk factor scores (mean 2.6, 95 % CI 2.0-3.3) compared to those classified as SIDS (mean 1.6, 95 % CI 1.2-1.9), or medical causes for death (mean 1.1, 95 % CI 0.8-1.3). 9/20 (47 %) of medical deaths, 19/21 (90 %) SIDS, and 23/24 (96 %) undetermined deaths were considered to be potentially preventable. There were inadequacies in medical provision identified in 5/20 (25 %) of medically explained deaths. The CDR program results in detailed information about risk factors for SUDI cases but failed to recognize deaths probably due to unintentional asphyxia. The misclassification of probable unintentional asphyxial deaths and SIDS as "undetermined deaths" is likely to limit learning from these deaths and inhibit prevention strategies. Many SUDI occurred in families with mental illness, substance misuse and chaotic lifestyles and most in unsafe sleep environments. This knowledge could be used to better target safe sleep advice for vulnerable families and prevent SUDI in the future.

Jumping the gun: firearms and the mental health of Australians.

PubMed

Dudley, M; Cantor, C; de Moore, G

1996-06-01

The aims of this study were to (i) survey mental health-related correlates of firearms ownership and availability in Australia, and (ii) assess possible causal relationships between civilian gun deaths, gun availability and mental disorders. Available data regarding firearms ownership, injuries and deaths were reviewed as well as studies of (i) gun ownership, suicide and homicide, and (ii) gun control laws and suicide. Findings indicated that 85% of firearm deaths are triggered by distress, as opposed to crime. Most firearm homicides are intrafamilial or involve familiar persons. Firearm suicide rates, although tapering off in recent years, continue to rise among certain groups. It was also found that: (1) Beyond reasonable doubt, a causal relationship exists between gun ownership and firearm suicides and homicides. The role of method substitution is controversial, but is probably less important among the young. (2) Outside the United States, legislation may be useful in reducing firearm and possibly overall suicide rates. (3) If firearm owners are representative of the community, then 15-20% suffer from a psychiatric disorder at any time. While a modest increase in risk of firearms misuse exists for this group, especially those with a history of substance abuse or violence, concern also arises regarding those with mental disorders who access firearms because owners have not secured them. No uniform definition or way of verifying self-reports exists for gun licence applicants regarding these issues. Further regulation of firearm safety and availability is warranted. Public health measures include improved surveillance regarding firearm events, advocacy for appropriate firearm legislation, and better education and communication about firearms.

Firearms in major motion pictures, 1995-2004.

PubMed

Binswanger, Ingrid A; Cowan, John A

2009-03-01

Firearms are a major cause of injury and death. We sought to determine (1) the prevalence of movie scenes that depicted firearms and verbal firearm safety messages; (2) the context and health outcomes in firearm scenes; and (3) the association between the Motion Picture Association of America ratings and firearm scene characteristics. Ten top revenue-grossing motion pictures were selected for each year from 1995 to 2004 in descending order of gross revenues. Data on firearm scenes were collected by movie coders using dual-monitor computer workstations and real-time collection tools. Seventy of the 100 movies had scenes with firearms and the majority of movies with firearms were rated PG-13. Firearm scenes (N = 624) accounted for 17% of screen time in movies with firearms. Among firearm scenes, crime or illegal activity was involved in 45%, deaths occurred in 19%, and injuries occurred in 12%. A verbal reference to safety was made in 0.8%. Depictions of firearms in top revenue-grossing movies were common, but safety messages were exceedingly rare. Major motion pictures present an under-used opportunity for education about firearm safety.

Storage of Poisonous Substances and Firearms in Homes with Young Children Visitors and Older Adults

PubMed Central

Coyne-Beasley, Tamera; Runyan, Carol W.; Baccaglini, Lorena; Perkis, David; Johnson, Renee M.

2011-01-01

Background Most unintentional childhood poisonings and firearm injuries occur in residential environments. Therefore, a preventive strategy includes limiting children’s access to poisons and firearms through safe storage. This study examines storage of poisons and firearms among households with older adults, and households where young children reside compared to those where they visit only. Methods Sample is from a 2002 national random-digit-dial survey of 1003 households. Analyses were weighted to reflect the national population. Results There were 637 households with children residents or visitors aged <6 years. Seventy-five percent of the households (n =480) had children aged <6 as visitors only, and 15% had older adult residents (aged ≥70 years). Poisons and firearms were stored less securely in homes with young children as visitors as compared to those homes with resident young children. In 55% of homes where young children lived, and 74% of homes where young children were only visitors, household chemicals were reportedly stored unlocked. Although firearm ownership was comparable between the two categories of households (33% vs 34%), homes in which children were only visitors were more likely to store firearms unlocked (56%), than homes in which children resided (33%). Homes with older adult residents had more firearms present. Conclusions Children are at risk from improperly stored poisonous substances and firearms in their own homes and homes they visit. Strategies are needed to improve the storage practices of both poisons and firearms to minimize in-home hazards to young children, particularly raising awareness of these hazards to young visitors. PMID:15626565

Childhood and adult mortality from unintentional falls in India

PubMed Central

Jagnoor, Jagnoor; Suraweera, Wilson; Keay, Lisa; Ivers, Rebecca Q; Thakur, JS; Gururaj, Gopalkrishna

2011-01-01

Abstract Objective To estimate fall-related mortality by type of fall in India. Methods The authors analysed unintentional injury data from the ongoing Million Death Study from 2001–2003 using verbal autopsy and coding of all deaths in accordance with the International statistical classification of diseases and related health problems, tenth revision, in a nationally representative sample of 1.1 million homes throughout the country. Findings Falls accounted for 25% (2003/8023) of all deaths from unintentional injury and were the second leading cause of such deaths. An estimated 160 000 fall-related deaths occurred in India in 2005; of these, nearly 20 000 were in children aged 0–14 years. The unintentional-fall-related mortality rate (MR) per 100 000 population was 14.5 (99% confidence interval, CI: 13.7–15.4). Rates were similar for males and females at 14.9 (99% CI: 13.7–16.0) and 14.2 (99% CI: 13.1–15.4) per 100 000 population, respectively. People aged 70 years or older had the highest mortality rate from unintentional falls (MR: 271.2; 99% CI: 249.0–293.5), and the rate was higher among women (MR: 281; 99% CI: 249.7–311.3). Falls on the same level were the most common among older adults, whereas falls from heights were more common in younger age groups. Conclusion In India, unintentional falls are a major public health problem that disproportionately affects older women and children. The contexts in which these falls occur and the resulting morbidity and disability need to be better understood. In India there is an urgent need to develop, test and implement interventions aimed at preventing falls. PMID:22084511

Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association.

PubMed

Weinberger, Steven E; Hoyt, David B; Lawrence, Hal C; Levin, Saul; Henley, Douglas E; Alden, Errol R; Wilkerson, Dean; Benjamin, Georges C; Hubbard, William C

2015-04-07

Deaths and injuries related to firearms constitute a major public health problem in the United States. In response to firearm violence and other firearm-related injuries and deaths, an interdisciplinary, interprofessional group of leaders of 8 national health professional organizations and the American Bar Association, representing the official policy positions of their organizations, advocate a series of measures aimed at reducing the health and public health consequences of firearms. The specific recommendations include universal background checks of gun purchasers, elimination of physician "gag laws," restricting the manufacture and sale of military-style assault weapons and large-capacity magazines for civilian use, and research to support strategies for reducing firearm-related injuries and deaths. The health professional organizations also advocate for improved access to mental health services and avoidance of stigmatization of persons with mental and substance use disorders through blanket reporting laws. The American Bar Association, acting through its Standing Committee on Gun Violence, confirms that none of these recommendations conflict with the Second Amendment or previous rulings of the U.S. Supreme Court.

The Global Burden of Unintentional Injuries and an Agenda for Progress

PubMed Central

Chandran, Aruna; Hyder, Adnan A.; Peek-Asa, Corinne

2010-01-01

According to the World Health Organization, unintentional injuries were responsible for over 3.9 million deaths and over 138 million disability-adjusted life-years in 2004, with over 90% of those occurring in low- and middle-income countries (LMIC). This paper utilizes the year 2004 World Health Organization Global Burden of Disease Study estimates to illustrate the global and regional burden of unintentional injuries and injury rates, stratified by cause, region, age, and gender. The worldwide rate of unintentional injuries is 61 per 100,000 population per year. Overall, road traffic injuries make up the largest proportion of unintentional injury deaths (33%). When standardized per 100,000 population, the death rate is nearly double in LMIC versus high-income countries (65 vs. 35 per 100,000), and the rate of disability-adjusted life-years is more than triple in LMIC (2,398 vs. 774 per 100,000). This paper calls for more action around 5 core areas that need research investments and capacity development, particularly in LMIC: 1) improving injury data collection, 2) defining the epidemiology of unintentional injuries, 3) estimating the costs of injuries, 4) understanding public perceptions about injury causation, and 5) engaging with policy makers to improve injury prevention and control. PMID:20570956

Who are the owners of firearms used in adolescent suicides?

PubMed

Johnson, Renee M; Barber, Catherine; Azrael, Deborah; Clark, David E; Hemenway, David

2010-12-01

In this brief report, the source of firearms used in adolescent suicides was examined using data from the National Violent Injury Statistics System, the pilot to the CDC's National Violent Death Reporting System, a uniform reporting system for violent and firearm-related deaths. Data represent the 63 firearm suicides among youth (<18 yrs) that occurred in 2001 or 2002 in one of four states (CT, ME, UT, WI) or two metropolitan counties (San Francisco, CA; Allegheny County, PA). Four-fifths of the suicides took place in the decedents' homes, and--when the firearm owner was known--most of the firearms were owned by parents. Findings replicate results from previous research and highlight the importance of limiting youth access to firearms.

Fatal school shootings and the epidemiological context of firearm mortality in the United States

PubMed Central

Shultz, James M; Cohen, Alyssa M; Muschert, Glenn W; Flores de Apodaca, Roberto

2013-01-01

Background The December 14, 2012 mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, USA, vaulted concerns regarding gun violence to the forefront of public attention. This high-visibility incident occurred within the epidemiological context of U.S. firearm mortality that claims more than 88 lives daily. Methods National epidemiologic data on firearm deaths over two decades were analyzed along with data registries on school shootings in order to place the tragedy at Sandy Hook in perspective. School shootings were classified as random or targeted. Results The U.S. has the highest rates of firearm deaths, suicides, and homicides among the world’s 34 “advanced economies.” Seventy percent of U.S. homicides and more than 50% of U.S. suicides are committed using a firearm. U.S. firearm homicide rates first declined, and then stabilized, during the past 23 years, 1990-2012. “Shooting massacres” in school settings, a new phenomenon within the past 50 years, are extremely rare events. Over 23 years, 1990-2012, 215 fatal school shooting incidents resulted in 363 deaths, equivalent to 0.12% of national firearm homicides during that time period. Most episodes were “targeted” shootings in which the perpetrator intentionally killed a specific individual in a school setting. Only 25 of these 215 events (11.6%) were “random” or “rampage” shootings, resulting in 135 deaths (0.04% of national firearm homicides). Among these, just three shooting rampages – Columbine High School, Virginia Tech University, and Sandy hook Elementary School – accounted for 72 (53.3%) of these 135 deaths. The frequency of random/rampage shooting incidents in schools has remained within the narrow range of 0 to 3 episodes per year. Conclusions Each year, more than 32,000 Americans die by firearms and more than 70,000 are wounded, representing a volume of preventable deaths and injuries that the U.S. government describes as a “public health crisis.” School massacres, such as Sandy Hook, occur periodically, galvanizing public reaction and bringing forth a collective call for intervention. Epidemiological analyses position these rare, but uniquely compelling, incidents within the broader national patterns of gun violence. The intention is to inform the selection of a balanced, comprehensive set of effective remedies to address the daily death toll from firearm suicides and “targeted” firearm homicides that account for more than 99% of firearm fatalities; as well as the rare, random, and sporadic rampage shootings in school or community settings. PMID:28228991

Fatal school shootings and the epidemiological context of firearm mortality in the United States.

PubMed

Shultz, James M; Cohen, Alyssa M; Muschert, Glenn W; Flores de Apodaca, Roberto

2013-01-01

Background The December 14, 2012 mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, USA, vaulted concerns regarding gun violence to the forefront of public attention. This high-visibility incident occurred within the epidemiological context of U.S. firearm mortality that claims more than 88 lives daily. Methods National epidemiologic data on firearm deaths over two decades were analyzed along with data registries on school shootings in order to place the tragedy at Sandy Hook in perspective. School shootings were classified as random or targeted. Results The U.S. has the highest rates of firearm deaths, suicides, and homicides among the world's 34 "advanced economies." Seventy percent of U.S. homicides and more than 50% of U.S. suicides are committed using a firearm. U.S. firearm homicide rates first declined, and then stabilized, during the past 23 years, 1990-2012. "Shooting massacres" in school settings, a new phenomenon within the past 50 years, are extremely rare events. Over 23 years, 1990-2012, 215 fatal school shooting incidents resulted in 363 deaths, equivalent to 0.12% of national firearm homicides during that time period. Most episodes were "targeted" shootings in which the perpetrator intentionally killed a specific individual in a school setting. Only 25 of these 215 events (11.6%) were "random" or "rampage" shootings, resulting in 135 deaths (0.04% of national firearm homicides). Among these, just three shooting rampages - Columbine High School, Virginia Tech University, and Sandy hook Elementary School - accounted for 72 (53.3%) of these 135 deaths. The frequency of random/rampage shooting incidents in schools has remained within the narrow range of 0 to 3 episodes per year. Conclusions Each year, more than 32,000 Americans die by firearms and more than 70,000 are wounded, representing a volume of preventable deaths and injuries that the U.S. government describes as a "public health crisis." School massacres, such as Sandy Hook, occur periodically, galvanizing public reaction and bringing forth a collective call for intervention. Epidemiological analyses position these rare, but uniquely compelling, incidents within the broader national patterns of gun violence. The intention is to inform the selection of a balanced, comprehensive set of effective remedies to address the daily death toll from firearm suicides and "targeted" firearm homicides that account for more than 99% of firearm fatalities; as well as the rare, random, and sporadic rampage shootings in school or community settings.

Intra- and perioral shooting fatalities.

PubMed

Azmak, D; Altun, G; Koç, S; Yorulmaz, C; Ozaslan, A

1999-05-17

Determination of the manner of death in the case of intra- and perioral firearm wounds can be difficult especially if death scene investigation is unclear and inadequate. In this study, we investigated some characteristics of these firearm wounds which were autopsied in Istanbul. During the 5-year period from 1991 through 1995, there were 15 intra- and perioral firearm fatalities investigated. In all the cases, only one shot was fired into the mouth. They constituted 1% of all the firearm fatalities. The mean age of the victims was 27 years and males constituted 73.3% of the victims. Most of the wounds were caused by handguns. Homicides accounted for 53.3% of these deaths. Three of 15 cases could not be identified as intraoral firearm wounds by general practitioners during the scene investigations.

Firearms in the home: parental perceptions.

PubMed

Farah, M M; Simon, H K; Kellermann, A L

1999-11-01

Each year, thousands of children are injured or killed from unintentional gunshot wounds. Discovering a gun while playing in the home places children at risk of being injured by the firearm. To determine parental firearm storage practices and parental perceptions of the behavior of their children around guns. Cross-sectional survey of parents of children from 4 to 12 years of age. A sample of 424 parents, bringing their children to one of five pediatric ambulatory care centers, were asked to complete a 20-point self-administered questionnaire at the time of their visit. A total of 400 parents (94%) completed the questionnaire; 113 parents (28%) reported keeping a firearm (most often a handgun) in the home. Firearm owners were predominantly male, 30 years of age or older, white, and married. Of the gun owners, 52% stored their firearms loaded or unlocked, and 13% kept one or more guns loaded and unlocked. Three fourths of gun-owning parents believed that their 4- to 12-year-old child could tell the difference between a toy gun and a real gun, and 23% believed that their child could be trusted with a loaded gun. Although the majority of gun-owning parents (53%) endorsed safe storage as the best firearm injury prevention strategy, 61% of parents who do not own firearms endorse not owning guns as the best way to prevent pediatric firearm injuries. A majority of gun-owning parents store their firearms loaded or unlocked, substantially underestimating the risk of injury to their children. Many firearm-owning parents trust their child with a loaded gun and believe that their young child can tell the difference between a toy gun and a real gun.

Nineteen Victims of Homicide and Attempted Homicide in Sweden-Their Injuries, Cause of Death, and Offender Relationship.

PubMed

Khoshnood, Ardavan; Väfors Fritz, Marie; Ekelund, Ulf

2017-09-01

Victims of homicide and attempted homicide are not uncommon in Sweden. We therefore aimed to study these victims to understand their injuries, their cause of death, and their relationship to the offender. All cases during five years in a district court in Sweden, where an offender had been convicted for homicide or attempted homicide, were identified and the court documents reviewed. Nineteen victims were identified; 14 males and five females, with an average age of 39.1 years. Although knife/sharp weapon was the most common weapon used, the use of firearm caused more deaths. Our study shows higher rates of firearm use than many other countries. The most common anatomical site to be injured by knife/sharp weapon and firearm was the thorax followed by the head. The most common cause of death was hypovolemia, followed by intracranial injuries. The high rate of firearm use shows that firearms are common modus operandi in Sweden often causing lethal injuries, if the offender intends to kill the victim. Our results support other studies showing that it is foremost injuries to the vessels, intracranial injuries, and injuries to intrathoracic organs, which causes a victim's death when assaulted with knife/sharp weapon or firearm.

State Firearm Laws and Interstate Firearm Deaths From Homicide and Suicide in the United States: A Cross-sectional Analysis of Data by County.

PubMed

Kaufman, Elinore J; Morrison, Christopher N; Branas, Charles C; Wiebe, Douglas J

2018-03-05

Firearm laws in one state may be associated with increased firearm death rates from homicide and suicide in neighboring states are uncertain. To determine whether counties located closer to states with lenient firearm policies have higher firearm death rates. This cross-sectional study of firearm death rates by county for January 2010 to December 2014 examined data from the US Centers for Disease Control and Prevention for firearm suicide and homicide decedents for 3108 counties in the 48 contiguous states of the United States. Each county was assigned 2 scores, a state policy score (range, 0-12) based on the strength of its state firearm laws, and an interstate policy score (range, -1.33 to 8.31) based on the sum of population-weighted and distance-decayed policy scores for all other states. Counties were divided into those with low, medium, and high home state and interstate policy scores. County-level rates of firearm, nonfirearm, and total homicide and suicide. With multilevel Bayesian spatial Poisson models, we generated incidence rate ratios (IRR) comparing incidence rates between each group of counties and the reference group, counties with high home state and high interstate policy scores. Stronger firearm laws in a state were associated with lower firearm suicide rates and lower overall suicide rates regardless of the strength of the other states' laws. Counties with low state scores had the highest rates of firearm suicide. Rates were similar across levels of interstate policy score (low: IRR, 1.34; 95% credible interval [CI], 1.11-1.65; medium: IRR, 1.36, (95% CI, 1.15-1.65; and high: IRR, 1.43; 95% CI, 1.20-1.73). Counties with low state and low or medium interstate policy scores had the highest rates of firearm homicide. Counties with low home state and interstate scores had higher firearm homicide rates (IRR, 1.38; 95% CI, 1.02-1.88) and overall homicide rates (IRR, 1.32; 95% CI, 1.03-1.67). Counties in states with low firearm policy scores had lower rates of firearm homicide only if the interstate firearm policy score was high. Strong state firearm policies were associated with lower suicide rates regardless of other states' laws. Strong policies were associated with lower homicide rates, and strong interstate policies were also associated with lower homicide rates, where home state policies were permissive. Strengthening state firearm policies may prevent firearm suicide and homicide, with benefits that may extend beyond state lines.

Gun ownership and firearm-related deaths.

PubMed

Bangalore, Sripal; Messerli, Franz H

2013-10-01

A variety of claims about possible associations between gun ownership rates, mental illness burden, and the risk of firearm-related deaths have been put forward. However, systematic data on this issue among various countries remain scant. Our objective was to assess whether the popular notion "guns make a nation safer" has any merits. Data on gun ownership were obtained from the Small Arms Survey, and for firearm-related deaths from a European detailed mortality database (World Health Organization), the National Center for Health Statistics, and others. Crime rate was used as an indicator of safety of the nation and was obtained from the United Nations Surveys of Crime Trends. Age-standardized disability-adjusted life-year rates due to major depressive disorder per 100,000 inhabitants with data obtained from the World Health Organization database were used as a putative indicator for mental illness burden in a given country. Among the 27 developed countries, there was a significant positive correlation between guns per capita per country and the rate of firearm-related deaths (r = 0.80; P <.0001). In addition, there was a positive correlation (r = 0.52; P = .005) between mental illness burden in a country and firearm-related deaths. However, there was no significant correlation (P = .10) between guns per capita per country and crime rate (r = .33), or between mental illness and crime rate (r = 0.32; P = .11). In a linear regression model with firearm-related deaths as the dependent variable with gun ownership and mental illness as independent covariates, gun ownership was a significant predictor (P <.0001) of firearm-related deaths, whereas mental illness was of borderline significance (P = .05) only. The number of guns per capita per country was a strong and independent predictor of firearm-related death in a given country, whereas the predictive power of the mental illness burden was of borderline significance in a multivariable model. Regardless of exact cause and effect, however, the current study debunks the widely quoted hypothesis that guns make a nation safer. Copyright © 2013 Elsevier Inc. All rights reserved.

27 CFR 479.42 - Changes through death of owner.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Changes through death of owner. 479.42 Section 479.42 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO... death of owner. Whenever any person who has paid special (occupational) tax dies, the surviving spouse...

Unintentional Injury Mortality Among American Indians and Alaska Natives in the United States, 1990–2009

PubMed Central

Pokhrel, Pallavi; Worthington, Anne; Billie, Holly; Sewell, Mack; Bill, Nancy

2014-01-01

Objectives. We describe the burden of unintentional injury (UI) deaths among American Indian and Alaska Native (AI/AN) populations in the United States. Methods. National Death Index records for 1990 to 2009 were linked with Indian Health Service registration records to identify AI/AN deaths misclassified as non-AI/AN deaths. Most analyses were restricted to Contract Health Service Delivery Area counties in 6 geographic regions of the United States. We compared age-adjusted death rates for AI/AN persons with those for Whites; Hispanics were excluded. Results. From 2005 to 2009, the UI death rate for AI/AN people was 2.4 times higher than for Whites. Death rates for the 3 leading causes of UI death—motor vehicle traffic crashes, poisoning, and falls—were 1.4 to 3 times higher among AI/AN persons than among Whites. UI death rates were higher among AI/AN males than among females and highest among AI/AN persons in Alaska, the Northern Plains, and the Southwest. Conclusions. AI/AN persons had consistently higher UI death rates than did Whites. This disparity in overall rates coupled with recent increases in unintentional poisoning deaths requires that injury prevention be a major priority for improving health and preventing death among AI/AN populations. PMID:24754624

A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research

PubMed Central

Ranney, Megan L.; Fletcher, Jonathan; Alter, Harrison; Barsotti, Christopher; Bebarta, Vikhyat S.; Betz, Marian E.; Carter, Patrick M.; Cerdá, Magdalena; Cunningham, Rebecca M.; Crane, Peter; Fahimi, Jahan; Miller, Matthew J.; Rowhani-Rahbar, Ali; Vogel, Jody A.; Wintemute, Garen J.; Shah, Manish N.; Waseem, Muhammad

2016-01-01

Objective To identify critical Emergency Medicine (EM)-focused firearm injury research questions and to develop an evidence-based research agenda. Methods National content experts were recruited to a technical advisory group for the American College of Emergency Physicians Research Committee. Nominal Group Technique (NGT) was used to identify research questions by consensus. The technical advisory group decided to focus on five widely accepted categorizations of firearm injury. Subgroups conducted literature reviews on each topic and developed preliminary lists of EM-relevant research questions. In-person meetings and conference calls were held to iteratively refine the extensive list of research questions, following NGT guidelines. Feedback from external stakeholders was reviewed and integrated. Results Fifty-nine final EM-relevant research questions were identified, including questions that cut across all firearm injury topics and questions specific to self-directed violence (suicide and attempted suicide); intimate partner violence; peer (non-partner) violence; mass violence; and unintentional (“accidental”) injury. Some questions could be addressed through research conducted in emergency departments (EDs); others would require work in other settings. Conclusions The technical advisory group identified key EM-relevant firearm injury research questions. EM-specific data is limited for most of these questions. Funders and researchers should consider increasing their attention to firearm injury prevention and control, particularly to the questions identified here and in other recently developed research agendas. PMID:27998625

A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research.

PubMed

Ranney, Megan L; Fletcher, Jonathan; Alter, Harrison; Barsotti, Christopher; Bebarta, Vikhyat S; Betz, Marian E; Carter, Patrick M; Cerdá, Magdalena; Cunningham, Rebecca M; Crane, Peter; Fahimi, Jahan; Miller, Matthew J; Rowhani-Rahbar, Ali; Vogel, Jody A; Wintemute, Garen J; Waseem, Muhammad; Shah, Manish N

2017-02-01

To identify critical emergency medicine-focused firearm injury research questions and develop an evidence-based research agenda. National content experts were recruited to a technical advisory group for the American College of Emergency Physicians Research Committee. Nominal group technique was used to identify research questions by consensus. The technical advisory group decided to focus on 5 widely accepted categorizations of firearm injury. Subgroups conducted literature reviews on each topic and developed preliminary lists of emergency medicine-relevant research questions. In-person meetings and conference calls were held to iteratively refine the extensive list of research questions, following nominal group technique guidelines. Feedback from external stakeholders was reviewed and integrated. Fifty-nine final emergency medicine-relevant research questions were identified, including questions that cut across all firearm injury topics and questions specific to self-directed violence (suicide and attempted suicide), intimate partner violence, peer (nonpartner) violence, mass violence, and unintentional ("accidental") injury. Some questions could be addressed through research conducted in emergency departments; others would require work in other settings. The technical advisory group identified key emergency medicine-relevant firearm injury research questions. Emergency medicine-specific data are limited for most of these questions. Funders and researchers should consider increasing their attention to firearm injury prevention and control, particularly to the questions identified here and in other recently developed research agendas. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Children and Firearms

MedlinePlus

... for Families - Vietnamese Spanish Facts for Families Guide Firearms and Children No. 37; Updated December 2014 Parents, ... large numbers of children and adolescents killed by firearms. In order to prevent further deaths, it is ...

Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study.

PubMed

Kalesan, Bindu; Mobily, Matthew E; Keiser, Olivia; Fagan, Jeffrey A; Galea, Sandro

2016-04-30

In an effort to reduce firearm mortality rates in the USA, US states have enacted a range of firearm laws to either strengthen or deregulate the existing main federal gun control law, the Brady Law. We set out to determine the independent association of different firearm laws with overall firearm mortality, homicide firearm mortality, and suicide firearm mortality across all US states. We also projected the potential reduction of firearm mortality if the three most strongly associated firearm laws were enacted at the federal level. We constructed a cross-sectional, state-level dataset from Nov 1, 2014, to May 15, 2015, using counts of firearm-related deaths in each US state for the years 2008-10 (stratified by intent [homicide and suicide]) from the US Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System, data about 25 firearm state laws implemented in 2009, and state-specific characteristics such as firearm ownership for 2013, firearm export rates, and non-firearm homicide rates for 2009, and unemployment rates for 2010. Our primary outcome measure was overall firearm-related mortality per 100,000 people in the USA in 2010. We used Poisson regression with robust variances to derive incidence rate ratios (IRRs) and 95% CIs. 31,672 firearm-related deaths occurred in 2010 in the USA (10·1 per 100,000 people; mean state-specific count 631·5 [SD 629·1]). Of 25 firearm laws, nine were associated with reduced firearm mortality, nine were associated with increased firearm mortality, and seven had an inconclusive association. After adjustment for relevant covariates, the three state laws most strongly associated with reduced overall firearm mortality were universal background checks for firearm purchase (multivariable IRR 0·39 [95% CI 0·23-0·67]; p=0·001), ammunition background checks (0·18 [0·09-0·36]; p<0·0001), and identification requirement for firearms (0·16 [0·09-0·29]; p<0·0001). Projected federal-level implementation of universal background checks for firearm purchase could reduce national firearm mortality from 10·35 to 4·46 deaths per 100,000 people, background checks for ammunition purchase could reduce it to 1·99 per 100,000, and firearm identification to 1·81 per 100,000. Very few of the existing state-specific firearm laws are associated with reduced firearm mortality, and this evidence underscores the importance of focusing on relevant and effective firearms legislation. Implementation of universal background checks for the purchase of firearms or ammunition, and firearm identification nationally could substantially reduce firearm mortality in the USA. None. Copyright © 2016 Elsevier Ltd. All rights reserved.

Youth Suicide and Guns. Firearm Facts.

ERIC Educational Resources Information Center

Duker, Laurie, Ed.

Whether or not a suicide attempt results in death depends in large part on the method chosen. If a teenager attempts suicide with a gun, his or her death is nearly guaranteed. This brief fact sheet presents data on firearms and suicide, the third leading cause of death for adolescents and young adults in the United States. Any number of societal…

Firearm mortality in California, 2000-2015: the epidemiologic importance of within-state variation.

PubMed

Pear, Veronica A; Castillo-Carniglia, Alvaro; Kagawa, Rose M C; Cerdá, Magdalena; Wintemute, Garen J

2018-05-01

Firearm mortality is a significant problem in the United States. Previous studies have largely focused on firearm mortality at the national or state level, leaving open the question of within-state variation. This study examined firearm mortality within California. We used Multiple Cause of Death data files to identify all firearm fatalities in California from 2000 to 2015. We described firearm mortality rates and counts over time, by age and county, stratifying by intent, gender, and race/ethnicity. County-level rates were smoothed with empirical Bayes estimates from random-effect Poisson models. From 2000 to 2015, there were 24,922 firearm homicides and 23,682 firearm suicides in California. Rates of firearm homicide decreased 30% and suicide rates increased 1% since the mid-2000s, but these trends varied substantially by county. Due to a decline in firearm homicides in metropolitan areas, there was no significant difference in these rates between urban and rural counties by 2015. Non-Hispanic black men had the highest rate of firearm homicide, but Hispanic men had the greatest number of deaths. We found considerable intrastate variation in firearm mortality in California. Our results will be of interest to researchers, policymakers, and public health practitioners. Similar epidemiologic profiles of firearm mortality are warranted for other states. Copyright © 2018 Elsevier Inc. All rights reserved.

Differences in Poisoning Mortality in the United States, 2003–2007: Epidemiology of Poisoning Deaths Classified as Unintentional, Suicide or Homicide

PubMed Central

Muazzam, Sana; Swahn, Monica H.; Alamgir, Hasanat; Nasrullah, Muazzam

2012-01-01

Introduction Poisoning, specifically unintentional poisoning, is a major public health problem in the United States (U.S.). Published literature that presents epidemiology of all forms of poisoning mortalities (i.e., unintentional, suicide, homicide) together is limited. This report presents data and summarizes the evidence on poisoning mortality by demographic and geographic characteristics to describe the burden of poisoning mortality and the differences among sub-populations in the U.S. for a 5-year period. Methods Using mortality data from the Center for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System, we presented the age-specific and age-adjusted unintentional and intentional (suicide, homicide) poisoning mortality rates by sex, age, race, and state of residence for the most recent years (2003–2007) of available data. Annual percentage changes in deaths and rates were calculated, and linear regression using natural log were used for time-trend analysis. Results There were 121,367 (rate=8.18 per 100,000) unintentional poisoning deaths. Overall, the unintentional poisoning mortality rate increased by 46.9%, from 6.7 per 100,000 in 2003 to 9.8 per100.000 in 2007, with the highest mortality rate among those aged 40–59 (rate=15.36), males (rate=11.02) and whites (rate=8.68). New Mexico (rate=18.2) had the highest rate. Unintentional poisoning mortality rate increased significantly among both sexes, and all racial groups except blacks (p<0.05 time-related trend for rate). Among a total of 29,469 (rate=1.97) suicidal poisoning deaths, the rate increased by 9.9%, from 1.9 per 100,000 in 2003 to 2.1 per 100,000 in 2007, with the highest rate among those aged 40–59 (rate=3.92), males (rate=2.20) and whites (rate=2.24). Nevada (rate=3.9) had the highest rate. Mortality rate increased significantly among females and whites only (p<0.05 time-related trend for rate). There were 463 (rate=0.03) homicidal poisoning deaths and the rate remained the same during 2003–2007. The highest rates were among aged 0–19 (rate=0.05), males (rate=0.04) and blacks (rate=0.06). Conclusion Prevention efforts for poisoning mortalities, especially unintentional poisoning, should be developed, implemented and strengthened. Differences exist in poisoning mortality by age, sex, location, and these findings underscore the urgency of addressing this public health burden as this epidemic continues to grow in the U.S. PMID:22900120

Trends in external causes of child and adolescent mortality in Poland, 1999-2012.

PubMed

Grajda, Aneta; Kułaga, Zbigniew; Gurzkowska, Beata; Góźdź, Magdalena; Wojtyło, Małgorzata; Litwin, Mieczysław

2017-01-01

To examine the pattern and trend of deaths due to external causes among Polish children and adolescents in 1999-2012, and to compare trends in Poland's neighboring countries. Death records were obtained from the Central Statistical Office of Poland. External causes mortality rates (MR) with 95 % confidence interval were calculated. The annual percentage change of MR was examined using linear regression. To compare MR with Belarus, Ukraine, Czech Republic and Germany, data from the European Mortality Database were used. MR were the highest in the age 15-19 years (33.7/100,000) and among boys (22.7/100,000). Unintentional injuries including transport accidents, drowning, and suicides (especially in children over 10 years old), were the main cause of death in the analyzed groups. Between 1999 and 2012 annual MR for unintentional injuries declined substantially. MR due to injuries and poisoning in Poland were higher compared with Czech Republic and Germany and lower in comparison with Belarus and Ukraine. Deaths due to unintentional injuries are still the leading cause of death among Polish children and adolescents. There are differences in death rates between Poland and neighboring countries.

Analysis of homicidal deaths in district DI Khan: an autopsy study.

PubMed

Humayun, Muhammad; Khan, Dilawar; Fasee-uz-Zaman; Khan, Jahanzeb; Khan, Omair; Parveen, Zahida; Humayun, Wajid

2009-01-01

One of the oldest crimes in human civilization is homicide which started from murder of Abel by the hands of Cane. With the passage of time manner of homicide have been changing. Study of pattern of homicide in any civil society is the first step towards development of intervention to reduce the impact of homicidal crimes. This study was conducted at the department of forensic medicine and toxicology Gomal Medical College DI Khan to know the pattern of the homicides, taking it as the first step in the prevention of crime. The present study was conducted over two years 2007-08. The data collected includes all reported unnatural deaths from the urban and rural areas of district on which autopsies were conducted in the district headquarter teaching hospital DI Khan and department of Forensic Medicine and Toxicology, Gomal Medical College DL Khan. Homicidal deaths constituted 259/341 (76%) of all autopsies. Out of these homicides 59.07% were caused by the firearm. The most common firearm weapons were high velocity rifled weapons (AK-47, rifles and pistols). A total of 304 injuries were found in various body regions giving an average of about two injuries per victim/person. The head, neck and face sustained the highest numbers of injuries 100, (32.90%) followed by chest 91 (29.93%) and abdomen 47 (15.4%); the extremities, buttock and genitalia together sustained 65 (21.38 %) injuries. A part from firearm injuries unfortunately in our this study the second highest cause of homicidal deaths was bomb blasts injuries either due to suicide bombers or remote control bombs. The numbers of deaths due to blast injuries were 82 for the year 2007/08 out of total homicidal deaths and percentage was 32.66%. The vast majority of homicidal deaths in this area are caused by firearms like other big cities of the province like Peshawar, which bring up issues related to possession of firearms and change in cultural attitude towards the use of firearm, if a decrease in firearm related homicides is desired.

Hartford's gun buy-back program: are we on target?

PubMed

Marinelli, Laura W; Thaker, Shefali; Borrup, Kevin; Shapiro, David S; Bentley, George C; Saleheen, Hassan; Lapidus, Garry; Campbell, Brendan T

2013-09-01

Gunbuy-backprograms have been proposed as away to remove unwanted firearms from circulation, but remain controversial because their ability to prevent firearm injuries remains unproven. The purpose of this study is to describe the demographics of individuals participating in Connecticut's gun buy-backprogram in the context of annual gun sales and the epidemiology of firearm violence in the state. Over four years the buy-back program collected 464 firearms, including 232 handguns. In contrast, 91,602 firearms were sold in Connecticut during 2009 alone. The incidence of gun-related deaths was unchanged in the two years following the inception of the buy-back program. Suicide was associated with older age (mean = 51 +/- 18years) and Caucasian race (n = 539, 90%). Homicide was associated with younger age (mean = 30 +/- 12 years) and minority race (n = 425, 81%). A gun buy-back program alone is not likely to produce a measurable decrease in firearm injuries and deaths.

Surveillance for violent deaths--National Violent Death Reporting System, 16 states, 2008.

PubMed

Karch, Debra L; Logan, Joseph; Patel, Nimesh

2011-08-26

An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 U.S. states for 2008. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. 2008. NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS data collection began in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004, four (California, Kentucky, New Mexico, and Utah) in 2005, and two in 2010 (Ohio and Michigan) for a total of 19 states. This report includes data from 16 states that collected statewide data in 2008; data from California are not included in this report because NVDRS was implemented only in a limited number of California cities and counties rather than statewide. Ohio and Michigan are excluded because they did not begin data collection until 2010. For 2008, a total of 15,755 fatal incidents involving 16,138 deaths were captured by NVDRS in the 16 states included in this report. The majority (58.7%) of deaths were suicides, followed by homicides and deaths involving legal intervention (i.e. deaths caused by police and other persons with legal authority to use deadly force, excluding legal executions) (26.4%), deaths of undetermined intent (14.5%), and unintentional firearm deaths (0.4%). Suicides occurred at higher rates among males, American Indians/Alaska Natives (AI/ANs), non-Hispanic whites, and persons aged 45-54 years. Suicides occurred most often in a house or apartment (70.6%) and involved the use of firearms (51.5%). Suicides were precipitated primarily by mental health (45.4%), intimate partner (30.9%), or physical health problems (22.6%), or by a crisis during the preceding 2 weeks (27.9%). Homicides occurred at higher rates among males and persons aged 20-24 years; rates were highest among non-Hispanic black males. The majority of homicides involved the use of a firearm (65.8%) and occurred in a house or apartment (52.5%) or on a street/highway (21.3%). Homicides were precipitated primarily by arguments (41.4%) and interpersonal conflicts (18.4%) or in conjunction with another crime (30.2%). Other manners of death and special situations or populations also are highlighted in this report. This report provides a detailed summary of data from NVDRS for 2008. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected adults aged <55 years, males, and certain minority populations. For homicides and suicides, relationship problems, interpersonal conflicts, mental health problems, and recent crises were among the primary precipitating factors. Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary. For the occurrence of violent deaths in the United States to be better understood and ultimately prevented, accurate, timely, and comprehensive surveillance data are necessary. NVDRS data can be used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states participating in NVDRS, with an ultimate goal of full national representation.

Suicide, guns, and buyback programs: An epidemiologic analysis of firearm-related deaths in Connecticut.

PubMed

Baumann, Laura; Clinton, Heather; Berntsson, Rob; Williams, Susan S; Rovella, James C; Shapiro, David; Thaker, Shefali; Borrup, Kevin; Lapidus, Garry; Campbell, Brendan T

2017-12-01

Gun buyback programs aim to remove unwanted firearms from the community with the goal of preventing firearm injury and death. Buyback programs are held in many communities, but evidence demonstrating their effectiveness is lacking. The purpose of this study is to compare firearms collected at buyback events to crime guns and firearms used in homicides and suicides. Detailed firearm and case data were obtained from the Hartford Police Department and the Office of the Chief Medical Examiner from January through December of 2015. Information was reviewed for guns collected at buyback events, crime guns confiscated by police, and for weapons associated with firearm fatalities. Detailed firearm data included type, manufacturer, model, and caliber (small, ≤ 0.32 caliber; medium, 0.357 caliber to 9 mm; large, ≥ 0.40 caliber). χ analyses were used for comparisons between groups. In 2015, 224 crime guns were seized by the Hartford Police, 169 guns were collected at four community buyback events, and there were 187 firearm-related deaths statewide (105 suicides, 81 homicides, 1 legal intervention). Comparisons between buyback, crime, and fatality-related firearms are shown in the table below. Medium caliber handguns account for the majority of crime guns and fatalities, and buyback programs collected smaller caliber handguns. The demographics of individuals who turn in guns at buyback events and commit suicide are similar: age (buyback, 63 ± 11; suicide, 52 ± 18; homicide, 34 ± 12 years), sex (buyback, 81%; suicide, 91%; homicide, 84% men), and race (buyback, 80%; suicide, 97%; homicide, 47% white). Handguns account for the majority of crime guns and firearm-related fatalities in Connecticut. Buyback programs are both an opportunity to remove unwanted handguns from the community and to remove firearms from the homes of individuals at increased risk of suicide. Epidemiologic/therapeutic study, level IV.

Reducing firearm violence: a research agenda

PubMed Central

Weiner, Janet; Wiebe, Douglas J; Richmond, Therese S; Beam, Kristen; Berman, Alan L; Branas, Charles C; Cheney, Rose A; Coyne-Beasley, Tamera; Firman, John; Fishbein, Martin; Hargarten, Stephen; Hemenway, David; Jeffcoat, Robert; Kennedy, David; Koper, Christopher S; Lemaire, Jean; Miller, Matthew; Roth, Jeffrey A; Schwab, C William; Spitzer, Robert; Teret, Stephen; Vernick, Jon; Webster, Daniel

2007-01-01

In the United States, firearms are involved in tens of thousands of deaths and injuries each year. The magnitude of this problem prompted the National Academy of Sciences (NAS) to issue a report in 2004 detailing the strengths and limitations of existing research on the relationship between firearms and violence. In response, a multidisciplinary group of experts in the field of firearms and violence formed the National Research Collaborative on Firearm Violence. The Collaborative met for 2 days in June 2005 to (1) critically review the main findings of the NAS report and (2) define a research agenda that could fill research and data gaps and inform policy that reduces gun-related crime, deaths and injuries. This article summarizes the Collaborative's conclusions and identifies priorities for research and funding. PMID:17446246

Violence-related firearm deaths among residents of metropolitan areas and cities---United States, 2006--2007.

PubMed

2011-05-13

Violence-related firearm deaths remain an important public health concern in the United States. During 2006--2007, a total of 25,423 firearm homicides and 34,235 firearm suicides occurred among U.S. residents. These national totals include 4,166 firearm homicides and 1,446 firearm suicides among youths aged 10--19 years; the rate of firearm homicides among youths slightly exceeded the rate among persons of all ages. This report presents statistics on firearm homicides and firearm suicides for major metropolitan areas and cities, with an emphasis on youths aged 10--19 years in recognition of the importance of early prevention efforts. It integrates analyses conducted by CDC in response to requests for detailed information, arising from a heightened focus on urban violence by the media, the public, and policymakers over the past year. Firearm homicides and suicides and annual rates were tabulated for the 50 largest U.S. metropolitan statistical areas (MSAs) and their central cities for 2006--2007, using data from the National Vital Statistics System and the U.S. Census Bureau. Firearm homicide rates in approximately two thirds of the MSAs exceeded the national rate, and 86% of cities had rates higher than those of their MSAs. The youth firearm homicide rate exceeded the all-ages rate in 80% of the MSAs and in 88% of the cities. Firearm suicide rates in just over half of the MSAs were below the national rate, and 55% of cities had rates below those of their MSAs. Youth firearm suicide rates in the MSAs and cities were collectively low compared with all-ages rates. Such variations in firearm homicide and firearm suicide rates, with respect to both urbanization and age, should be considered in the continuing development of prevention programs directed at reducing firearm violence.

FastStats: Health of Hispanic or Latino Population

MedlinePlus

... 1 [PDF – 2.7 MB] Leading causes of death Cancer Heart disease Accidents (unintentional injuries) Source: Deaths: ... 2015, table D [PDF – 2.3 MB] Infant deaths Infant deaths per 1,000 live births: 5. ...

Rates of firearm homicide by Chicago region, age, sex, and race/ethnicity, 2005-2010.

PubMed

Walker, Garth Nyambi; McLone, Suzanne; Mason, Maryann; Sheehan, Karen

2016-10-01

The United States reports the highest levels of firearm homicide incidences compared to other high income countries, and the focus and causes of these incidences within the US differ by demographic characteristics and location such as urban versus rural environment. Despite these findings, few studies have published on rates varied by region within a city. This study aims to provide descriptive analysis of the rates of firearm homicide by age, sex, and race/ethnicity in each of the seven City of Chicago regions, and to determine if the rates of firearm homicide differ by demographics among the seven City of Chicago regions. The Illinois Violent Death Reporting System conducts routine surveillance of violent deaths. Decedents were selected according to the following criteria: manner of death was homicide, weapon type was firearm, and location of injury that led to death was the City of Chicago. Location of injury was broken down by regions: North, Northwest, Center, West, South, Southwest, and Far South. Multiyear rates per 100,000 and corresponding 95% confidence intervals were calculated. There were 2,254 victims of homicide by firearm in the City of Chicago. The overall rate across Chicago for all demographics was 12.9 (12.1-13.5 per 100,000) with an average age of 27.4. The highest age group (20-24) for firearm homicide rates was 43.2 (39.7-46.7) per 100,000. For the youngest age group (10-14), only the Southwest (3.3-10.4) region reported any firearm incidence. The 20 to 24 age group reported the highest rates of all age groups within the South (107.9-151.7), West (80.3-108.2), and Far South (69.6-105.3) regions, whereas the North and Northwest reported the lowest rates for all regions by age. Black firearm homicide rates were 33.5 (31.9-35.1) per 100,000 versus Hispanic and non-Hispanic white firearm homicide rates of 8.5 (7.7-9.3) and 1.2 (1-1.5) per 100,000, respectively. Lastly, the West reported the highest firearm rates at 29.1 (657). In conclusion, Chicago is a large city that has high variation in firearm homicide rates among its constituent regions; therefore, an overall firearm homicide rate for the city of Chicago as a whole is not an accurate representation of the true nature of firearm homicides. Policy implementation may be made more effective by providing more regional analysis and targeted interventions via multipronged initiatives to help reduce future firearm rates, and funding for issues that address systemic poverty and adequate access to care and medical facilities. Epidemiologic study, level IV.

Suicide in Canada

PubMed Central

McFaull, Steven; Rhodes, Anne E.; Bowes, Matthew; Rockett, Ian R. H.

2016-01-01

Objective: The aim of this study is to compare Canadian suicide rates with other external causes of death to examine potential poisoning misclassifications as a contributor to suicide underreporting. Method: The study used Statistics Canada mortality data from 2000 to 2011 to calculate sex-and age-specific ratios by external cause of injury codes. Results: The overall Canadian suicide rate, as well as the poisoning suicide rate, declined over the study timeframe by an average annual percentage change (AAPC) of 1.0% each year. However, unintentional and undetermined poisonings increased significantly during the timeframe. Unintentional poisoning mortality (primarily narcotics and hallucinogens, including opioids) increased in proportion to suicides for both sexes, although females were consistently higher. The undetermined death to suicide ratio was higher and increasing for females. Poisonings of undetermined intent increased over time to comprise 47% to 80% of the undetermined death category for males and females combined. Conclusions: Canadian poisoning suicide rates declined, in contrast to rising unintentional and undetermined poisoning mortality rates. This trend is similar to that of the United States, supporting the hypothesis that misclassification of poisoning deaths may also be an issue in Canada.

FastStats: Health of American Indian or Alaska Native Population

MedlinePlus

... 1 [PDF – 2.7 MB] Leading causes of death Heart disease Cancer Accidents (unintentional injuries) Source: Deaths: ... 2015, table 1 [PDF – 2.3 MB] Infant deaths Infant deaths per 1,000 live births: 7. ...

Perceptions of firearms and suicide: The role of misinformation in storage practices and openness to means safety measures.

PubMed

Anestis, Michael D; Butterworth, Sarah E; Houtsma, Claire

2018-02-01

Firearm ownership and unsafe storage increase risk for suicide. Little is known regarding factors that influence storage practices and willingness to engage in means safety. Utilizing Amazon's Mechanical Turk program, we recruited an online sample of 300 adults living in the US who own at least one firearm. Firearm storage practices and openness to means safety measures were assessed using items designed for this study. Data were collected and analyzed in 2017. Firearms stored in non-secure locations and without a locking device were associated with lower beliefs in the relationship between firearm storage and suicide risk. Fearlessness about death moderated the association between current secure versus non-secure storage and beliefs regarding firearm storage and suicide risk, in that storage practices and beliefs were more strongly related at higher levels of fearlessness about death. For both secure and locked storage of a firearm, there was a significant indirect effect of current storage practices on willingness to engage in means safety in the future through current beliefs regarding the relationship between firearm storage and suicide risk. Unsafe storage practices were largely associated with an unwillingness to store firearms more safely or to allow a trusted peer to temporarily store the firearm outside the home in order to prevent their own or someone else's suicide. Self-report and cross-sectional data were used. Results may not generalize to non-firearm owners. Firearm owners are prone to inaccurate beliefs about the relationship between firearms and suicide. These beliefs may influence both current firearm storage practices and the willingness to engage in means safety. Copyright © 2017 Elsevier B.V. All rights reserved.

FastStats: Adolescent Health

MedlinePlus

... 2 [PDF – 2.7 MB] Leading causes of death Leading causes of deaths among adolescents aged 15–19 years: Accidents (unintentional injuries) Suicide Homicide Source: Deaths: Leading Causes for 2015, table 1 [PDF – 2. ...

3 CFR 8484 - Proclamation 8484 of March 15, 2010. National Poison Prevention Week, 2010

Code of Federal Regulations, 2011 CFR

2011-01-01

..., childhood death rates from unintentional poisonings have fallen considerably. However, adult death rates... senseless injuries and deaths. With nearly two million poison exposures reported each year, we must take...

Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics.

PubMed

Jann, Michael; Kennedy, William Klugh; Lopez, Gaylord

2014-02-01

The misuse and abuse of prescription medications in the United States continues to increase despite interventions by health care professionals, regulatory, and law enforcement agencies. Opioid analgesics are the leading class of prescription drugs that have caused unintentional overdose deaths. Benzodiazepines when taken alone are relatively safe agents in overdose. However, a 5-fold increase in deaths attributed to benzodiazepines occurred from 1999 to 2009. Emergency department visits related to opioid analgesics increased by 111% followed by benzodiazepines 89%. During 2003 to 2009, the 2 prescriptions drugs with the highest increase in death rates were oxycodone 264.6% and alprazolam 233.8%. Therefore, benzodiazepines have a significant impact on prescription drug unintentional overdoses second only to the opioid analgesics. The combination prescribing of benzodiazepines and opioid analgesics commonly takes place. The pharmacokinetic drug interactions between benzodiazepines and opioid analgesics are complex. The pharmacodynamic actions of these agents differ as their combined effects produce significant respiratory depression. Physician and pharmacy shopping by patients occurs, and prescription drug-monitoring programs can provide important information on benzodiazepine and opioid analgesic prescribing patterns and patient usage. Health care professionals need to inform patients and work closely with regulatory agencies and legislatures to stem the increasing fatalities from prescription drug unintentional overdoses.

Effectiveness of measures to prevent unintentional deaths of infants and children from suffocation and strangulation.

PubMed Central

Kraus, J F

1985-01-01

Unintentional deaths from suffocation and strangulation account for about 20 percent of all nontransport-related infant and child fatalities in the United States. In the late 1950s, some preventive countermeasures were introduced to reduce the number of deaths resulting from refrigerator or freezer entrapment. A few years later, countermeasures were introduced to prevent deaths resulting from suffocation by plastic bags, inhumation, and mechanical strangulation from wedging in infant cribs. For three of these major causes of suffocation and strangulation deaths among infants and children (refrigerator or freezer entrapment, suffocation by plastic bag, and inhumation at construction sites), there appears to have been a significant decline in incidence; however, there is no evidence of a significant reduction in deaths from mechanical strangulation in cribs. The impact of current countermeasures is discussed, and some suggestions for new or modified approaches are made. PMID:3920722

QuickStats: Age-Adjusted Death Rates* for Females Aged 15-44 Years, by the Five Leading Causes of Death(†) - United States, 1999 and 2014.

PubMed

2016-07-01

The age-adjusted death rate for females aged 15-44 years was 5% lower in 2014 (82.1 per 100,000 population) than in 1999 (86.5). Among the five leading causes of death, the age-adjusted rates of three were lower in 2014 than in 1999: cancer (from 19.6 to 15.3, a 22% decline), heart disease (8.9 to 8.2, an 8% decline), and homicide (4.2 to 2.8, a 33% decline). The age-adjusted death rates for two of the five causes were higher in 2014 than in 1999: unintentional injuries (from 17.0 to 20.1, an 18% increase) and suicide (4.8 to 6.5, a 35% increase). Unintentional injuries replaced cancer as the leading cause of death in this demographic group.

Internists' attitudes toward prevention of firearm injury.

PubMed

Butkus, Renee; Weissman, Arlene

2014-06-17

Professional organizations have called for the medical community's attention to the prevention of firearm injury. However, little is known about physicians' attitudes and practices in preventing firearm injury. To determine internists' attitudes and practices about firearms and to assess whether opinions differ according to whether there are gun owners in a physician's home. Cross-sectional survey. Internal medicine practices. 573 internists representative of American College of Physicians' members. Respondents' experiences and reported practice behaviors related to firearms and their opinions about contributors and public policies related to firearm violence, as well as physician education and training in firearm safety. The survey response rate was 56.5%. Eighty-five percent of respondents believed that firearm injury is a public health issue, and 71% believed that it is a bigger problem today than a decade ago. Seventy-six percent of respondents believed that stricter gun control legislation would help reduce the risks for gun-related injuries or deaths. Although 66% of respondents believed that physicians should have the right to counsel patients on preventing deaths and injuries from firearms, 58% reported never asking whether patients have guns in their homes. The generalizability of these findings to non-American College of Physicians' member internists and other physicians is unknown. Responses may not reflect actual behavior. Most respondents believed that firearm-related violence is a public health issue and favored policy initiatives aimed at reducing it. Although most internists supported a physician's right to counsel patients about gun safety, few reported currently doing it. None.

Traumatic child death and documented maltreatment history, Los Angeles.

PubMed Central

Sorenson, S B; Peterson, J G

1994-01-01

OBJECTIVES. Child abuse is a presumed but largely untested risk factor for child homicide. This research investigated the social and child protective service history of child homicide victims. METHODS. A pairwise matched case-control design was used to assess documented child maltreatment as a risk factor for homicide vs unintentional injury death. Homicide victims aged 0 to 14 years were identified through Los Angeles Police Department case summaries. Control subjects (children who died of an unintentional injury) were matched to case subjects (children who died from homicide) by age, sex, race/ethnicity, and date of death. Case and control subjects were linked with county service records to determine any known history of maltreatment. RESULTS. A total of 220 children were homicide victims during 1978 through 1987 in the city of Los Angeles. Only one in six children who died (of homicide or unintentional injury) or his/her family was known to county social or child protective services prior to the death. Recorded history of child protective services was associated with homicide victimization (adjusted odds ratio = 3.40, 95% confidence interval = 1.25, 9.27). CONCLUSIONS. Current service systems need assistance in identifying and protecting children at high risk of homicide. PMID:8154567

CDC School Health Guidelines to Prevent Unintentional Injuries and Violence

ERIC Educational Resources Information Center

Barrios, Lisa C.; Sleet, David A.; Mercy, James A.

2003-01-01

Approximately two-thirds of all deaths among children and adolescents aged five to 19 years results from injury-related causes: motor-vehicle crashes, all other unintentional injuries, homicide, and suicide. Schools have a responsibility to prevent injuries from occurring on school property and at school-sponsored events. In addition, schools can…

Change in child mortality patterns after injuries in Sweden: a nationwide 14-year study.

PubMed

Bäckström, D; Steinvall, I; Sjöberg, F

2017-06-01

Sweden has one of the world's lowest child injury mortality rates, but injuries are still the leading cause of death among children. Child injury mortality in the country has been declining, but this decline seems to decrease recently. Our objective was therefore to further examine changes in the mortality of children's death from injury over time and to assess the contribution of various effects on mortality. The underlying hypothesis for this investigation is that the incidence of lethal injuries in children, still is decreasing and that this may be sex specific. We studied all deaths from injury in Sweden under-18-year-olds during the 14 years 1999-2012. We identified those aged under 18 whose underlying cause of death was recorded as International Classification of Diseases, 10th Revision (ICD-10) diagnosis from V01 to X39 in the Swedish cause of death, where all dead citizens are registered. From the 1 January 1999 to 31 December 2012, 1213 children under the age of 18 died of injuries in Sweden. The incidence declined during this period (r = -0.606, p = 0.02) to 3.3 deaths/100,000 children-years (95 % CI 2.6-4.2). Death from unintentional injury was more common than that after intentional injury (p < 0.0001). There was a reduction in the incidence of unintentional injuries during the study period (r = -0.757, p = 0.03). The most common causes of death were injury to the brain (n = 337, 41 %), followed by drowning (n = 109, 13 %). The number of deaths after intentional injury increased (r = 0.585, p = 0.03) and at the end of the period was 1.5 deaths/100,000 children-years. The most common causes of death after intentional injuries were asphyxia (n = 177, 45 %), followed by injury to the brain (n = 76, 19 %). Mortality patterns in injured children in Sweden have changed from being dominated by unintentional injuries to a more equal distribution between unintentional and intentional injuries as well as between sexes and the overall rate has declined further. These findings are important as they might contribute to the preventive work that is being done to further reduce mortality in injured children.

Overdose Deaths Related to Fentanyl and Its Analogs - Ohio, January-February 2017.

PubMed

Daniulaityte, Raminta; Juhascik, Matthew P; Strayer, Kraig E; Sizemore, Ioana E; Harshbarger, Kent E; Antonides, Heather M; Carlson, Robert R

2017-09-01

Ohio is experiencing unprecedented loss of life caused by unintentional drug overdoses (1), with illicitly manufactured fentanyl (IMF) emerging as a significant threat to public health (2,3). IMF is structurally similar to pharmaceutical fentanyl, but is produced in clandestine laboratories and includes fentanyl analogs that display wide variability in potency (2); variations in chemical composition of these drugs make detection more difficult. During 2010-2015, unintentional drug overdose deaths in Ohio increased 98%, from 1,544 to 3,050.* In Montgomery County (county seat: Dayton), one of the epicenters of the opioid epidemic in the state, unintentional drug overdose deaths increased 40% in 1 year, from 249 in 2015 to 349 in 2016 (estimated unadjusted mortality rate = 57.7 per 100,000) (4). IMFs have not been part of routine toxicology testing at the coroner's offices and other types of medical and criminal justice settings across the country (2,3). Thus, data on IMF test results in the current outbreak have been limited. The Wright State University and the Montgomery County Coroner's Office/Miami Valley Regional Crime Laboratory (MCCO/MVRCL) collaborated on a National Institutes of Health study of fentanyl analogs and metabolites and other drugs identified in 281 unintentional overdose fatalities in 24 Ohio counties during January-February 2017. Approximately 90% of all decedents tested positive for fentanyl, 48% for acryl fentanyl, 31% for furanyl fentanyl, and 8% for carfentanil. Pharmaceutical opioids were identified in 23% of cases, and heroin in 6%, with higher proportions of heroin-related deaths in Appalachian counties. The majority of decedents tested positive for more than one type of fentanyl. Evidence suggests the growing role of IMFs, and the declining presence of heroin and pharmaceutical opioids in unintentional overdose fatalities, compared with 2014-2016 data from Ohio and other states (3-5). There is a need to include testing for IMFs as part of standard toxicology panels for biological specimens used in the medical, substance abuse treatment, and criminal justice settings.

Firearm-related mortality: a review of four hundred-forty four deaths in Diyarbakir, Turkey between 1996 and 2001.

PubMed

Goren, Suleyman; Subasi, Mehmet; Tirasci, Yasar; Kemaloglu, Serdar

2003-11-01

The current study is based on a retrospective investigation of firearm deaths in Diyarbakir, which were autopsied by the Diyarbakir Branch of the Council of Forensic Medicine during the 6- year period. Four hundred-forty four deaths were investigated from January 1996 through December 2001, including homicide (296 cases, 66.7%), suicide (120 cases, 27%) and accidental shootings (28 cases, 6.3%). The age range of all firearm deaths in the study period was 5 to 75 years with a median age of 29.8 years. The majority were in the groups aged 16-25 years (38.7%). In the homicide group, 248 subjects (83.8%) were male, and 48 (16.2%) were female. The 31.1% of the homicide victims were in the group aged at 20-30 years. Of the 120 suicide victims, 56 (46.7%) were in the group aged 16-20 years. The head was by far the favoured site, accounting for 82 (68.3%) deaths: entry wounds in the right temple accounted for 72 of these. Twenty-eight cases were accidental shootings and 18 of them were male (64.3%). Twelve of the 28 accidental victims (42.9%) were in the group aged 0-10 years. The eight cases were due to their own accidental shootings, and the remaining 20 cases were shot by others. Our findings show that the contributing factors for increasing death by firearm are terrorists' activities, traditional habits of obtaining and using guns and blood feuds.

Fatal occupational injuries in a southern state.

PubMed

Loomis, D P; Richardson, D B; Wolf, S H; Runyan, C W; Butts, J D

1997-06-15

Fatal occupational injuries were studied using data from medical examiners' reports in North Carolina for the years 1977-1991. Cases were defined as deaths due to accidents or homicide at the workplace, and populations at risk were estimated from the 1980 and 1990 US Censuses. Mortality rate ratios and proportionate mortality ratios were used as measures of association, and the population attributable risk percentage was used as an indicator of the burden of injury. Standard weights for direct age-adjustment of rates were obtained from the total state workforce. There were 2,524 eligible deaths-83 percent from unintentional traumatic injuries, 14 percent from homicide, and the remainder from other causes. This report focuses on unintentional trauma deaths, which were strongly associated with the wood production, fishing, and transportation industries. Elderly, African-American, and self-employed workers had higher fatality rates than members of other groups. Among male workers, motor vehicle crashes were the principal cause of death on the job, followed by falling objects, machinery, and falls. The industries contributing the largest proportions of these deaths were construction, trucking, agriculture, and logging (population attributable risk percentages were 16.8%, 8.8%, 7.9%, and 6.9%, respectively). The fatality patterns of female workers were different: Numbers of deaths from homicide and unintentional trauma were equal, and 27% of the latter deaths occurred in one catastrophic fire. Decentralized and rural industries were the most hazardous, but many deaths were outside the current jurisdiction of occupational safety and health agencies. These patterns suggest that greater scrutiny of such industries, through both research and intervention, is warranted.

Police deaths in New York and London during the twentieth century

PubMed Central

Kyriacou, D N; Monkkonen, E H; Peek‐Asa, C; Lucke, R E; Labbett, S; Pearlman, K S; Hutson, H R

2006-01-01

Objectives To describe the incidences and causes of occupational police deaths in New York City in the United States and Greater London in the United Kingdom during the twentieth century. To assess the relation between overall societal violence and violence directed toward police officers in these metropolitan areas. Design and setting Ecological study of New York and London from 1900 through 1999. Main outcome measures Intentional and unintentional occupational police mortality rates for New York and London were estimated for each decade. The general population homicide rates of both New York and London were assessed for their correlation with their respective intentional occupational police mortality rates. Results During the 20th century, 585 police officers in New York and 160 police officers in London died while participating in law enforcement activities. New York had markedly greater intentional police mortality rates compared to London throughout most of the 20th century, but these differences decreased significantly by the end of the century. Intentional gunshot wounds comprised 290 police deaths in New York, but only 14 police deaths in London. In New York, gun shot wounds (both intentional and unintentional) accounted for more occupational police deaths (51.6%) than did all other injury mechanisms combined. In London, motor vehicle collision was the most common cause (47.5%) of occupational police death. There were no apparent correlations between the general population homicide rates and intentional police mortality rates in either New York (r2 = 0.05, 95% CI −0.77 to 0.81) or London (r2 = 0.34, 95% CI −0.61 to 0.89). Conclusions During the 20th century, both intentional and unintentional occupational police mortality rates were significantly greater in New York compared to London. These differences are likely from several socioeconomic, cultural, and occupational factors. The declines in police deaths in New York during the latter part of the 20th century indicate that at least some measures taken by the New York Police Department have been successful at significantly reducing the incidence of both intentional and unintentional police deaths. PMID:16887942

Association between the inception of a SAFE KIDS Coalition and changes in pediatric unintentional injury rates

PubMed Central

Tamburro, R; Shorr, R; Bush, A; Kritchevsky, S; Stidham, G; Helms, S

2002-01-01

Setting: Shelby County, Tennessee. Design: Retrospective observational analysis. Patients: County residents nine years of age or younger presenting to the children's medical center, its emergency department, or its outpatient clinics from 1990–97. Intervention: Implementation of a SAFE KIDS Coalition. Main outcome measures: Rates of unintentional injuries targeted by the SAFE KIDS Coalition that resulted in hospitalization or in death. Rates of motor vehicle occupant injuries that resulted in hospitalization or in death. Rates of non-targeted unintentional injuries, namely injuries secondary to animals and by exposure to toxic plants. Rates of severe injuries (defined as those targeted injuries that required hospitalization or resulted in death), and specifically, severe motor vehicle occupant injuries were compared before and after the inception of the coalition using Poisson regression analysis. Results: The relative risk of targeted severe injury rates decreased after implementation of the coalition even after controlling for changes in hospital admission rates. Specifically, severe motor vehicle occupant injury rates decreased 30% (relative risk 0.70; 95% confidence interval 0.54 to 0.89) after initiation of the coalition. Conclusions: The implementation of a SAFE KIDS Coalition was associated with a decrease in severe targeted injuries, most notably, severe motor vehicle occupant injuries. Although causality cannot be determined, these data suggest that the presence of a coalition may be associated with decreased severe unintentional injury rates. PMID:12226125

Magnitude and Trends in Heavy Episodic Drinking, Alcohol-Impaired Driving, and Alcohol-Related Mortality and Overdose Hospitalizations Among Emerging Adults of College Ages 18-24 in the United States, 1998-2014.

PubMed

Hingson, Ralph; Zha, Wenxing; Smyth, Daniel

2017-07-01

This article estimates percentages of U.S. emerging adults ages 18-24 engaging in past-month heavy episodic drinking and past-year alcohol-impaired driving, and numbers experiencing alcohol-related unintentional injury deaths and overdose hospitalizations between 1998 and 2014. We analyzed national injury mortality data from coroner, census, and college enrollment statistics, the National Survey on Drug Use and Health, and the Nationwide Inpatient Sample. From 1999 to 2005, percentages of emerging adults ages 18-24 reporting past-month heavy episodic drinking rose from 37.1% to 43.1% and then declined to 38.8% in 2014. Alcohol-impaired driving rose from 24% to 25.5% and then declined to 16.0%. Alcohol-related unintentional injury deaths increased from 4,807 in 1998 to 5,531 in 2005 and then declined to 4,105 in 2014, a reduction of 29% per 100,000 since 1998. Alcohol-related traffic deaths increased from 3,783 in 1998 to 4,114 in 2005 and then declined to 2,614 in 2014, down 43% per 100,000 since 1998. Alcohol-related overdose deaths increased from 207 in 1998 to 891 in 2014, a 254% increase per 100,000. Other types of nontraffic unintentional injury deaths declined. Alcohol-overdose hospitalizations rose 26% per 100,000 from 1998 to 2014, especially from increases in alcohol/other drug overdoses, up 61% (alcohol/opioid overdoses up 197%). Among emerging adults, a trend toward increased alcohol-related unintentional injury deaths, heavy episodic drinking, and alcohol-impaired driving between 1998 and 2005 was reversed by 2014. Persistent high levels of heavy episodic drinking and related problems among emerging adults underscore a need to expand individually oriented interventions, college/community collaborative programs, and evidence-supported policies to reduce their drinking and related problems.

Adolescent Homicides, Suicides, and the Role of Firearms: A Narrative Review

ERIC Educational Resources Information Center

Price, James H.; Khubchandani, Jagdish

2017-01-01

Background: The United States has more than 90% of all youth firearm deaths that occur in high-income countries. Purpose: We summarize the epidemiological literature on the prevalence, risk factors, and protective factors associated with adolescent homicides and suicides and the role of firearms in the loss of these lives. Methods: A systematic…

Fatalities in the Peace Corps: a retrospective study, 1984 to 2003.

PubMed

Nurthen, Nancy M; Jung, Paul

2008-01-01

To determine causes of death for Peace Corps Volunteers (PCV) between 1984 and 2003 and compare them with prior Volunteer death rates and with US death rates. We conducted a retrospective cohort study of all PCV between 1984 and 2003 and compared them to published data for prior years and against US death rates. Of the 66 deaths in our study period, the major causes were unintentional injury, homicide, medical illness, and suicide. Comparisons to US mortality data controlled for age, marital status, and educational attainment found equal or lower death rates among Volunteers. When compared to previous study results from 1961 to 1983, the total number of deaths, as well as the death rate per Volunteer-year, decreased. Deaths from unintentional injury, suicide, and medical illness decreased in number and rate; only homicides increased in number during our study period, but this increase did not reach statistical significance. PCV are exposed to unique risks, but these risks have become significantly less fatal over the past 20 years when compared to prior Peace Corps data and matched US population data.

Where have all the gun deaths gone?

PubMed

Matzopoulos, Richard; Groenewald, Pamela; Abrahams, Naeemah; Bradshaw, Debbie

2016-05-19

The low number of firearm assaults and overall assault-related deaths in Statistics South Africa's death notification reports is incongruous with other recently released data, including police crime statistics. We conducted a review of all gunshot injuries recorded in death notifications from 1997 to 2013, including all cases in which the underlying cause of death was ascribed to cause-specific codes in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) that referred to a gunshot injury. We identified 105 694 gunshot-related injury deaths over the 17-year period, an average of 6 217 per annum. The total annual number of gunshot injuries increased from 1997 to 2000, at which point firearm-related deaths peaked at 9 540 recorded cases. Thereafter there was a steadily decreasing trend (interrupted only in 2006 and 2008) until 2011, when 3 793 deaths were attributed to gunshot-related injuries as the underlying cause - a decrease of >60% from the peak in 2000. The cause-specific profile for gunshot injury deaths in this study indicated extensive misclassification, which explained the near-absence of these injuries among assault cases. However, the trend in gunshot-related injury deaths irrespective of intent provides further support for the hypothesis that stricter gun control, coinciding with the implementation of the Firearms Control Act of 2000, accounts for this decrease.

Preventing suicide and homicide in the United States: the potential benefit in human lives.

PubMed

Papadopoulos, Fotios C; Skalkidou, Alkistis; Sergentanis, Theodoros N; Kyllekidis, Spyros; Ekselius, Lisa; Petridou, Eleni Th

2009-09-30

In order to assess the potential benefit in human lives if all geographical regions in the US (Northeast, South, Midwest, and West) achieved the lowest suicide and homicide rates observed within these regions, age-, race- and gender-adjusted suicide and homicide rates for each of the four regions were calculated based on data retrieved using the Centers for Disease Control and Prevention database for 1999-2004. Data on known risk factors were retrieved from online sources. Overall suicide rates (10.42 per 100,000) exceeded homicide rates (6.97 per 100,000). Almost 27% (12,942 lives per year) of the 288,222 suicide and homicide deaths during the study period might have been avoided if all US regions achieved the mortality rate reported by the Northeast. A firearm was used in 55% of all suicides and 66% of all homicides. In the total estimate of avoidable deaths, firearm suicides (90%) and firearm homicides (75%) were overrepresented. The Northeast had the lowest access to firearms (20%) contrasted to almost double in the other regions, whereas greater firearms availability was related to unrestricted firearm legislation. Measures to restrict firearms availability should be highly prioritized in the public health agenda in order to achieve an impressive benefit in human lives.

FastStats: Older Persons' Health

MedlinePlus

... 11 [PDF – 4.4 MB] Leading causes of death among persons aged 65 and over Heart disease ... Among Centenarians in the United States, 2000-2014 Deaths From Unintentional Injury Among Adults Aged 65 and ...

Mobilizing Black America

DTIC Science & Technology

1993-04-01

cancer, heart disease and stroke, infant mortality, diabetes , homicide and unintentional injuries and chemical dependency. Today an additional major...INFORMATION CLEARINGHOUSE Offers information for consumers and professionals on sudden infant death syndrome (SIDS), infantile apnea, and death and

Surveillance for violent deaths - National Violent Death Reporting System, 16 states, 2010.

PubMed

Parks, Sharyn E; Johnson, Linda L; McDaniel, Dawn D; Gladden, Matthew

2014-01-17

An estimated 55,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 U.S. states for 2010. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. 2010. NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplementary homicide reports, hospital data, and crime laboratory data). NVDRS data collection began in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004, four (California, Kentucky, New Mexico, and Utah) in 2005, and two in 2010 (Ohio and Michigan), for a total of 19 states. This report includes data from 16 states that collected statewide data in 2010; data from California are not included in this report because data were not collected after 2009. Ohio and Michigan were excluded because data collection, which began in 2010, did not occur statewide until 2011. For 2010, a total of 15,781 fatal incidents involving 16,186 deaths were captured by NVDRS in the 16 states included in this report. The majority (62.8%) of deaths were suicides, followed by homicides and deaths involving legal intervention (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions) (24.4%), deaths of undetermined intent (12.2%), and unintentional firearm deaths (0.7%). Suicides occurred at higher rates among males, non-Hispanic whites, American Indians/Alaska Natives, and persons aged 45-54 years. Suicides most often occurred in a house or apartment and involved the use of firearms. Suicides were preceded primarily by a mental health or intimate partner problem, a crisis during the previous 2 weeks, or a physical health problem. Homicides occurred at higher rates among males and persons aged 20-24 years; rates were highest among non-Hispanic black males. The majority of homicides involved the use of a firearm and occurred in a house or apartment or on a street/highway. Homicides were precipitated primarily by arguments and interpersonal conflicts or in conjunction with another crime. This report provides a detailed summary of data from NVDRS for 2010. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected persons aged <55 years, males, and certain minority populations. For homicides and suicides, relationship problems, interpersonal conflicts, mental health problems, and recent crises were among the primary precipitating factors. Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary. For the occurrence of violent deaths in the United States to be better understood and ultimately prevented, accurate, timely, and comprehensive surveillance data are necessary. NVDRS data can be used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths at the national, state, and local levels. NVDRS data have been used to enhance prevention programs. Examples include use of linked NVDRS data and adult protective service data to better target elder maltreatment prevention programs and improve staff training to identify violent death risks for older adults in North Carolina, use of Oklahoma VDRS homicide data to help evaluate the effectiveness of a new police and advocate intervention at domestic violence incident scenes, and data-informed changes in primary care practice in Oregon to more effectively address older adult suicide prevention. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal impacts of violence. Further efforts are needed to increase the number of states participating in NVDRS, with an ultimate goal of full national representation.

Growing up - or not - with Gun Violence.

PubMed

Schaechter, Judy; Alvarez, Patricia G

2016-10-01

Firearm injury is a leading cause of death and injury for children and adolescents, able to cause disability and interfere with normal development. Child developmental stages, variance of behavior, and mental health may all put children at risk for firearm injury or lead to increased morbidity after experiencing firearm violence. Family, community, and contextual factors can accentuate the risk of violence. Adults and social structures have the responsibility to protect children and adolescents from firearm violence. Copyright © 2016 Elsevier Inc. All rights reserved.

Media accounts of unintentional child injury deaths in New Zealand: a teachable moment?

PubMed

John, Savesh; Kool, Bridget

2017-09-01

To review media accounts of fatal child unintentional injury events reported in leading New Zealand newspapers for their completeness and potential to deliver evidence-based injury prevention messages. Media accounts of fatal unintentional child (0-14 years) injury events in New Zealand's four largest newspapers between 2011 and 2015 were reviewed. Variables of interest included: date, mechanism of injury and victim details. The article prominence, presence of prevention messages and case ascertainment for the two leading causes of death (2011 to 2013 only) were evaluated. Two hundred and forty-two media accounts detailing 122 fatal child injury events (133 deaths) were located for the five-year period. The most common causes of injury were transport-related (56%) and drownings (21%). Only 20% (n=49) of accounts included clear prevention messages. Just over 33% of accounts included images and 66% were located within the first three pages. Case ascertainment in the media accounts was complete for all transport deaths and all but one drowning. The low frequency of prevention messages in the media accounts reviewed highlights a missed opportunity for the dissemination of prevention messages to the New Zealand public. The findings confirm the utility of these accounts as a timely source of fatal child injury information.

Suicide, guns, and public policy.

PubMed

Lewiecki, E Michael; Miller, Sara A

2013-01-01

Suicide is a serious public health concern that is responsible for almost 1 million deaths each year worldwide. It is commonly an impulsive act by a vulnerable individual. The impulsivity of suicide provides opportunities to reduce the risk of suicide by restricting access to lethal means. In the United States, firearms, particularly handguns, are the most common means of suicide. Despite strong empirical evidence that restriction of access to firearms reduces suicides, access to firearms in the United States is generally subject to few restrictions. Implementation and evaluation of measures such as waiting periods and permit requirements that restrict access to handguns should be a top priority for reducing deaths from impulsive suicide in the United States.

Suicide, Guns, and Public Policy

PubMed Central

Miller, Sara A.

2013-01-01

Suicide is a serious public health concern that is responsible for almost 1 million deaths each year worldwide. It is commonly an impulsive act by a vulnerable individual. The impulsivity of suicide provides opportunities to reduce the risk of suicide by restricting access to lethal means. In the United States, firearms, particularly handguns, are the most common means of suicide. Despite strong empirical evidence that restriction of access to firearms reduces suicides, access to firearms in the United States is generally subject to few restrictions. Implementation and evaluation of measures such as waiting periods and permit requirements that restrict access to handguns should be a top priority for reducing deaths from impulsive suicide in the United States. PMID:23153127

Firearm-related deaths in Brescia (Northern Italy) between 1994 and 2006: a retrospective study.

PubMed

Verzeletti, Andrea; Astorri, Paolo; De Ferrari, Francesco

2009-08-01

This retrospective study analyzes post-mortem examination data of 164 firearm-related casualties recorded by the Brescia, Italy Institute of Forensic Medicine between the years 1994 and 2006. The following variables were considered: year, month and day of death, gender and age of the victim, manner of death (homicide, suicide, accidental), type of weapon used, anatomical site and number of wounds, scene of death, and, whenever requested by the local District Attorney's Office, results of the toxicological examinations conducted on the corpses of the deceased. In the County of Brescia, Italy, the 2006 firearm-related mortality rate amounted to 0.84 per 100,000 residents, with an average of 12.6 cases per year. The most common manner of death was suicide (60.4%), followed by homicide (35.9%) and accidental death (3.7%). Most victims were male, with an average age of 47.2 in cases of suicide, 37.9 in cases of homicide, and 47.5 in cases of accidental death. Considering all of the death manners contemplated in this study, the weapon types most frequently resorted to were single-action, short-barrelled guns, followed by multiple-action, long-barrelled ones. In cases of suicide, entry wounds were primarily situated on the head (right temple) and chest (precordium), while in cases of homicide no conclusions could be drawn as to the entry wounds' predominant location.

3 CFR 8940 - Proclamation 8940 of March 15, 2013. National Poison Prevention Week, 2013

Code of Federal Regulations, 2014 CFR

2014-01-01

... have dramatically reduced childhood death rates from accidental poisoning—but work remains. To keep our...-800-222-1222. Today, the majority of unintentional poisoning deaths are caused by overdoses involving...

A culture gap in the United States: Implications for policy on limiting access to firearms for suicidal persons.

PubMed

Marino, Elizabeth; Wolsko, Christopher; Keys, Susan G; Pennavaria, Laura

2016-09-01

Suicide is a critical public health problem worldwide. In the United States (US), firearm ownership is common, and firearms account for the majority of deaths by suicide. While suicide prevention strategies may include limiting access to firearms, the contentious nature of gun regulations in the US, particularly among members of rural communities, often gives rise to constitutional concerns and political polarization that could inhibit suicidal persons from seeking the help they need. We examine potential outcomes of public health strategies in the US that encourage limiting access to firearms for populations who both value firearm ownership and are vulnerable to suicide. Based on preliminary results from a firearm safety study, we argue that attempts to limit access to firearms among those at risk of suicide will only succeed when the most affected cultural groups are engaged in collaborative discussions.

Association between firearm ownership, firearm-related risk and risk reduction behaviours and alcohol-related risk behaviours.

PubMed

Wintemute, Garen J

2011-12-01

Alcohol use and firearm ownership are risk factors for violent injury and death. To determine whether firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours, the author conducted a cross-sectional study using Behavioral Risk Factor Surveillance System data for eight states in the USA from 1996 to 1997 (the most recent data available). Altogether, 15 474 respondents provided information on firearm exposure. After adjustment for demographics and state of residence, firearm owners were more likely than those with no firearms at home to have ≥5 drinks on one occasion (OR 1.32; 95% CI 1.16 to 1.50), to drink and drive (OR 1.79; 95% CI 1.34 to 2.39) and to have ≥60 drinks per month (OR 1.45; 95% CI 1.14 to 1.83). Heavy alcohol use was most common among firearm owners who also engaged in behaviours such as carrying a firearm for protection against other people and keeping a firearm at home that was both loaded and not locked away. The author concludes that firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours.

A review of legislation restricting the intersection of firearms and alcohol in the U.S.

PubMed

Carr, Brendan G; Porat, Gali; Wiebe, Douglas J; Branas, Charles C

2010-01-01

In the United States, injury is a leading cause of alcohol-related death, and alcohol use is the leading risk factor for injury. We reviewed state and federal legislation regulating the intersection of alcohol and firearms. We examined the current criminal codes of all 50 states and the District of Columbia using the databases Westlaw and LexisNexis to review restrictions on firearm use while intoxicated. We found three types of laws in 26 states that restrict firearm use by intoxicated people: sales or transfers are restricted in six states, carrying of concealed weapons is restricted in four states, and possession or discharge of a firearm while intoxicated is restricted in 20 states. Regulation of the carrying and use of firearms by acutely intoxicated individuals may represent a public health opportunity to reduce firearm-related injury.

Child welfare professionals' determination of when children's access or potential access to loaded firearms constitutes child neglect.

PubMed

Evans, Erin M; Jennissen, Charles A; Oral, Resmiye; Denning, Gerene M

2017-11-01

Pediatric deaths and injuries from access to firearms are a significant public health problem. No studies have examined how experts determine child neglect regarding firearm access in the home. Our study objectives were to identify factors that influenced pediatric experts' finding of firearm-related child neglect and to assess their attitudes toward child access prevention (CAP) laws. A survey was distributed to the American Academy of Pediatrics Section on Child Abuse and Neglect members. Demographics, attitudes regarding CAP laws, and ages (up to 14 years old) at which experts deemed several scenarios as child neglect were determined. Scenarios tested potential versus actual loaded firearm access, presence or absence of a CAP law, and injury versus no injury when the firearm was accessed. One hundred ninety-three surveys were completed. Experts agreed (>95%) that CAP laws were important, even for children up to age 15 years. Although a high percentage considered potential access to a loaded firearm as child neglect, a CAP law significantly increased the percentage for each age. In addition, higher percentages of respondents from states with CAP laws than those without deemed potential access as child neglect for 12- and 14-year-olds. In contrast, if the child had accessed a loaded firearm, there were no significant differences in the high percentages that deemed the scenario as child neglect under any conditions, including with and without a CAP law. Although almost all child neglect experts considered potential and actual access to loaded firearms as child neglect, CAP laws increased the percentage for cases of potential access. Universal CAP laws may help ensure that determinations of child neglect are more consistent across states. The deterrent effect of potential child neglect findings may increase the number of parents securing firearms in ways that prevent child access and reduce firearm-related deaths and injuries. Epidemiologic study, level III.

75 FR 21307 - Injury Prevention Program; Announcement Type: Cooperative Agreement

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-23

... effective will be considered. Motor vehicle related injuries and deaths impact AI/AN communities in... leading cause of death and disability for AI/AN communities. Injuries cause more deaths among AI/AN ages 1... AI/AN communities. Unintentional falls reduce independence and quality of life for adults ages 65 and...

Firearms legislation and reductions in firearm-related suicide deaths in New Zealand.

PubMed

Beautrais, A L; Fergusson, D M; Horwood, L J

2006-03-01

To examine the impact of introducing more restrictive firearms legislation (Amendment to the Arms Act, 1992) in New Zealand on suicides involving firearms. National suicide data were examined for 8 years before, and 10 years following the introduction of the legislation. After legislation, the mean annual rate of firearm-related suicides decreased by 46% for the total population (p < 0.0001), 66% for youth (15-24 years; p < 0.0001) and 39% for adults (> or = 25 years; p < 0.01). The fraction of all suicides accounted for by firearm-related suicides also reduced for all three populations (p < 0.0001). However, the introduction of firearms legislation was not associated with reductions in overall rates of suicide for all three populations. Following the introduction of legislation restricting ownership and access to firearms, firearm-related suicides significantly decreased, particularly among youth. Overall rates of youth suicide also decreased over this time but it is not possible to determine the extent to which this was accounted for by changes in firearms legislation or other causes.

Significance of Crime Scene Visit by Forensic Pathologist in Cases of Atypical Firearm Injuries.

PubMed

Thejaswi, H T; Kumar, A; Krishna, K

2015-01-01

Deaths due to firearms are some of the interesting and contentious cases that a forensic pathologist/autopsy surgeon encounters in his practice. Whenever there is 'ambiguity' regarding the nature or sequence of events any unnatural deaths including those caused by firearms the practice of visiting crime scene should be encouraged especially in a country like India where autopsy surgeons often neglect it. Here we present a case report in which there were inconsistencies in the autopsy findings with the alleged history. The witnesses heard about four to six gunshot sounds, whereas only two spent cartridge cases were retrieved from the crime scene. Authors identified the atypical nature of firearm injuries sustained by the victims that were possible by just two bullets. Crime scene visit was undertaken where we discovered the possibility of the echo effect behind the production of four to six sounds. Further by using computer software program, positions of the gunman, victims and the bullet trajectory of the two bullets was created.

Predictors of firearm violence in urban communities: A machine-learning approach.

PubMed

Goin, Dana E; Rudolph, Kara E; Ahern, Jennifer

2018-05-01

Interpersonal firearm violence is a leading cause of death and injuries in the United States. Identifying community characteristics associated with firearm violence is important to improve confounder selection and control in health research, to better understand community-level factors that are associated with firearm violence, and to enhance community surveillance and control of firearm violence. The objective of this research was to use machine learning to identify an optimal set of predictors for urban interpersonal firearm violence rates using a broad set of community characteristics. The final list of 18 predictive covariates explain 77.8% of the variance in firearm violence rates, and are publicly available, facilitating their inclusion in analyses relating violence and health. This list includes the black isolation and segregation indices, rates of educational attainment, marital status, indicators of wealth and poverty, longitude, latitude, and temperature. Copyright © 2018 Elsevier Ltd. All rights reserved.

Quality of consumer-targeted internet guidance on home firearm and ammunition storage.

PubMed

Freundlich, Katherine L; Skoczylas, Maria Shakour; Schmidt, John P; Keshavarzi, Nahid R; Mohr, Bethany Anne

2016-10-01

Four storage practices protect against unintentional and/or self-inflicted firearm injury among children and adolescents: keeping guns locked (1) and unloaded (2) and keeping ammunition locked up (3) and in a separate location from the guns (4). Our aim was to mimic common Google search strategies on firearm/ammunition storage and assess whether the resulting web pages provided recommendations consistent with those supported by the literature. We identified 87 web pages by Google search of the 10 most commonly used search terms in the USA related to firearm/ammunition storage. Two non-blinded independent reviewers analysed web page technical quality according to a 17-item checklist derived from previous studies. A single reviewer analysed readability by US grade level assigned by Flesch-Kincaid Grade Level Index. Two separate, blinded, independent reviewers analysed deidentified web page content for accuracy and completeness describing the four accepted storage practices. Reviewers resolved disagreements by consensus. The web pages described, on average, less than one of four accepted storage practices (mean 0.2 (95% CL 0.1 to 0.4)). Only two web pages (2%) identified all four practices. Two web pages (2%) made assertions inconsistent with recommendations; both implied that loaded firearms could be stored safely. Flesch-Kincaid Grade Level Index averaged 8.0 (95% CL 7.3 to 8.7). The average technical quality score was 7.1 (95% CL 6.8 to 7.4) out of an available score of 17. There was a high degree of agreement between reviewers regarding completeness (weighted κ 0.78 (95% CL 0.61 to 0.97)). The internet currently provides incomplete information about safe firearm storage. Understanding existing deficiencies may inform future strategies for improvement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Children and guns: The detection of recent contact with firearms on children's hands by the PDT reagent.

PubMed

Bar-Or, Karni L; Almog, Joseph

2015-08-01

Throughout the world, young children are worryingly found to be involved in both unintentional and intentional gun violence, rendering the forensic investigation of gun handling by children a highly important matter. The effectiveness of the PDT reaction for mapping iron traces on hands of children has been tested and compared to its application on adults. Counter-intuitively, children were found to produce considerably more intense PDT impressions than adults. A plausible explanation which is based on physiological differences between children and adolescents is suggested. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

School-Based and Community-Based Gun Safety Educational Strategies for Injury Prevention.

PubMed

Holly, Cheryl; Porter, Sallie; Kamienski, Mary; Lim, Aubrianne

2018-05-01

Nearly 1,300 children in the United States die because of firearm-related injury each year and another 5,790 survive gunshot wounds, making the prevention of firearm-related unintentional injury to children of vital importance to families, health professionals, and policy makers. To systematically review the evidence on school-based and community-based gun safety programs for children aged 3 to 18 years. Systematic review. Twelve databases were searched from their earliest records to December 2016. Interventional and analytic studies were sought, including randomized controlled trials, quasi-experimental studies, as well as before-and-after studies or cohort studies with or without a control that involved an intervention. The low level of evidence, heterogeneity of studies, and lack of consistent outcome measures precluded a pooled estimate of results. A best evidence synthesis was performed. Results support the premise that programs using either knowledge-based or active learning strategies or a combination of these may be insufficient for teaching gun safety skills to children. Gun safety programs do not improve the likelihood that children will not handle firearms in an unsupervised situation. Stronger research designs with larger samples are needed to determine the most effective way to transfer the use of the gun safety skills outside the training session and enable stronger conclusions to be drawn.

In-state and interstate associations between gun shows and firearm deaths and injuries: A quasi-experimental study

PubMed Central

Matthay, Ellicott C.; Galin, Jessica; Rudolph, Kara E.; Farkas, Kriszta; Wintemute, Garen; Ahern, Jennifer

2018-01-01

Background Gun shows are an important source of firearms, but no adequately powered studies have examined whether these events are associated with increases in firearm injuries. Objective To determine whether gun shows are associated with short-term increases in locally occurring firearm injuries and whether this association differs by the state in which the gun show occurs. Design Quasi-experimental. Setting California. Study Population Individuals 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 to the two weeks before gun shows occurred, post-show firearm injury rates remained stable in regions near California gun shows but increased from 0.67 (95% CI, 0.55 to 0.80) to 1.14 (95% CI, 0.97 to 1.30) per 100,000 in regions near Nevada shows. After adjustment for seasonality and clustering, California shows were not associated with increases in local firearm injuries (RR, 0.99 [95% CI, 0.97 to 1.02]), but Nevada shows were associated with increases in injuries occurring in California (RR, 1.69 [95% CI, 1.16 to 2.45]). The pre-post difference was significantly higher for Nevada shows compared to California shows (Ratio of RRs, 1.70 [95% CI, 1.17 to 2.47]). The Nevada association was driven by significant increases in interpersonal violence firearm injuries (RR, 2.23 [95% CI, 1.01 to 4.89), but corresponded to a small increase in absolute numbers. Non-firearm injuries served as a negative control and were not associated with California or Nevada gun shows. Results were robust to sensitivity analyses. Limitation We only examined firearm injuries in California, and gun show occurrence was not randomized. Conclusion Gun shows occurring in Nevada, but not California, are 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 firearms regulations. PMID:29059689

Alcohol misuse, firearm violence perpetration, and public policy in the United States.

PubMed

Wintemute, Garen J

2015-10-01

Firearm violence is a significant public health problem in the United States, and alcohol is frequently involved. This article reviews existing research on the relationships between alcohol misuse; ownership, access to, and use of firearms; and the commission of firearm violence, and discusses the policy implications of these findings. Narrative review augmented by new tabulations of publicly-available data. Acute and chronic alcohol misuse is positively associated with firearm ownership, risk behaviors involving firearms, and risk for perpetrating both interpersonal and self-directed firearm violence. In an average month, an estimated 8.9 to 11.7 million firearm owners binge drink. For men, deaths from alcohol-related firearm violence equal those from alcohol-related motor vehicle crashes. Enforceable policies restricting access to firearms for persons who misuse alcohol are uncommon. Policies that restrict access on the basis of other risk factors have been shown to reduce risk for subsequent violence. The evidence suggests that restricting access to firearms for persons with a documented history of alcohol misuse would be an effective violence prevention measure. Restrictions should rely on unambiguous definitions of alcohol misuse to facilitate enforcement and should be rigorously evaluated. Copyright © 2015 Elsevier Inc. All rights reserved.

A case of homicidal intraoral gunshot and review of the literature.

PubMed

Berens, Sandra; Ketterer, Thomas; Kneubuehl, Beat P; Thali, Michael J; Ross, Steffen; Bolliger, Stephan A

2011-06-01

Determination of the manner of death in case of intraoral firearm wounds can be a challenge, especially if the circumstances of the incident are unclear and crime scene investigation is inadequate. It is a well-known fact that the mouth is one of the selected sites for suicide with firearms. Homicidal shooting through the mouth is said to be rare, but does occur, and can be mistaken for a suicide. For discrimination between suicide and homicide in cases of intraoral firearm wounds, some useful points are the site of entry wound, the direction of the internal bullet path, the range of fire and the circumstances of death. We demonstrate these points in a case of a homicidal gunshot to the mouth assessed by both classical autopsy and post-mortem CT (PMCT).

Homemade Firearm Suicide With Dumbbell Pipe Triggering by an Air-Compressed Gun: Case Report and Review of Literature.

PubMed

Le Garff, Erwan; Delannoy, Yann; Mesli, Vadim; Berthezene, Jean Marie; Morbidelli, Philippe; Hédouin, Valéry

2015-12-01

Firearm suicides are frequent and well described in the forensic literature, particularly in Europe and the United States. However, the use of homemade and improvised firearms is less well described. The present case reports a suicide with an original improvised gun created using an air-compressed pellet gun and a dumbbell pipe. The aims of this study were to describe the scene, the external examination of the corpse, the body scan, and the autopsy; to understand the mechanism of death; and to compare the results with a review of the forensic literature to highlight the epidemiology of homemade firearm use, the tools used for homemade and improvised firearms in suicides versus homicides, and the manners in which homemade firearms are used (homicide or suicide, particularly in complex suicide cases).

The relationship between gun ownership and firearm homicide rates in the United States, 1981-2010.

PubMed

Siegel, Michael; Ross, Craig S; King, Charles

2013-11-01

We examined the relationship between levels of household firearm ownership, as measured directly and by a proxy-the percentage of suicides committed with a firearm-and age-adjusted firearm homicide rates at the state level. We conducted a negative binomial regression analysis of panel data from the Centers for Disease Control and Prevention's Web-Based Injury Statistics Query and Reporting Systems database on gun ownership and firearm homicide rates across all 50 states during 1981 to 2010. We determined fixed effects for year, accounted for clustering within states with generalized estimating equations, and controlled for potential state-level confounders. Gun ownership was a significant predictor of firearm homicide rates (incidence rate ratio = 1.009; 95% confidence interval = 1.004, 1.014). This model indicated that for each percentage point increase in gun ownership, the firearm homicide rate increased by 0.9%. We observed a robust correlation between higher levels of gun ownership and higher firearm homicide rates. Although we could not determine causation, we found that states with higher rates of gun ownership had disproportionately large numbers of deaths from firearm-related homicides.

Firearms and suicide in US cities.

PubMed

Miller, Matthew; Warren, Molly; Hemenway, David; Azrael, Deborah

2015-04-01

On an average day in the USA more than 100 Americans die by suicide-half use firearms. Suicide rates overall and by firearms are higher, on average, in states where household firearm ownership is more common. In general this means in states where a greater proportion of the population lives in rural areas. The current ecological study focuses on the relation between measures of household firearm prevalence and suicide mortality in urban areas (metropolitan statistical areas and divisions) using survey-based measures of firearm ownership. Suicide rates (1999-2010) for metropolitan statistical areas that are comprised of large US cities come from death certificate records; rates of household firearm ownership come from the 2002 and 2004 Behavioural Risk Factor Surveillance System. Higher rates of firearm ownership are strongly associated with higher rates of overall suicide and firearm suicide, but not with non-firearm suicide. Stratification by gender, age and race did not materially affect the association between firearms and suicide. This study provides evidence consistent with previous case-control work and extends evidence from previous state- and region-level ecological studies that firearms in the home impose suicide risk above and beyond baseline. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Adolescents' Views of Guns in a High-Violence Community

ERIC Educational Resources Information Center

Black, Sally; Hausman, Alice

2008-01-01

Firearms account for the majority of deaths among young Black men in America. This article presents a qualitative investigation of youth temptations, emotional reactions, and subsequent behavior with respect to guns. Twenty-three youth enrolled in a community-based firearm reduction program have participated in interviews on retrospective…

27 CFR 19.133 - Partnerships.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Partnerships. 19.133 Section 19.133 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Amending An Operating Permit § 19.133 Partnerships. (a) If there is a death or insolvency of a partner in a...

Root causes, clinical effects, and outcomes of unintentional exposures to buprenorphine by young children.

PubMed

Lavonas, Eric J; Banner, William; Bradt, Pamela; Bucher-Bartelson, Becki; Brown, Kimberly R; Rajan, Pradeep; Murrelle, Lenn; Dart, Richard C; Green, Jody L

2013-11-01

To characterize the rates, root causes, and clinical effects of unintentional exposures to buprenorphine sublingual formulations among young children and to determine whether exposure characteristics differ between formulations. Unintentional exposures to buprenorphine-containing products among children 28 days to less than 6 years old were collected from the Researched Abuse, Diversion, and Addiction-Related Surveillance System Poison Center Program and Reckitt Benckiser Pharmaceuticals' pharmacovigilance system from October 2009-March 2012. After adjustment for drug availability, negative binomial regression was used to estimate average exposure rates. Root cause assessment was conducted, and an expert clinician panel adjudicated causality and severity of moderate to severe adverse events (AEs). A total of 2380 cases were reviewed, including 4 deaths. Exposures to buprenorphine-naloxone combination film were significantly less frequent than exposures to buprenorphine tablets (rate ratio 3.5 [95% CI, 2.7-4.5]) and buprenorphine-naloxone combination tablets (rate ratio 8.8 [7.2-10.6]). The most commonly identified root causes were medication stored in sight, accessed from a bag or purse, and not stored in the original packaging. Among 536 panel review cases, the most common AEs reported for all formulations were lethargy, respiratory depression, miosis, and vomiting. The highest level AE severity did not differ significantly by formulation. Unintentional exposure to buprenorphine can cause central nervous system depression, respiratory depression, and death in young children. Exposure rates to film formulations are significantly less than to tablet formulations. Package and storage deficiencies contribute to unintentional exposures in young children. Copyright © 2013 Mosby, Inc. All rights reserved.

Geographic distribution of risk of death due to homicide in Puerto Rico, 2001-2010.

PubMed

Zavala-Zegarra, Diego E; López-Charneco, Magdalena; Garcia-Rivera, Enid J; Concha-Eastman, Alberto; Rodriguez, José F; Conte-Miller, María

2012-11-01

To raise awareness of the impact of homicides in Puerto Rico based on the findings of the spatial and temporal distribution of homicides and the use of firearms, by age and gender, using reports of interpersonal violent deaths from the Institute of Forensic Science (IFS) headquartered in San Juan, Puerto Rico. This was a descriptive study of all homicide incidents in Puerto Rico reported by the IFS for the period 2001-2010. For each of the 8 542 cases, data analyzed included age, sex, municipality of incident, date of death, and mechanism. Crude sex- and age-specific mortality rates for Puerto Rico and for each municipality per year and for the 10-year period were calculated. Cumulative rate and cumulative risks were estimated and defined as lifetime risk. The relative distribution of cumulative rates for each municipality was categorized into quartiles of highest to lowest risk and displayed as a map. The risk of homicide death among males is 13 times greater than among females. The highest rates were observed among males 20-24 years of age (198.4 homicides per 100 000). In any given year, firearms were used in at least 80% of homicides. The average lifetime risk of homicide death for males is 1 in 34. Young adult males with access to firearms are at greatest risk of homicide in Puerto Rico. Also, highly urbanized municipalities are at highest risk; however, certain non-urban municipalities along the coast also have a very high homicide risk. Top priorities should be applying the WHO "ecological model" for violent injury prevention and establishing a surveillance system that will assist in identifying the role that socioeconomics, illegal firearms trade, and drug trafficking are playing.

Autopsy findings of suicidal deaths committed by firearms in Ankara, Turkey.

PubMed

Canturk, Gurol; Canturk, Nergis; Odabasi, Aysun Balseven; Erkol, Zerrin; Bosgelmez, Memnune

2009-07-01

The purpose of this study was to examine autopsy findings from suicidal deaths using firearms in Ankara, Turkey, and to compare the results with those reported from other studies. We retrospectively evaluated suicidal deaths by firearms referred for autopsy to the Morgue Department, Institute of Forensic Medicine, between 2002 and 2004. Results were subjected to discriminant analyses using SPSS 11.5 package program. One hundred and fifteen cases (83.3%) were male, the ratio of male to female was 5 to 1 and the mean age was 31.96 years (range:12-85 years). Forty cases were aged between 12 years and 20 years, 28 were aged between 0 and 18 (20.29%). One hundred and thirty-three cases (96.4%) had one bullet entry and five cases (3.6%) had two bullet entries. Out of 143 bullet entries, 116 (81.12%) were caused by gunshots fired from contact or near contact range. Regarding bullet entry sites, 103 (72.03%) were on the head with 56 (54.37%) located on the right temporal region. Gunshot related crimes are an increasing cause for concern in Turkey. However, a simple preventive measure may prevent the suicidal deaths of many young people.

In-State and Interstate Associations Between Gun Shows and Firearm Deaths and Injuries: A Quasi-experimental Study.

PubMed

Matthay, Ellicott C; Galin, Jessica; Rudolph, Kara E; Farkas, Kriszta; Wintemute, Garen J; Ahern, Jennifer

2017-12-19

Gun shows are an important source of firearms, but no adequately powered studies have examined whether they are associated with increases in firearm injuries. 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. Quasi-experimental. California. Persons in California within driving distance of gun shows. 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. 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. Firearm injuries were examined only in California, and gun show occurrence was not randomized. 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. National Institutes of Health; University of California, Berkeley; and Heising-Simons Foundation.

Health maintenance in school-aged children: Part II. Counseling recommendations.

PubMed

Riley, Margaret; Locke, Amy B; Skye, Eric P

2011-03-15

School-aged children (kindergarten through early adolescence) are establishing patterns of behavior that may last a lifetime; therefore, it is important to counsel these patients about healthy lifestyle practices during well-child examinations. Children and families should be advised to eat a diet high in fruits, vegetables, whole grains, low-fat or nonfat dairy products, beans, fish, and lean meats, while limiting sugar, fast food, and highly processed foods. Children should engage in at least 60 minutes per day of moderate to vigorous physical activity, and screen time (e.g., television, computer, video games) should be limited to no more than one to two hours of quality programming daily. Most school-aged children require 11 hours of sleep per night. Decreased sleep is associated with behavioral issues, decreased concentration at school, and obesity. Children should brush their teeth twice per day with a toothpaste containing fluoride. Unintentional injury is the leading cause of death in this age group in the United States, and families should be counseled on traffic, water, sports, and firearm safety. Because high-risk behaviors may start in early adolescence, many experts recommend screening for tobacco, alcohol, and drug use beginning at 11 years of age. Sexually active adolescents should be counseled on protecting against sexually transmitted infections, and should be screened for these infections if indicated.

Overdose pattern and outcome in paracetamol-induced acute severe hepatotoxicity

PubMed Central

Craig, Darren G N; Bates, Caroline M; Davidson, Janice S; Martin, Kirsty G; Hayes, Peter C; Simpson, Kenneth J

2011-01-01

AIMS Paracetamol (acetaminophen) hepatotoxicity is the commonest cause of acute liver failure (ALF) in the UK. Conflicting data regarding the outcomes of paracetamol-induced ALF resulting from different overdose patterns are reported. METHODS Using prospectively defined criteria, we have analysed the impact of overdose pattern upon outcome in a cohort of 938 acute severe liver injury patients admitted to the Scottish Liver Transplantation Unit. RESULTS Between 1992 and 2008, 663 patients were admitted with paracetamol-induced acute severe liver injury. Of these patients, 500 (75.4%) had taken an intentional paracetamol overdose, whilst 110 (16.6%) had taken an unintentional overdose. No clear overdose pattern could be determined in 53 (8.0%). Unintentional overdose patients were significantly older, more likely to abuse alcohol, and more commonly overdosed on compound narcotic/paracetamol analgesics compared with intentional overdose patients. Unintentional overdoses had significantly lower admission paracetamol and alanine aminotransferase concentrations compared with intentional overdoses. However, unintentional overdoses had greater organ dysfunction at admission, and subsequently higher mortality (unintentional 42/110 (38.2%), intentional 128/500 (25.6%), P < 0.001). The King's College poor prognostic criteria had reduced sensitivity in unintentional overdoses (77.8%, 95% confidence intervals (CI) 62.9, 88.8) compared with intentional overdoses (89.9%, 95% CI 83.4, 94.5). Unintentional overdose was independently predictive of death or liver transplantation on multivariate analysis (odds ratio 1.91 (95% CI 1.07, 3.43), P= 0.032). CONCLUSIONS Unintentional paracetamol overdose is associated with increased mortality compared with intentional paracetamol overdose, despite lower admission paracetamol concentrations. Alternative prognostic criteria may be required for unintentional paracetamol overdoses. PMID:21219409

Worldwide Prevalence and Trends in Unintentional Drug Overdose: A Systematic Review of the Literature.

PubMed

Martins, Silvia S; Sampson, Laura; Cerdá, Magdalena; Galea, Sandro

2015-11-01

Drug overdose is an important, yet an inadequately understood, public health problem. Global attention to unintentional drug overdose has been limited by comparison with the scope of the problem. There has been a substantial increase in drug overdose incidence and prevalence in several countries worldwide over the past decade, contributing to both increased costs and mortality. The aim of this study was to systematically synthesize the peer-reviewed literature to document the global epidemiological profile of unintentional drug overdoses and the prevalence, time trends, mortality rates, and correlates of drug overdoses. We searched different combinations of Medical Subject Headings (MeSH) terms in PubMed for articles published from 1980 until July 2013, and we organized these results in tabular spreadsheets and compared them. We restricted the search to English-language articles that deal with unintentional overdose, focusing on 1 or more of the following key constructs: prevalence, time trends, mortality rates, and correlates. The term "overdose" as a MeSH major topic yielded 1076 publications. In addition, we searched the following combinations of nonmajor MeSH terms: "street drugs" and "overdose" yielded 180, "death" and "overdose" yielded 114, and "poisoning" and "drug users" yielded 17. There was some overlap among the searches. Based on the search and inclusion and exclusion criteria, we selected a total of 169 relevant articles for this article based on a close review of abstracts. We found wide variability in lifetime prevalence of experiencing a nonfatal overdose or witnessing an overdose, and in mortality rates attributable to overdose. Lifetime prevalence of witnessed overdose among drug users (n = 17 samples) ranged from 50% to 96%, with a mean of 73.3%, a median of 70%, and a standard deviation of 14.1%. Lifetime prevalence of drug users personally experiencing a nonfatal overdose (n = 27 samples), ranged from 16.6% to 68.0% with a mean of 45.4%, a median of 47%, and a standard deviation of 14.4%. Population-based crude overdose mortality rates (n = 28 samples) ranged from 0.04 to 46.6 per 100 000 person-years. This range is likely attributable to the diversity in regions, time periods, and samples. Most studies on longitudinal trends of overdose death rates or overdose-related hospitalization rates showed increases in overdose death rates and in overdose-related hospitalization rates across time, which have led to peaks in these rates at the present time. An overall trend of increasing deaths from prescription opioid use and decreasing deaths from illicit drug use in the past several years has been noted across most of the literature. With the increase in prescription opioid overdose deaths, drug overdose is not just an urban problem: rural areas have seen an important increase in overdose deaths. Lastly, cocaine, prescription opioids, and heroin are the drugs most commonly associated with unintentional drug overdoses worldwide and the demographic and psychiatric correlates associated with unintentional drug overdoses are similar globally. There is a need to invest in research to understand the distinct determinants of prescription drug overdose worldwide. Several other countries need to collect in a systematic and continuous fashion such data on sales of prescription opioids and other prescription drugs, nonmedical use of prescription drugs, and hospitalization secondary to overdoses on prescription drugs. The sparse evidence on the environmental determinants of overdose suggests a need for research that will inform the types of environmental interventions we can use to prevent drug overdose. Methodological issues for future studies include enhancing data collection methods on unintentional fatal and nonfatal overdoses, and collecting more detailed information on drug use history, source of drug use (for prescription drugs), and demographic and psychiatric history characteristics of the individual who overdosed.

Reductions in firearm-related mortality and hospitalizations in Brazil after gun control.

PubMed

Marinho de Souza, Maria de Fátima; Macinko, James; Alencar, Airlane Pereira; Malta, Deborah Carvalho; de Morais Neto, Otaliba Libânio

2007-01-01

This paper provides evidence suggesting that gun control measures have been effective in reducing the toll of violence on population health in Brazil. In 2004, for the first time in more than a decade, firearm-related mortality declined 8 percent from the previous year. Firearm-related hospitalizations also reversed a historical trend that year by decreasing 4.6 percent from 2003 levels. These changes corresponded with anti-gun legislation passed in late 2003 and disarmament campaigns undertaken throughout the country since mid-2004. The estimated impact of these measures, if they prove causal, could be as much as 5,563 firearm-related deaths averted in 2004 alone.

Misclassification of suicide deaths: examining the psychiatric history of overdose decedents.

PubMed

Bohnert, Amy S B; McCarthy, John F; Ignacio, Rosalinda V; Ilgen, Mark A; Eisenberg, Anna; Blow, Frederic C

2013-10-01

The intent of a death from overdose can be difficult to determine. The goal of this study was to examine the association of psychiatric diagnoses among overdose deaths ruled by a medical examiner as intentional, unintentional and indeterminate intent. All Veterans Health Administration patients in Fiscal Year 1999 (n=3 291 891) were followed through Fiscal Year 2006. We tested the relative strength of association between psychiatric disorders among types of overdoses (categorised by intent) using multinomial models, adjusted for age, sex, Veterans Affairs priority status and Charlson comorbidity scores. Data were from National Death Index records and patient medical records. Substance use disorders (SUD) had a stronger association with indeterminate intent overdoses than intentional overdoses (adjusted OR (AOR)=1.80, 95% CI 1.47 to 2.22). SUDs also had a stronger association with unintentional overdoses than intentional (AOR=1.48, 95% CI 1.27 to 1.72), but the reverse was true for all other psychiatric disorders (except post-traumatic stress disorder). Overdoses ruled indeterminate may be misclassified suicide deaths and are important to suicide surveillance and prevention efforts. Additionally, overdose deaths not classified as suicides may include some cases due to suicidal-like thinking without overt suicidal intent.

Alcohol Use and Firearm Violence

PubMed Central

Branas, Charles C.; Han, SeungHoon; Wiebe, Douglas J.

2016-01-01

Although the misuse of firearms is necessary to the occurrence of firearm violence, there are other contributing factors beyond simply firearms themselves that might also be modified to prevent firearm violence. Alcohol is one such key modifiable factor. To explore this, we undertook a 40-year (1975–2014) systematic literature review with meta-analysis. One large group of studies showed that over one third of firearm violence decedents had acutely consumed alcohol and over one fourth had heavily consumed alcohol prior to their deaths. Another large group of studies showed that alcohol was significantly associated with firearm use as a suicide means. Two controlled studies showed that gun injury after drinking, especially heavy drinking, was statistically significant among self-inflicted firearm injury victims. A small group of studies investigated the intersection of alcohol and firearms laws and alcohol outlets and firearm violence. One of these controlled studies found that off-premise outlets selling takeout alcohol were significantly associated with firearm assault. Additional controlled, population-level risk factor and intervention studies, including randomized trials of which only 1 was identified, are needed. Policies that rezone off-premise alcohol outlets, proscribe blood alcohol levels and enhance penalties for carrying or using firearms while intoxicated, and consider prior drunk driving convictions as a more precise criterion for disqualifying persons from the purchase or possession of firearms deserve further study. PMID:26811427

Repeal of Comprehensive Background Check Policies and Firearm Homicide and Suicide.

PubMed

Kagawa, Rose M C; Castillo-Carniglia, Alvaro; Vernick, Jon S; Webster, Daniel; Crifasi, Cassandra; Rudolph, Kara E; Cerdá, Magdalena; Shev, Aaron; Wintemute, Garen J

2018-04-02

In 2016, firearms killed 38,658 people in the United States. Federal law requires licensed gun dealers, but not private parties, to conduct background checks on prospective firearm purchasers with the goal of preventing prohibited persons from obtaining firearms. Our objective was to estimate the effect of the repeal of comprehensive background check laws - requiring a background check for all handgun sales, not just sales by licensed dealers - on firearm homicide and suicide rates in Indiana and Tennessee. We compared age-adjusted firearm homicide and suicide rates, measured annually from 1981-2008 and 1994-2008 in Indiana and Tennessee, respectively, to rates in control groups constructed using the synthetic control method. The average rates of firearm homicide and suicide in Indiana and Tennessee following repeal were within the range of what could be expected given natural variation (differences = 0.7 firearm homicides and 0.5 firearm suicides per 100,000 residents in Indiana and 0.4 firearm homicides and 0.3 firearm suicides per 100,000 residents in Tennessee). Sensitivity analyses resulted in similar findings. We found no evidence of an association between the repeal of comprehensive background check policies and firearm homicide and suicide rates in Indiana and Tennessee. In order to understand whether comprehensive background check policies reduce firearm deaths in the United States generally, more evidence on the impact of such policies from other states is needed.

Goods for Guns--the use of a gun buyback as an injury prevention/community education tool.

PubMed

McGuire, Margaret; Manno, Mariann; Rook, Allison; Maranda, Louise; Renaud, Elizabeth; DeRoss, Anthony; Hirsh, Michael

2011-11-01

US children aged between 5 years and 14 years have a rate of gun-related homicide 17 times higher and a rate of gun-related suicide and unintentional firearm injury 10 times higher than other developed countries. Gun buyback programs have been criticized as ineffective interventions in decreasing violence. The Injury Free Coalition for Kids-Worcester (IFCK-W) Goods for Guns buyback is a multipronged approach to address these concerns and to reduce the number of firearms in the community. The IFCK-W buyback program is funded by corporate sponsors, grants, and individual donations. Citizens are instructed to transport guns, ammunition, and weapons safely to police headquarters on two Saturdays in December. Participants are guaranteed anonymity by the District Attorney's office and receive gift certificates for operable guns. Trained volunteers administer an anonymous survey to willing participants. Individuals who disclose having unsafely stored guns remaining at home receive educational counseling and trigger locks. Guns and ammunition are destroyed at a later time in a gun crushing ceremony. Since 2002, 1,861 guns (444 rifle/shotgun, 738 pistol/revolver, and 679 automatic/semiautomatic) have been collected at a cost of $99,250 (average, $53/gun). Seven hundred ten people have surrendered firearms, 534 surveys have been administered, and ≈ 75 trigger locks have been distributed per year. IFCK-W Goods for Guns is a relatively inexpensive injury prevention model program that removes unwanted firearms from homes, raises community awareness about gun safety, and provides high-risk individuals with trigger locks and educational counseling.

Variability of undetermined manner of death classification in the US.

PubMed

Breiding, M J; Wiersema, B

2006-12-01

To better understand variations in classification of deaths of undetermined intent among states in the National Violent Death Reporting System (NVDRS). Data from the NVDRS and the National Vital Statistics System were used to compare differences among states. Percentages of deaths assigned undetermined intent, rates of deaths of undetermined intent, rates of fatal poisonings broken down by cause of death, composition of poison types within the undetermined-intent classification. Three states within NVDRS (Maryland, Massachusetts, and Rhode Island) evidenced increased numbers of deaths of undetermined intent. These same states exhibited high rates of undetermined death and, more specifically, high rates of undetermined poisoning deaths. Further, these three states evidenced correspondingly lower rates of unintentional poisonings. The types of undetermined poisonings present in these states, but not present in other states, are typically the result of a combination of recreational drugs, alcohol, or prescription drugs. The differing classification among states of many poisoning deaths has implications for the analysis of undetermined deaths within the NVDRS and for the examination of possible/probable suicides contained within the undetermined- or accidental-intent classifications. The NVDRS does not collect information on unintentional poisonings, so in most states data are not collected on these possible/probable suicides. The authors believe this is an opportunity missed to understand the full range of self-harm deaths in the greater detail provided by the NVDRS system. They advocate a broader interpretation of suicide to include the full continuum of deaths resulting from self-harm.

Deaths: leading causes for 2005.

PubMed

Heron, Melonie; Tejada-Vera, Betzaida

2009-12-23

This report presents final 2005 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2005. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2005, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Alzheimer's disease; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Septicemia. They accounted for about 77 percent of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2005 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birthweight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Newborn affected by complications of placenta, cord and membranes; Accidents (unintentional injuries); Respiratory distress of newborn; Bacterial sepsis of newborn; Neonatal hemorrhage; and Necrotizing enterocolitis of newborn. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.

Gun availability and use of guns for suicide, homicide, and murder in Canada.

PubMed

Bridges, F Stephen; Kunselman, Julie C

2004-04-01

A reliability check of Lester's (2000b) 1970-1995 time series that examined associations between the availability of firearms and their use for homicide and suicide in Canada. For the period 1974 to 1999, the relative availability of firearms as measured by the rate of accidental death from firearms and the average of the percentages of suicides + homicides using firearms was positively associated with the rate of homicide by firearms but not negatively associated with the rate of homicide by all other methods, and positively associated with the rate of suicide by firearms and negatively associated with the rate of suicide by all other methods. Correlations for the homicide versus murder rates, homicide rate using guns versus murder rate using guns, and homicide rate by all other methods versus murder rate by all other methods were very similar. There was a decrease over time of total suicide and homicide rates and firearm suicide and homicide rates, and with a slight indication of substitution of other methods for suicide.

Vulnerability to unintentional injuries associated with land-use activities and search and rescue in Nunavut, Canada.

PubMed

Clark, Dylan G; Ford, James D; Pearce, Tristan; Berrang-Ford, Lea

2016-11-01

Injury is the leading cause of death for Canadians aged 1 to 44, occurring disproportionately across regions and communities. In the Inuit territory of Nunavut, for instance, unintentional injury rates are over three times the Canadian average. In this paper, we develop a framework for assessing vulnerability to injury and use it to identify and characterize the determinants of injuries on the land in Nunavut. We specifically examine unintentional injuries on the land (outside of hamlets) because of the importance of land-based activities to Inuit culture, health, and well-being. Semi-structured interviews (n = 45) were conducted in three communities that have varying rates of search and rescue (SAR), complemented by an analysis of SAR case data for the territory. We found that risk of land-based injuries is affected by socioeconomic status, Inuit traditional knowledge, community organizations, and territorial and national policies. Notably, by moving beyond common conceptualizations of unintentional injury, we are able to better assess root causes of unintentional injury and outline paths for prevention. Copyright © 2016 Elsevier Ltd. All rights reserved.

Knowledge, Attitudes, and Practices of Family Physicians and Nurses Regarding Unintentional Injuries among Children under 15 Years in Cairo, Egypt

PubMed Central

Elboray, Shereen; Elawdy, Mohamed Yehia; Dewedar, Sahar; Elezz, Nahla Abo; El-Setouhy, Maged; Smith, Gordon S.; Hirshon, Jon Mark

2015-01-01

Unintentional injuries are a leading cause of death among children, especially in developing countries. Lack of reliable data regarding primary health care professionals’ role in childhood unintentional injury prevention hinders development of effective prevention strategies. A survey of 99 family physicians and nurses from 10 family health centres sought to develop insight into their knowledge, attitudes and practices regarding unintentional injury prevention for children <15 in Cairo, Egypt. Approximately 60% were familiar with the terms unintentional injuries and injury prevention. Falls and road traffic crashes were identified as primary causes of childhood injuries by 54.5%. While > 90% agreed injury prevention counselling (IPC) could be effective, only 50.5% provided IPC. Lack of time and educational materials were the leading barriers to provision of IPC (91.9%, 85.9%, respectively), while thinking counseling is not part of their clinical duties was the least perceived barrier (9.1%). There is a large disconnect between providers’ knowledge, attitudes and practices regarding IPC, more training and provision of counseling tools are essential for improving IPC by Egyptian medical providers. PMID:26176681

Protect Children Instead of Guns, 2001.

ERIC Educational Resources Information Center

Children's Defense Fund, Washington, DC.

Noting that firearms outnumber children by a margin of almost three to one in the United States, this report advocates gun safety policies to protect children. The report provides information on trends in youth firearm deaths and finds the statistics alarming, despite recent decline. The first of three tables in the report delineates 1979-1999…

Firearm Possession Among Adolescents Presenting to an Urban Emergency Department for Assault

PubMed Central

Walton, Maureen A.; Newton, Manya F.; Clery, Michael; Whiteside, Lauren K.; Zimmerman, Marc A.; Cunningham, Rebecca M.

2013-01-01

BACKGROUND AND OBJECTIVES: Firearm violence is a leading cause of death among youth. The objectives of this study were (1) determine firearm possession rates and associated correlates among youth seeking care for assault in an emergency department (ED); (2) understand differences in risk factors for youth with firearm possession; and (3) identify firearm possession characteristics in this population: type, reason for possession, and source of firearms. METHODS: Youth (14 to 24 years old) presenting to a Level 1 ED with assault were administered a computerized screening survey. Validated instruments were administered, measuring demographics, firearm rates and characteristics, attitudes toward aggression, substance use, and previous violence history. RESULTS: Among 689 assault-injured youth, 23% reported firearm possession in the past 6 months. Only 17% of those reporting firearm possession obtained the gun from a legal source; 22% reported ownership of highly lethal automatic/semiautomatic weapons and 37.1% reported having a firearm for protection. Logistic regression analysis identified significant correlates of firearm possession, including male gender, higher socioeconomic status, illicit drug use, recent serious fight, and retaliatory attitudes. CONCLUSIONS: ED assault-injured youth had high rates of firearm possession (23.1%), most of which were not obtained from legal sources. Youth with firearm possession were more likely to have been in a recent serious fight, and to endorse aggressive attitudes that increase their risk for retaliatory violence. Future prevention efforts should focus on minimizing illegal firearm access among high-risk youth, nonviolent alternatives to retaliatory violence, and substance use prevention. PMID:23837181

Firearm possession among adolescents presenting to an urban emergency department for assault.

PubMed

Carter, Patrick M; Walton, Maureen A; Newton, Manya F; Clery, Michael; Whiteside, Lauren K; Zimmerman, Marc A; Cunningham, Rebecca M

2013-08-01

Firearm violence is a leading cause of death among youth. The objectives of this study were (1) determine firearm possession rates and associated correlates among youth seeking care for assault in an emergency department (ED); (2) understand differences in risk factors for youth with firearm possession; and (3) identify firearm possession characteristics in this population: type, reason for possession, and source of firearms. Youth (14 to 24 years old) presenting to a Level 1 ED with assault were administered a computerized screening survey. Validated instruments were administered, measuring demographics, firearm rates and characteristics, attitudes toward aggression, substance use, and previous violence history. Among 689 assault-injured youth, 23% reported firearm possession in the past 6 months. Only 17% of those reporting firearm possession obtained the gun from a legal source; 22% reported ownership of highly lethal automatic/semiautomatic weapons and 37.1% reported having a firearm for protection. Logistic regression analysis identified significant correlates of firearm possession, including male gender, higher socioeconomic status, illicit drug use, recent serious fight, and retaliatory attitudes. ED assault-injured youth had high rates of firearm possession (23.1%), most of which were not obtained from legal sources. Youth with firearm possession were more likely to have been in a recent serious fight, and to endorse aggressive attitudes that increase their risk for retaliatory violence. Future prevention efforts should focus on minimizing illegal firearm access among high-risk youth, nonviolent alternatives to retaliatory violence, and substance use prevention.

Non-firearm-related homicide, New Mexico, 2001-3.

PubMed

Kazerouni, N Neely; Shah, N; Lathrop, S; Landen, M G

2009-10-01

New Mexico (NM) has the highest rate of non-firearm-related homicide in the USA and ranks 20th in firearm-related homicides. Because non-firearm-related homicides are inadequately described in the literature, characterisation of non-firearm-related homicide victims will enhance efforts to reduce homicides. Homicide victims were identified through the Office of the Medical Investigator. Age-specific and age-adjusted homicide death rates were calculated for 2001-3 by sex and race/ethnicity, and associations between covariates and non-firearm-related homicide were measured. Non-firearm-related homicides comprised 33% of US homicide victims, 47% of NM homicide victims, and 74% of NM American Indian (AI) homicide victims. Of 212 NM non-firearm-related homicide victims, 37% had been beaten, 32% had been stabbed, and 12% had been strangled. Females comprised 30% of non-firearm-related homicide victims and 18% of firearm-related homicide victims. A blood alcohol concentration (BAC) >or=0.08 mg/dl was detected among 43% of non-firearm-related (61% of AI) and 33% of firearm-related (50% of AI) homicide victims. Non-firearm-related homicide rates were highest among AI men aged 25-34 years (31/100,000). Non-firearm-related homicide victims were more likely than firearm-related victims to be AI (adjusted odds ratio (AOR) 4.20; 95% CI 2.16 to 8.16) and female (AOR 2.05; 95% CI 1.27 to 3.31), and to have had a BAC >or=0.08 mg/dl (AOR 1.65; 95% CI 1.08 to 2.52). Homicide-prevention efforts among AIs in NM should focus on non-firearm-related homicides. The association between excessive drinking and non-firearm-related homicide should be further characterised. Continued surveillance for non-firearm-related homicides will assist these efforts.

Association of Drug and Alcohol Use With Adolescent Firearm Homicide at Individual, Family, and Neighborhood Levels.

PubMed

Hohl, Bernadette C; Wiley, Shari; Wiebe, Douglas J; Culyba, Alison J; Drake, Rebecca; Branas, Charles C

2017-03-01

Homicide is the third leading cause of death for adolescents in the United States and the leading cause of death for adolescents who are African American. Large cities have disproportionate homicide rates. To determine the relationships between exposures to drugs and alcohol at the individual, family, and neighborhood levels and adolescent firearm homicide and to inform new approaches to preventing firearm violence. Population-based case-control study from January 2010 to December 2012 of all 13- to 20-year-olds who were homicide victims in Philadelphia during the study period matched to randomly selected 13- to 20-year-old controls from the general population. Individual drug and alcohol use at the time of injury, history of drug and alcohol use, caregiver drug and alcohol use, and neighborhood availability of alcohol and illegal drugs. We also controlled for age, race, school suspensions, arrests, and neighborhood ethnicity. Adolescent firearm homicide identified from police and medical examiner's reports. We enrolled 161 adolescent homicide cases, including 157 (97.5%) firearm homicide cases and 172 matched controls, including 166 (96.5%) firearm homicide controls. Adolescents with a history of alcohol use (adjusted odds ratio [AOR], 4.1; 95% CI, 1.2-14.0) or drug use (AOR, 4.4; 95% CI, 1.7-11.6) had increased odds of firearm homicide. Adolescents whose caregiver had a history of drug use had increased odds of firearm homicide (AOR, 11.7; 95% CI, 2.8-48.0). Adolescents in neighborhoods with high densities of alcohol outlets (AOR, 3.2; 95% CI, 1.1-9.1) and moderate or high drug availability had increased odds of firearm homicide (AOR, 3.4; 95% CI, 1.1-10.3 vs AOR, 7.5; 95% CI, 2.2-25.8). Almost all adolescent homicides in Philadelphia between 2010 and 2012 were committed with a firearm. Substance use at the individual, family, and neighborhood levels was associated with increased odds of adolescent firearm homicide; drug use was associated at all 3 levels and alcohol at the individual and neighborhood levels. Expanding violence prevention efforts to target drug and alcohol use at multiple levels may help to reduce the firearm violence that disproportionately affects adolescents in minority populations in large US cities.

Injuries due to firearms and air guns among U.S. military members not participating in overseas combat operations, 2002-2011.

PubMed

2012-09-01

During 2002-2011, active component U.S. service members sustained 4,657 firearm-related injuries in circumstances other than deployment to the wars in Iraq/Afghanistan; 35 percent of the injuries were fatal. The highest firearm-related injury rates reflected service members in law enforcement/security and combat occupations. Of fatal injuries, 28 percent and 24 percent were suicides and homicides, respectively; among service members 30 and older, 84 percent of noncombat firearm-related deaths were suicides and 14 percent were homicides. In circumstances other than war, rates of both fatal and nonfatal firearm- related injuries are much lower among military members than civilian males aged 18-44. During the period, rates of nonfatal firearm-related injuries among non-deployed military members increased sharply, peaking in 2008. The trend reflects that among U.S. civilian males aged 18-44. However, firearm-related fatality rates were stable among civilians but increased among military members. The increase in rates of firearm-related fatalities among non-deployed military members reflects the increase in rates of suicides by firearms. Rates of injuries due to BB, pellet or paintball guns also increased during the period.

Firearm Prevalence and Homicides of Law Enforcement Officers in the United States

PubMed Central

Simmons, Molly M.; Dominici, Francesca; Hemenway, David

2015-01-01

Objectives. In the United States, state firearm ownership has been correlated with homicide rates. More than 90% of homicides of law enforcement officers (LEOs) are committed with firearms. We examined the relationship between state firearm ownership rates and LEO occupational homicide rates. Methods. We obtained the number LEOs killed from 1996 to 2010 from a Federal Bureau of Investigation (FBI) database. We calculated homicide rates per state as the number of officers killed per number of LEOs per state, obtained from another FBI database. We obtained the mean household firearm ownership for each state from the Behavioral Risk Factor Surveillance System. Results. Using Poisson regression and controlling for factors known to affect homicide rates, we associated firearm ownership with the homicide rates for LEOs (incidence rate ratio = 1.044; P = .005); our results were supported by cross-sectional and longitudinal sensitivity analyses. LEO homicide rates were 3 times higher in states with high firearm ownership compared with states with low firearm ownership. Conclusions. High public gun ownership is a risk for occupational mortality for LEOs in the United States. States could consider methods for reducing firearm ownership as a way to reduce occupational deaths of LEOs. PMID:26270316

Firearm Prevalence and Homicides of Law Enforcement Officers in the United States.

PubMed

Swedler, David I; Simmons, Molly M; Dominici, Francesca; Hemenway, David

2015-10-01

In the United States, state firearm ownership has been correlated with homicide rates. More than 90% of homicides of law enforcement officers (LEOs) are committed with firearms. We examined the relationship between state firearm ownership rates and LEO occupational homicide rates. We obtained the number LEOs killed from 1996 to 2010 from a Federal Bureau of Investigation (FBI) database. We calculated homicide rates per state as the number of officers killed per number of LEOs per state, obtained from another FBI database. We obtained the mean household firearm ownership for each state from the Behavioral Risk Factor Surveillance System. Using Poisson regression and controlling for factors known to affect homicide rates, we associated firearm ownership with the homicide rates for LEOs (incidence rate ratio = 1.044; P = .005); our results were supported by cross-sectional and longitudinal sensitivity analyses. LEO homicide rates were 3 times higher in states with high firearm ownership compared with states with low firearm ownership. High public gun ownership is a risk for occupational mortality for LEOs in the United States. States could consider methods for reducing firearm ownership as a way to reduce occupational deaths of LEOs.

Trends in Unintentional Fall-Related Traumatic Brain Injury Death Rates in Older Adults in the United States, 1980-2010: A Joinpoint Analysis.

PubMed

Sung, Kuan-Chin; Liang, Fu-Wen; Cheng, Tain-Junn; Lu, Tsung-Hsueh; Kawachi, Ichiro

2015-07-15

Unintentional fall-related traumatic brain injury (TBI) death rate is high in older adults in the United States, but little is known regarding trends of these death rates. We sought to examine unintentional fall-related TBI death rates by age and sex in older adults from 1980 through 2010 in the United States. We used multiple-cause mortality data from 1980 through 2010 (31 years of data) to identify fall-related TBI deaths. Using a joinpoint regression program, we determined the joinpoints (years at which trends change significantly) and annual percentage changes (APCs) in mortality trends. The fall-related TBI death rates (deaths per 100,000 population) in older adults ages 65-74, 75-84, and 85 years and above were 2.7, 9.2, and 21.5 for females and 8.5, 18.2, and 40.8 for males, respectively, in 1980. The rate was about the same in 1992, yet increased markedly to 5.9, 23.4, and 68.9 for females and 11.6, 41.2, and 112.4 for males, respectively, in 2010. For males all 65 years years of age and above, we found the first joinpoint in 1992, when the APC for 1980 through 1992, -0.8%, changed to 6.2% for 1992-2005. The second joinpoint occurred in 2005, when the APC decreased to 3.7% for 2005-2010. For all females 65 years of age and above, the first joinpoint was in 1993 when the APC for 1980 through 1993, -0.2%, changed to 7.6% from 1993 to 2005. The second joinpoint occurred in 2005 when the APC decreased to 3.8% for 2005-2010. This descriptive epidemiological study suggests increasing fall-related TBI death rates from 1992 to 2005 and then a slowdown of increasing trends between 2005 and 2010. Continued monitoring of fall-related TBI death rate trends is needed to determine the burden of this public health problem among older adults in the United States.

Impact of Firearm Availability and Gun Regulation on State Suicide Rates.

PubMed

Kposowa, Augustine; Hamilton, David; Wang, Katy

2016-12-01

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. © 2016 The American Association of Suicidology.

Availability and quality of cause-of-death data for estimating the global burden of injuries

PubMed Central

Harrison, James E; Shahraz, Saeid; Fingerhut, Lois A

2010-01-01

Abstract Objective To assess the availability and quality of global death registration data used for estimating injury mortality. Methods The completeness and coverage of recent national death registration data from the World Health Organization mortality database were assessed. The quality of data on a specific cause of injury death was judged high if fewer than 20% of deaths were attributed to any of several partially specified causes of injury, such as “unspecified unintentional injury”. Findings Recent death registration data were available for 83 countries, comprising 28% of the global population. They included most high-income countries, most countries in Latin America and several in central Asia and the Caribbean. Categories commonly used for partially specified external causes of injury resulting in death included “undetermined intent,” “unspecified mechanism of unintentional injury,” “unspecified road injury” and “unspecified mechanism of homicide”. Only 20 countries had high-quality data. Nevertheless, because the partially specified categories do contain some information about injury mechanisms, reliable estimates of deaths due to specific external causes of injury, such as road injury, suicide and homicide, could be derived for many more countries. Conclusion Only 20 countries had high-quality death registration data that could be used for estimating injury mortality because injury deaths were frequently classified using imprecise partially specified categories. Analytical methods that can derive national estimates of injury mortality from alternative data sources are needed for countries without reliable death registration systems. PMID:21076564

Deaths: leading causes for 2002.

PubMed

Anderson, Robert N; Smith, Betty L

2005-03-07

This report presents final 2002 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 States and the District of Columbia in 2002. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. In 2002, the 10 leading causes of death were (in rank order) Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Influenza and pneumonia; Alzheimer's disease; Nephritis, nephrotic syndrome and nephrosis; and Septicemia and accounted for about 79 percent of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2002 were (in rank order) Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birthweight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Newborn affected by complications of placenta, cord and membranes; Accidents (unintentional injuries); Respiratory distress of newborn; Bacterial sepsis of newborn; Diseases of the circulatory system; and Intrauterine hypoxia and birth asphyxia. Important variation in the leading causes of infant death is noted for the neonatal and postneonatal periods.

Deaths: leading causes for 2003.

PubMed

Heron, Melonie P; Smith, Betty L

2007-03-15

This report presents final 2003 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2003. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. In 2003, the 10 leading causes of death were (in rank order): Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Influenza and pneumonia; Alzheimer's disease; Nephritis, nephrotic syndrome and nephrosis; and Septicemia and accounted for about 78 percent of all deaths occurring in the United States. Differences in the ranking are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2003 were (in rank order): Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Newborn affected by complications of placenta, cord and membranes; Accidents (unintentional injuries); Respiratory distress of newborn; Bacterial sepsis of newborn; Neonatal hemorrhage; and Diseases of the circulatory system. Important variation in the leading causes of infant death is noted for the neonatal and postneonatal periods.

Deaths: leading causes for 2004.

PubMed

Heron, Melonie

2007-11-20

This report presents final 2004 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2004. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. In 2004, the 10 leading causes of death were (in rank order) Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Alzheimer's disease; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Septicemia and accounted for about 78 percent of all deaths occurring in the United States. Differences in the ranking are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2004 were (in rank order) Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Respiratory distress of newborn; Bacterial sepsis of newborn; Neonatal hemorrhage; and Diseases of the circulatory system. Important variation in the leading causes of infant death is noted for the neonatal and postneonatal periods.

Quantifying underreporting of law-enforcement-related deaths in United States vital statistics and news-media-based data sources: A capture–recapture analysis

PubMed Central

Gruskin, Sofia; Coull, Brent A.

2017-01-01

Background Prior research suggests that United States governmental sources documenting the number of law-enforcement-related deaths (i.e., fatalities due to injuries inflicted by law enforcement officers) undercount these incidents. The National Vital Statistics System (NVSS), administered by the federal government and based on state death certificate data, identifies such deaths by assigning them diagnostic codes corresponding to “legal intervention” in accordance with the International Classification of Diseases–10th Revision (ICD-10). Newer, nongovernmental databases track law-enforcement-related deaths by compiling news media reports and provide an opportunity to assess the magnitude and determinants of suspected NVSS underreporting. Our a priori hypotheses were that underreporting by the NVSS would exceed that by the news media sources, and that underreporting rates would be higher for decedents of color versus white, decedents in lower versus higher income counties, decedents killed by non-firearm (e.g., Taser) versus firearm mechanisms, and deaths recorded by a medical examiner versus coroner. Methods and findings We created a new US-wide dataset by matching cases reported in a nongovernmental, news-media-based dataset produced by the newspaper The Guardian, The Counted, to identifiable NVSS mortality records for 2015. We conducted 2 main analyses for this cross-sectional study: (1) an estimate of the total number of deaths and the proportion unreported by each source using capture–recapture analysis and (2) an assessment of correlates of underreporting of law-enforcement-related deaths (demographic characteristics of the decedent, mechanism of death, death investigator type [medical examiner versus coroner], county median income, and county urbanicity) in the NVSS using multilevel logistic regression. We estimated that the total number of law-enforcement-related deaths in 2015 was 1,166 (95% CI: 1,153, 1,184). There were 599 deaths reported in The Counted only, 36 reported in the NVSS only, 487 reported in both lists, and an estimated 44 (95% CI: 31, 62) not reported in either source. The NVSS documented 44.9% (95% CI: 44.2%, 45.4%) of the total number of deaths, and The Counted documented 93.1% (95% CI: 91.7%, 94.2%). In a multivariable mixed-effects logistic model that controlled for all individual- and county-level covariates, decedents injured by non-firearm mechanisms had higher odds of underreporting in the NVSS than those injured by firearms (odds ratio [OR]: 68.2; 95% CI: 15.7, 297.5; p < 0.01), and underreporting was also more likely outside of the highest-income-quintile counties (OR for the lowest versus highest income quintile: 10.1; 95% CI: 2.4, 42.8; p < 0.01). There was no statistically significant difference in the odds of underreporting in the NVSS for deaths certified by coroners compared to medical examiners, and the odds of underreporting did not vary by race/ethnicity. One limitation of our analyses is that we were unable to examine the characteristics of cases that were unreported in The Counted. Conclusions The media-based source, The Counted, reported a considerably higher proportion of law-enforcement-related deaths than the NVSS, which failed to report a majority of these incidents. For the NVSS, rates of underreporting were higher in lower income counties and for decedents killed by non-firearm mechanisms. There was no evidence suggesting that underreporting varied by death investigator type (medical examiner versus coroner) or race/ethnicity. PMID:29016598

Quantifying underreporting of law-enforcement-related deaths in United States vital statistics and news-media-based data sources: A capture-recapture analysis.

PubMed

Feldman, Justin M; Gruskin, Sofia; Coull, Brent A; Krieger, Nancy

2017-10-01

Prior research suggests that United States governmental sources documenting the number of law-enforcement-related deaths (i.e., fatalities due to injuries inflicted by law enforcement officers) undercount these incidents. The National Vital Statistics System (NVSS), administered by the federal government and based on state death certificate data, identifies such deaths by assigning them diagnostic codes corresponding to "legal intervention" in accordance with the International Classification of Diseases-10th Revision (ICD-10). Newer, nongovernmental databases track law-enforcement-related deaths by compiling news media reports and provide an opportunity to assess the magnitude and determinants of suspected NVSS underreporting. Our a priori hypotheses were that underreporting by the NVSS would exceed that by the news media sources, and that underreporting rates would be higher for decedents of color versus white, decedents in lower versus higher income counties, decedents killed by non-firearm (e.g., Taser) versus firearm mechanisms, and deaths recorded by a medical examiner versus coroner. We created a new US-wide dataset by matching cases reported in a nongovernmental, news-media-based dataset produced by the newspaper The Guardian, The Counted, to identifiable NVSS mortality records for 2015. We conducted 2 main analyses for this cross-sectional study: (1) an estimate of the total number of deaths and the proportion unreported by each source using capture-recapture analysis and (2) an assessment of correlates of underreporting of law-enforcement-related deaths (demographic characteristics of the decedent, mechanism of death, death investigator type [medical examiner versus coroner], county median income, and county urbanicity) in the NVSS using multilevel logistic regression. We estimated that the total number of law-enforcement-related deaths in 2015 was 1,166 (95% CI: 1,153, 1,184). There were 599 deaths reported in The Counted only, 36 reported in the NVSS only, 487 reported in both lists, and an estimated 44 (95% CI: 31, 62) not reported in either source. The NVSS documented 44.9% (95% CI: 44.2%, 45.4%) of the total number of deaths, and The Counted documented 93.1% (95% CI: 91.7%, 94.2%). In a multivariable mixed-effects logistic model that controlled for all individual- and county-level covariates, decedents injured by non-firearm mechanisms had higher odds of underreporting in the NVSS than those injured by firearms (odds ratio [OR]: 68.2; 95% CI: 15.7, 297.5; p < 0.01), and underreporting was also more likely outside of the highest-income-quintile counties (OR for the lowest versus highest income quintile: 10.1; 95% CI: 2.4, 42.8; p < 0.01). There was no statistically significant difference in the odds of underreporting in the NVSS for deaths certified by coroners compared to medical examiners, and the odds of underreporting did not vary by race/ethnicity. One limitation of our analyses is that we were unable to examine the characteristics of cases that were unreported in The Counted. The media-based source, The Counted, reported a considerably higher proportion of law-enforcement-related deaths than the NVSS, which failed to report a majority of these incidents. For the NVSS, rates of underreporting were higher in lower income counties and for decedents killed by non-firearm mechanisms. There was no evidence suggesting that underreporting varied by death investigator type (medical examiner versus coroner) or race/ethnicity.

The Epidemiology of Unintentional and Violence-Related Injury Morbidity and Mortality among Children and Adolescents in the United States.

PubMed

Ballesteros, Michael F; Williams, Dionne D; Mack, Karin A; Simon, Thomas R; Sleet, David A

2018-03-28

Injuries and violence among young people have a substantial emotional, physical, and economic toll on society. Understanding the epidemiology of this public health problem can guide prevention efforts, help identify and reduce risk factors, and promote protective factors. We examined fatal and nonfatal unintentional injuries, injuries intentionally inflicted by other (i.e., assaults and homicides) among children ages 0-19, and intentionally self-inflicted injuries (i.e., self-harm and suicides) among children ages 10-19. We accessed deaths (1999-2015) and visits to emergency departments (2001-2015) for these age groups through the Centers for Disease Control and Prevention's (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS), and examined trends and differences by age, sex, race/ethnicity, rural/urban status, and injury mechanism. Almost 13,000 children and adolescents age 0-19 years died in 2015 from injury and violence compared to over 17,000 in 1999. While the overall number of deaths has decreased over time, there were increases in death rates among certain age groups for some categories of unintentional injury and for suicides. The leading causes of injury varied by age group. Our results indicate that efforts to reduce injuries to children and adolescents should consider cause, intent, age, sex, race, and regional factors to assure that prevention resources are directed at those at greatest risk.

Taking the long view: a systematic review reporting long-term perspectives on child unintentional injury.

PubMed

Mytton, Julie A; Towner, Elizabeth M L; Powell, Jane; Pilkington, Paul A; Gray, Selena

2012-10-01

The relative significance of child injury as a cause of preventable death has increased as mortality from infectious diseases has declined. Unintentional child injuries are now a major cause of death and disability across the world with the greatest burden falling on those who are most disadvantaged. A review of long-term data on child injury mortality was conducted to explore trends and inequalities and consider how data were used to inform policy, practice and research. The authors systematically collated and quality appraised data from publications and documents reporting unintentional child injury mortality over periods of 20 years or more. A critical narrative synthesis explored trends by country income group, injury type, age, gender, ethnicity and socioeconomic group. 31 studies meeting the inclusion criteria were identified of which 30 were included in the synthesis. Only six were from middle income countries and none were from low income countries. An overall trend in falling child injury mortality masked rising road traffic injury deaths, evidence of increasing vulnerability of adolescents and widening disparities within countries when analysed by ethnic group and socioeconomic status. Child injury mortality trend data from high and middle income countries has illustrated inequalities within generally falling trends. There is scope for greater use of existing trend data to inform policy and practice. Similar evidence from low income countries where the burden of injury is greatest is needed.

Negative freedom and death in the United States.

PubMed

Ackerson, Leland K; Subramanian, S V

2010-11-01

Personal freedoms have been characterized as "positive" (freedom to pursue opportunities) and "negative" (freedom from external constraints on decision making). An ecological analysis of US data revealed a strong positive association (r = 0.41; P = .003) between state-level negative personal freedom (defined in terms of regulation of personal behavior) and state-level age-adjusted rates of unintentional injury. A conceptual emphasis on positive freedom construed as freedom to pursue a life without risk of unintentional injury could help motivate a conversation to improve public health.

National SAFE KIDS Campaign releases 10-year report.

PubMed

Pike-Paris, A

1999-01-01

Unintentional injury is the leading cause of death and disability in children 14 years and under. The National SAFE KIDS Campaign, a nationwide organization aimed at education and prevention of unintentional injury, recently released its 10-year report that describes areas of success, areas in need of improvement, and goals for the future. The full 61-page report is worthy of reading and referencing for all those involved with children and their health care. Highlights of the report are summarized below.

Health Problems and Male Firearm Suicide

ERIC Educational Resources Information Center

Hempstead, Katherine; Nguyen, Tuan; David-Rus, Richard; Jacquemin, Bretta

2013-01-01

Drawing on constructs of masculinity as it relates to both gun ownership and men's health, we use a rich data set, the New Jersey Violent Death Reporting System as well as hospital discharge data, to analyze 3,413 completed male suicides between the years of 2003 and 2009. We test the hypotheses that the use of firearms is more common when…

Protect Children Instead of Guns, 2000.

ERIC Educational Resources Information Center

Children's Defense Fund, Washington, DC.

Noting that firearms outnumber children by a margin of almost three to one in the United States, this report advocates gun safety policies to protect children. The report provides information on trends in youth firearm deaths from 1994 and 1999 and comparisons of U.S. data to those of other industrialized countries. A table delineates 1996-1998…

Deaths: Leading Causes for 2012.

PubMed

Heron, Melonie

2015-08-31

This report presents final 2012 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2012," the National Center for Health Statistics' annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2012. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2012, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). These causes accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2012 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.

Insomnia Symptoms and Risk for Unintentional Fatal Injuries—The HUNT Study

PubMed Central

Laugsand, Lars Erik; Strand, Linn B.; Vatten, Lars J.; Janszky, Imre; Bjørngaard, Johan Håkon

2014-01-01

Study Objectives: To assess the association between insomnia symptoms and risk of fatal unintentional injuries. Design: Population-based prospective cohort study with a mean follow-up of 14 y, linking health survey data with information on insomnia symptoms to the National Cause of Death Registry. Setting: Nord-Trøndelag County, Norway. Participants: A total of 54,399 men and women 20-89 y of age who participated in the Nord-Trøndelag Health Study between 1995 and 1997. Interventions: N/A. Measurements and results: There were 277 unintentional fatal injuries, including 57 fatal motor vehicle injuries during follow-up. There was a dose-dependent association between the number of insomnia symptoms and risk of unintentional fatal injuries (P for trend 0.001) and fatal motor vehicle injuries (P for trend 0.023), respectively. The proportion of unintentional fatal injuries cases that could have been prevented in the absence of difficulties initiating sleep, difficulties maintaining sleep, and having a feeling of nonrestorative sleep were 8%, 9%, and 8%, respectively. The corresponding estimates for motor vehicle injuries were 34%, 11%, and 10%. Conclusion: Insomnia is a major contributor to both unintentional fatal injuries in general as well as fatal motor vehicle injuries. Increasing public health awareness about insomnia and identifying persons with insomnia may be important in preventing unintentional fatal injuries. Citation: Laugsand LE, Strand LB, Vatten LJ, Janszky I, Bjørngaard JH. Insomnia symptoms and risk for unintentional fatal injuries—the HUNT Study. SLEEP 2014;37(11):1777-1786. PMID:25364073

Relationship of opioid prescription sales and overdoses, North Carolina.

PubMed

Modarai, F; Mack, K; Hicks, P; Benoit, S; Park, S; Jones, C; Proescholdbell, S; Ising, A; Paulozzi, L

2013-09-01

In the United States, fatal drug overdoses have tripled since 1991. This escalation in deaths is believed to be driven primarily by prescription opioid medications. This investigation compared trends and patterns in sales of opioids, opioid drug overdoses treated in emergency departments (EDs), and unintentional overdose deaths in North Carolina (NC). Our ecological study compared rates of opioid sales, opioid related ED overdoses, and unintentional drug overdose deaths in NC. Annual sales data, provided by the Drug Enforcement Administration, for select opioids were converted into morphine equivalents and aggregated by zip code. These opioid drug sales rates were trended from 1997 to 2010. In addition, opioid sales were correlated and compared to opioid related ED visits, which came from a Centers for Disease Control and Prevention syndromic surveillance system, and unintentional overdose deaths, which came from NC Vital Statistics, from 2008 to 2010. Finally, spatial cluster analysis was performed and rates were mapped by zip code in 2010. Opioid sales increased substantially from 1997 to 2010. From 2008 to 2010, the quarterly rates of opioid drug overdoses treated in EDs and opioid sales correlated (r=0.68, p=0.02). Specific regions of the state, particularly in the southern and western corners, had both high rates of prescription opioid sales and overdoses. Temporal trends in sales of prescription opioids correlate with trends in opioid related ED visits. The spatial correlation of opioid sales with ED visit rates shows that opioid sales data may be a timely way to identify high-risk communities in the absence of timely ED data. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Deaths: leading causes for 2007.

PubMed

Heron, Melonie

2011-08-26

This report presents final 2007 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the Division of Vital Statistics' annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2007. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2007, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Septicemia. They accounted for approximately 76 percent of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2007 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.

Deaths: leading causes for 2009.

PubMed

Heron, Melonie

2012-10-26

This report presents final 2009 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the Division of Vital Statistics' annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2009. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2009, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). These causes accounted for approximately 75% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2009 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.

Deaths: leading causes for 2008.

PubMed

Heron, Melonie

2012-06-06

This report presents final 2008 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the Division of Vital Statistics' annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2008. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. in 2008, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for approximately 76 percent of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2008 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.

Worldwide Prevalence and Trends in Unintentional Drug Overdose: A Systematic Review of the Literature

PubMed Central

Sampson, Laura; Cerdá, Magdalena; Galea, Sandro

2015-01-01

Background. Drug overdose is an important, yet an inadequately understood, public health problem. Global attention to unintentional drug overdose has been limited by comparison with the scope of the problem. There has been a substantial increase in drug overdose incidence and prevalence in several countries worldwide over the past decade, contributing to both increased costs and mortality. Objectives. The aim of this study was to systematically synthesize the peer-reviewed literature to document the global epidemiological profile of unintentional drug overdoses and the prevalence, time trends, mortality rates, and correlates of drug overdoses. We searched different combinations of Medical Subject Headings (MeSH) terms in PubMed for articles published from 1980 until July 2013, and we organized these results in tabular spreadsheets and compared them. We restricted the search to English-language articles that deal with unintentional overdose, focusing on 1 or more of the following key constructs: prevalence, time trends, mortality rates, and correlates. The term “overdose” as a MeSH major topic yielded 1076 publications. In addition, we searched the following combinations of nonmajor MeSH terms: “street drugs” and “overdose” yielded 180, “death” and “overdose” yielded 114, and “poisoning” and “drug users” yielded 17. There was some overlap among the searches. Based on the search and inclusion and exclusion criteria, we selected a total of 169 relevant articles for this article based on a close review of abstracts. Results. We found wide variability in lifetime prevalence of experiencing a nonfatal overdose or witnessing an overdose, and in mortality rates attributable to overdose. Lifetime prevalence of witnessed overdose among drug users (n = 17 samples) ranged from 50% to 96%, with a mean of 73.3%, a median of 70%, and a standard deviation of 14.1%. Lifetime prevalence of drug users personally experiencing a nonfatal overdose (n = 27 samples), ranged from 16.6% to 68.0% with a mean of 45.4%, a median of 47%, and a standard deviation of 14.4%. Population-based crude overdose mortality rates (n = 28 samples) ranged from 0.04 to 46.6 per 100 000 person-years. This range is likely attributable to the diversity in regions, time periods, and samples. Most studies on longitudinal trends of overdose death rates or overdose-related hospitalization rates showed increases in overdose death rates and in overdose-related hospitalization rates across time, which have led to peaks in these rates at the present time. An overall trend of increasing deaths from prescription opioid use and decreasing deaths from illicit drug use in the past several years has been noted across most of the literature. With the increase in prescription opioid overdose deaths, drug overdose is not just an urban problem: rural areas have seen an important increase in overdose deaths. Lastly, cocaine, prescription opioids, and heroin are the drugs most commonly associated with unintentional drug overdoses worldwide and the demographic and psychiatric correlates associated with unintentional drug overdoses are similar globally. Conclusions. There is a need to invest in research to understand the distinct determinants of prescription drug overdose worldwide. Several other countries need to collect in a systematic and continuous fashion such data on sales of prescription opioids and other prescription drugs, nonmedical use of prescription drugs, and hospitalization secondary to overdoses on prescription drugs. The sparse evidence on the environmental determinants of overdose suggests a need for research that will inform the types of environmental interventions we can use to prevent drug overdose. Methodological issues for future studies include enhancing data collection methods on unintentional fatal and nonfatal overdoses, and collecting more detailed information on drug use history, source of drug use (for prescription drugs), and demographic and psychiatric history characteristics of the individual who overdosed. PMID:26451760

Potentially preventable deaths from the five leading causes of death--United States, 2008-2010.

PubMed

Yoon, Paula W; Bastian, Brigham; Anderson, Robert N; Collins, Janet L; Jaffe, Harold W

2014-05-02

In 2010, the top five causes of death in the United States were 1) diseases of the heart, 2) cancer, 3) chronic lower respiratory diseases, 4) cerebrovascular diseases (stroke), and 5) unintentional injuries. The rates of death from each cause vary greatly across the 50 states and the District of Columbia (2). An understanding of state differences in death rates for the leading causes might help state health officials establish disease prevention goals, priorities, and strategies. States with lower death rates can be used as benchmarks for setting achievable goals and calculating the number of deaths that might be prevented in states with higher rates. To determine the number of premature annual deaths for the five leading causes of death that potentially could be prevented ("potentially preventable deaths"), CDC analyzed National Vital Statistics System mortality data from 2008-2010. The number of annual potentially preventable deaths per state before age 80 years was determined by comparing the number of expected deaths (based on average death rates for the three states with the lowest rates for each cause) with the number of observed deaths. The results of this analysis indicate that, when considered separately, 91,757 deaths from diseases of the heart, 84,443 from cancer, 28,831 from chronic lower respiratory diseases, 16,973 from cerebrovascular diseases (stroke), and 36,836 from unintentional injuries potentially could be prevented each year. In addition, states in the Southeast had the highest number of potentially preventable deaths for each of the five leading causes. The findings provide disease-specific targets that states can use to measure their progress in preventing the leading causes of deaths in their populations.

Association of suicide rates, gun ownership, conservatism and individual suicide risk.

PubMed

Kposowa, Augustine J

2013-09-01

The purpose of the study was to examine the association of suicide rates, firearm ownership, political conservatism, religious integration at the state level, and individual suicide risk. Social structural and social learning and social integration theories were theoretical frameworks employed. It was hypothesized that higher suicide rates, higher state firearm availability, and state conservatism elevate individual suicide risk. Data were pooled from the Multiple Cause of Death Files. Multilevel logistic regression models were fitted to all deaths occurring in 2000 through 2004 by suicide. The state suicide rate significantly elevated individual suicide risk (AOR = 1.042, CI = 1.037, 1.046). Firearm availability at the state level was associated with significantly higher odds of individual suicide (AOR = 1.004, CI = 1.003, 1.006). State political conservatism elevated the odds of individual suicides (AOR = 1.005, CI = 1.003, 1.007), while church membership at the state level reduced individual odds of suicide (AOR = 0.995, CI = 0.993, 0.996). The results held even after controlling for socioeconomic and demographic variables at the individual level. It was concluded that the observed association between individual suicide odds and national suicide rates, and firearm ownership cannot be discounted. Future research ought to focus on integrating individual level data and contextual variables when testing for the impact of firearm ownership. Support was found for social learning and social integration theories.

The Relationship Between Gun Ownership and Firearm Homicide Rates in the United States, 1981–2010

PubMed Central

Ross, Craig S.

2013-01-01

Objectives. We examined the relationship between levels of household firearm ownership, as measured directly and by a proxy—the percentage of suicides committed with a firearm—and age-adjusted firearm homicide rates at the state level. Methods. We conducted a negative binomial regression analysis of panel data from the Centers for Disease Control and Prevention’s Web-Based Injury Statistics Query and Reporting Systems database on gun ownership and firearm homicide rates across all 50 states during 1981 to 2010. We determined fixed effects for year, accounted for clustering within states with generalized estimating equations, and controlled for potential state-level confounders. Results. Gun ownership was a significant predictor of firearm homicide rates (incidence rate ratio = 1.009; 95% confidence interval = 1.004, 1.014). This model indicated that for each percentage point increase in gun ownership, the firearm homicide rate increased by 0.9%. Conclusions. We observed a robust correlation between higher levels of gun ownership and higher firearm homicide rates. Although we could not determine causation, we found that states with higher rates of gun ownership had disproportionately large numbers of deaths from firearm-related homicides. PMID:24028252

The child as a projectile.

PubMed

Tibbs, R E; Haines, D E; Parent, A D

1998-12-01

Unintentional injury is the leading cause of death in children under the age of fourteen. The majority of these injuries/deaths occur when the child becomes airborne during an accident. The most common mechanisms by which children become airborne are motor vehicle collisions, bicycling accidents, and falls. A head injury is seen in a significant number of children in this setting. This includes injury to the scalp, skull, coverings of the brain, or the brain itself. These injuries are the most common cause of death in children resulting from unintentional injury. Other typical injuries include external bruises and abrasions, extremity fractures, and bruising or bleeding of internal organs. We propose to name this constellation of injuries the projectile child syndrome. This refers to those injuries occurring in infants and children as a result of becoming airborne during the events of an accident. The pattern of injuries seen as related to the anatomy of the child is stressed. A review of the impact to society and guidelines for prevention are presented.

African American legislators' perceptions of firearm violence prevention legislation.

PubMed

Payton, Erica; Thompson, Amy; Price, James H; Sheu, Jiunn-Jye; Dake, Joseph A

2015-06-01

Firearm mortality is the leading cause of death for young African American males, however, few studies have focused on racial/ethnic minority populations and firearm violence. The National Black Caucus of State Legislators advocates for legislation that promotes the health of African Americans. Thus, the purpose of this study was to collect baseline data on African American legislators' perceptions regarding firearm violence in the African American community. A cross-sectional study of African American legislators (n = 612) was conducted to investigate the research questions. Of the 612 questionnaires mailed, 12 were not deliverable, and 170 were returned (28%). Utilizing a three wave mailing process, African American legislators were invited to participate in the study. The majority (88%) of respondents perceived firearm violence to be very serious among African Americans. Few (10%) legislators perceived that addressing legislative issues would be an effective strategy in reducing firearm violence among African Americans. The majority (72%) of legislators perceived the most effective strategy to reducing firearm violence in the African American community should focus on addressing societal issues (e.g. crime and poverty). After adjusting for the number of perceived barriers, the number of perceived benefits was a significant predictor of legislators' perceived effectiveness of firearm violence prevention legislation for 8 of the 24 potential firearm violence prevention legislative bills.

Prior suicide attempts are less common in suicide decedents who died by firearms relative to those who died by other means.

PubMed

Anestis, Michael D

2016-01-01

Suicide prevention efforts often center on the identification of risk factors (e.g., prior suicide attempts); however, lists of risk factors without consideration of context may prove incapable of impacting suicide rates. One contextual variable worth considering is attempt method. Utilizing data from the National Violent Death Reporting System (2005-2012), I examined suicide deaths (n=71,775) by firearms and other means to determine whether prior suicide attempts were more common in one group versus the other. Significantly fewer suicide decedents who died by firearms reported a prior history of suicide attempts (12.10%) than did decedents who died by other means (28.66%). This result was further replicated within each state that contributed data to the NVDRS. Only 17 states have contributed to the NVDRS thus far and, within those states, not all suicide deaths were reported. Due to the nature of the data, I was unable to test proposed mediators within our model. Suicide decedents who die by firearms may die on their first attempt more often than other decedents due to a capability and willingness to utilize a highly lethal means. Current risk assessment protocols may be ill equipped to identify such individuals prospectively on their own. Broader methods of implementing means restriction (e.g., legislation) may thus be pivotal in suicide prevention efforts. Copyright © 2015 Elsevier B.V. All rights reserved.

Increasing deaths involving oxycodone, Victoria, Australia, 2000-09.

PubMed

Rintoul, Angela C; Dobbin, Malcolm D H; Drummer, Olaf H; Ozanne-Smith, Joan

2011-08-01

In light of an emerging epidemic identified in the United States and Canada, to identify trends in fatal drug toxicity involving oxycodone and the demographic characteristics and indicators of socioeconomic disadvantage of the deceased. Population-based observational study in Victoria, Australia. Decedents whose death was reported to the Victorian Coroner between 2000 and 2009 and where oxycodone was detected. Association between supply of oxycodone and deaths. Demographic characteristics of decedents. Rate ratios of the rural or metropolitan location and socioeconomic indicators of disadvantage of the deceased. Supply to Victoria has increased nine-fold from 7.5 mg per capita in 2000 to 67.5 mg per capita in 2009. Detection of oxycodone in deaths reported to the Victorian Coroner has increased from 4 (0.08/100,000 population) in 2000 to 97 (1.78/100,000 population) in 2009-a 21-fold increase in deaths. Of the 320 cases described, 53.8% (172) were the result of drug toxicity. Of these, 52.3% were unintentional and 19.8% intentional self-harm; the remaining 27.9% are either still under investigation by the coroner or intent is unknown. Drug toxicity deaths were overrepresented in both rural areas and areas indexed with high levels of disadvantage. The substantial increase in the number of deaths involving oxycodone is strongly and significantly associated with the increase in supply. Most drug toxicity deaths involving oxycodone were unintentional. This newly identified trend in fatalities in Victoria supports concerns that a pattern of increasing deaths involving oxycodone is emerging globally.

Evaluating the Impact of Florida's "Stand Your Ground" Self-defense Law on Homicide and Suicide by Firearm: An Interrupted Time Series Study.

PubMed

Humphreys, David K; Gasparrini, Antonio; Wiebe, Douglas J

2017-01-01

In 2005, Florida amended its self-defense laws to provide legal immunity to individuals using lethal force in self-defense. The enactment of "stand your ground" laws in the United States has been controversial and their effect on rates of homicide and homicide by firearm is uncertain. To estimate the impact of Florida's stand your ground law on rates of homicide and homicide by firearm. Using an interrupted time series design, we analyzed monthly rates of homicide and homicide by firearm in Florida between 1999 and 2014. Data were collected from the Wide-ranging Online Data for Epidemiologic Research (WONDER) web portal at the Centers for Disease Control and Prevention. We used seasonally adjusted segmented Poisson regression models to assess whether the onset of the law was associated with changes in the underlying trends for homicide and homicide by firearm in Florida. We also assessed the association using comparison states without stand your ground laws (New York, New Jersey, Ohio, and Virginia) and control outcomes (all suicides and suicides by firearm in Florida). October 1, 2005, the effective date of the law, was used to define homicides before and after the change. Monthly rates of homicide, firearm-related homicide, suicide, and suicide by firearm in Florida and the 4 comparison states. Prior to the stand your ground law, the mean monthly homicide rate in Florida was 0.49 deaths per 100 000 (mean monthly count, 81.93), and the rate of homicide by firearm was 0.29 deaths per 100 000 (mean monthly count, 49.06). Both rates had an underlying trend of 0.1% decrease per month. After accounting for underlying trends, these results estimate that after the law took effect there was an abrupt and sustained increase in the monthly homicide rate of 24.4% (relative risk [RR], 1.24; 95%CI, 1.16-1.33) and in the rate of homicide by firearm of 31.6% (RR, 1.32; 95% CI, 1.21-1.44). No evidence of change was found in the analyses of comparison states for either homicide (RR, 1.06; 95% CI, 0.98-1.13) or homicide by firearm (RR, 1.08; 95% CI, 0.99-1.17). Furthermore, no changes were observed in control outcomes such as suicide (RR, 0.99; 95% CI, 0.94-1.05) and suicide by firearm (RR, 0.98; 95% CI, 0.91-1.06) in Florida between 2005 and 2014. The implementation of Florida's stand your ground self-defense law was associated with a significant increase in homicides and homicides by firearm but no change in rates of suicide or suicide by firearm.

Gun utopias? Firearm access and ownership in Israel and Switzerland

PubMed Central

Rosenbaum, Janet

2011-01-01

The 2011 attempted assassination of a US representative renewed the national gun control debate. Gun advocates claim that mass-casualty events are mitigated and deterred with three policies: (1) permissive gun laws, (2) widespread gun ownership, (3) encouragement of armed civilians who can intercept shooters, and cite Switzerland and Israel as exemplars. We evaluate these claims with analysis of International Crime Victimization Survey (ICVS) data and translation of laws and original source material. Swiss and Israeli laws limit firearm ownership and require permit renewal 14 times annually. ICVS analysis finds that the US has more firearms per capita and per household than either country. Switzerland and Israel curtail off-duty soldiers firearm access to prevent firearm deaths. Suicide among soldiers decreased by 40% after the Israeli armys 2006 reforms. Compared with the US, Switzerland and Israel have lower gun ownership and stricter gun laws, and their policies discourage personal gun ownership. PMID:22089893

Gun utopias? Firearm access and ownership in Israel and Switzerland.

PubMed

Rosenbaum, Janet E

2012-02-01

The 2011 attempted assassination of a US representative renewed the national gun control debate. Gun advocates claim mass-casualty events are mitigated and deterred with three policies: (a) permissive gun laws, (b) widespread gun ownership, (c) and encouragement of armed civilians who can intercept shooters. They cite Switzerland and Israel as exemplars. We evaluate these claims with analysis of International Crime Victimization Survey (ICVS) data and translation of laws and original source material. Swiss and Israeli laws limit firearm ownership and require permit renewal one to four times annually. ICVS analysis finds the United States has more firearms per capita and per household than either country. Switzerland and Israel curtail off-duty soldiers' firearm access to prevent firearm deaths. Suicide among soldiers decreased by 40 per cent after the Israeli army's 2006 reforms. Compared with the United States, Switzerland and Israel have lower gun ownership and stricter gun laws, and their policies discourage personal gun ownership.

Assessing Legal Strains and Risk of Suicide Using Archived Court Data

ERIC Educational Resources Information Center

Cook, Thomas Bradley; Davis, Mark S.

2012-01-01

Relatively little is known about legal entanglements and suicide risk. This matched case-control study estimated the risk of suicide associated with legal strains using online court archives, a novel source of exposure data. Court records linked to suicide deaths (N = 315), controls (N = 630), and unintentional injury and poisoning deaths (N =…

Analysis of Prior Health System Contacts as a Harbinger of Subsequent Fatal Injury in American Indians

ERIC Educational Resources Information Center

Sanddal, Teri L.; Upchurch, James; Sanddal, Nels D.; Esposito, Thomas J.

2005-01-01

Many American Indian nations, tribes, and bands are at an elevated risk for premature death from unintentional injury. Previous research has documented a relationship between alcohol-related injury and subsequent injury death among predominately urban samples. The presence or nature of such a relationship has not been documented among American…

Association of Drug and Alcohol Use With Adolescent Firearm Homicide at Individual, Family, and Neighborhood Levels

PubMed Central

Hohl, Bernadette C.; Wiley, Shari; Wiebe, Douglas J.; Culyba, Alison J.; Drake, Rebecca; Branas, Charles C.

2017-01-01

IMPORTANCE Homicide is the third leading cause of death for adolescents in the United States and the leading cause of death for adolescents who are African American. Large cities have disproportionate homicide rates. OBJECTIVE To determine the relationships between exposures to drugs and alcohol at the individual, family, and neighborhood levels and adolescent firearm homicide and to inform new approaches to preventing firearm violence. DESIGN, SETTING, AND PARTICIPANTS Population-based case-control study from January 2010 to December 2012 of all 13- to 20-year-olds who were homicide victims in Philadelphia during the study period matched to randomly selected 13- to 20-year-old controls from the general population. EXPOSURES Individual drug and alcohol use at the time of injury, history of drug and alcohol use, caregiver drug and alcohol use, and neighborhood availability of alcohol and illegal drugs. We also controlled for age, race, school suspensions, arrests, and neighborhood ethnicity. MAIN OUTCOMES AND MEASURES Adolescent firearm homicide identified from police and medical examiner’s reports. RESULTS We enrolled 161 adolescent homicide cases, including 157 (97.5%) firearm homicide cases and 172 matched controls, including 166 (96.5%) firearm homicide controls. Adolescents with a history of alcohol use (adjusted odds ratio [AOR], 4.1; 95% CI, 1.2–14.0) or drug use (AOR, 4.4; 95% CI, 1.7–11.6) had increased odds of firearm homicide. Adolescents whose caregiver had a history of drug use had increased odds of firearm homicide (AOR, 11.7; 95% CI, 2.8–48.0). Adolescents in neighborhoods with high densities of alcohol outlets (AOR, 3.2; 95% CI, 1.1–9.1) and moderate or high drug availability had increased odds of firearm homicide (AOR, 3.4; 95% CI, 1.1–10.3 vs AOR, 7.5; 95% CI, 2.2–25.8). CONCLUSIONS AND RELEVANCE Almost all adolescent homicides in Philadelphia between 2010 and 2012 were committed with a firearm. Substance use at the individual, family, and neighborhood levels was associated with increased odds of adolescent firearm homicide; drug use was associated at all 3 levels and alcohol at the individual and neighborhood levels. Expanding violence prevention efforts to target drug and alcohol use at multiple levels may help to reduce the firearm violence that disproportionately affects adolescents in minority populations in large US cities. PMID:28055064

Survey of American College of Surgeons Committee on trauma members on firearm injury: Consensus and opportunities.

PubMed

Kuhls, Deborah A; Campbell, Brendan T; Burke, Peter A; Allee, Lisa; Hink, Ashley; Letton, Robert W; Masiakos, Peter T; Coburn, Michael; Alvi, Maria; Lerer, Trudy J; Gaines, Barbara A; Nance, Michael L; Schuerer, Douglas J E; Palmieri, Tina L; Davis, James W; Geehan, Douglas M; Elsey, James K; Sutton, Beth H; McAndrew, Mark P; Gross, Ronald I; Reed, Donald N; Van Boerum, Don H; Esposito, Thomas J; Albrecht, Roxie M; Sarani, Babak; Shapiro, David S; Wiggins-Dohlvik, Katie; Stewart, Ronald M

2017-05-01

In the United States, there is a perceived divide regarding the benefits and risks of firearm ownership. The American College of Surgeons Committee on Trauma Injury Prevention and Control Committee designed a survey to evaluate Committee on Trauma (COT) member attitudes about firearm ownership, freedom, responsibility, physician-patient freedom and policy, with the objective of using survey results to inform firearm injury prevention policy development. A 32-question survey was sent to 254 current U.S. COT members by email using Qualtrics. SPSS was used for χ exact tests and nonparametric tests, with statistical significance being less than 0.05. Our response rate was 93%, 43% of COT members have firearm(s) in their home, 88% believe that the American College of Surgeons should give the highest or a high priority to reducing firearm-related injuries, 86% believe health care professionals should be allowed to counsel patients on firearms safety, 94% support federal funding for firearms injury prevention research. The COT participants were asked to provide their opinion on the American College of Surgeons initiating advocacy efforts and there was 90% or greater agreement on 7 of 15 and 80% or greater on 10 of 15 initiatives. The COT surgeons agree on: (1) the importance of formally addressing firearm injury prevention, (2) allowing federal funds to support research on firearms injury prevention, (3) retaining the ability of health care professionals to counsel patients on firearms-related injury prevention, and (4) the majority of policy initiatives targeted to reduce interpersonal violence and firearm injury. It is incumbent on trauma and injury prevention organizations to leverage these consensus-based results to initiate prevention, advocacy, and other efforts to decrease firearms injury and death. Prognostic/epidemiologic study, level I; therapeutic care, level II.

Death among children and adolescents

MedlinePlus

... and genetic conditions that were present at birth Homicide 5 to 14 years: Accidents (unintentional injuries) Cancer ... trust is very important for preventing teen suicide. HOMICIDE Homicide is a complex issue that does not ...

Trends in BB/pellet gun injuries in children and teenagers in the United States, 1985-99.

PubMed

Nguyen, M H; Annest, J L; Mercy, J A; Ryan, G W; Fingerhut, L A

2002-09-01

To characterize national trends in non-fatal BB/pellet gun related injury rates for persons aged 19 years or younger in relation to trends in non-fatal and fatal firearm related injury rates and discuss these trends in light of injury prevention and violence prevention efforts. The National Electronic Injury Surveillance System (NEISS) includes approximately 100 hospitals with at least six beds that provide emergency services. These hospitals comprise a stratified probability sample of all US hospitals with emergency departments. The National Vital Statistics System (NVSS) is a complete census of all death certificates filed by states and is compiled annually. National data on BB/pellet gun related injuries and injury rates were examined along with fatal and non-fatal firearm related injuries and injury rates. Non-fatal injury data for all BB/pellet gun related injury cases from 1985 through 1999, and firearm related injury cases from 1993 through 1999 were obtained from hospital emergency department records using the NEISS. Firearm related deaths from 1985 through 1999 were obtained from the NVSS. BB/pellet gun related injury rates increased from age 3 years to a peak at age 13 years and declined thereafter. In contrast, firearm related injury and death rates increased gradually until age 13 and then increased sharply until age 18 years. For persons aged 19 years and younger, BB/pellet gun related injury rates increased from the late 1980s until the early 1990s and then declined until 1999; these injury rates per 100 000 population were 24.0 in 1988, 32.8 in 1992, and 18.3 in 1999. This trend was similar to those for fatal and non-fatal firearm related injury rates per 100 000 which were 4.5 in 1985, 7.8 in 1993, and 4.3 in 1999 (fatal) and 38.6 in 1993 and 16.3 in 1999 (non-fatal). In 1999, an estimated 14 313 (95% confidence interval (CI) 12 025 to 16 601) cases with non-fatal BB/pellet gun injuries and an estimated 12 748 (95% CI 7881-17 615) cases with non-fatal firearm related injuries among persons aged 19 years and younger were treated in US hospital emergency departments. BB/pellet gun related and firearm related injury rates show similar declines since the early 1990s. These declines coincide with a growing number of prevention efforts aimed at reducing injuries to children from unsupervised access to guns and from youth violence. Evaluations at the state and local level are needed to determine true associations.

Suicide in the Highlands of Scotland.

PubMed

Stark, C; Matthewson, F; O'Neill, N; Oates, K; Hay, A

2002-01-01

The Highlands have one of the highest suicide rates in Scotland. This paper describes suicide and deliberate self-harm in the Highlands in the last 20 years and explores possible reasons for the differences from the Scottish average. Retrospective analysis of routine data from the SMRI/SMR01 scheme and information on deaths from the Registrar General. Suicide and undetermined deaths were combined in the analysis. Highland and Scotland 1978-98. The high rates in Highland are caused by an excess of male deaths. Highland has had consistently high male suicide rates over the 20 year period compared to Scotland. These differences do not disappear when deaths of non-Highland residents are excluded. By comparison, deliberate self-harm admissions follow a similar pattern to Scotland as a whole. Causes of death differed from Scotland as a whole, with an over-representation of drowning, gases and firearm deaths. Highland suicide rates are elevated compared to Scotland. This is mainly due to an excess of deaths in men up to the age of 74 years, and is not accounted for by deaths of non-residents. Female deaths are not elevated in comparison to the rest of Scotland. Male attempted suicide rates do not differ from Scotland. Lethality of method--drowning, car exhausts and firearms--may contribute to the elevated male death rates.

Deaths: Leading Causes for 2015.

PubMed

Heron, Melonie

2017-11-01

Objectives-This report presents final 2015 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2015," the National Center for Health Statistics' annual report of final mortality statistics. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2015. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. Results-In 2015, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Accidents (unintentional injuries); Cerebrovascular diseases; Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2015 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Deaths: Leading Causes for 2013.

PubMed

Heron, Melonie

2016-02-16

This report presents final 2013 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2013," the National Center for Health Statistics’ annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2013. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD–10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2013, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Accidents (unintentional injuries); Cerebrovascular diseases; Alzheimer’s disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2013 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Newborn affected by maternal complications of pregnancy; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Deaths: Leading Causes for 2011.

PubMed

Heron, Melonie

2015-07-27

This report presents final 2011 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements ‘‘Deaths: Final Data for 2011,’’ the National Center for Health Statistics’ annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2011. Causes of death classified by the International Classification of Diseases, 10th Revision (ICD–10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2011, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer’s disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2011 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Negative Freedom and Death in the United States

PubMed Central

Subramanian, S. V.

2010-01-01

Personal freedoms have been characterized as “positive” (freedom to pursue opportunities) and “negative” (freedom from external constraints on decision making). An ecological analysis of US data revealed a strong positive association (r = 0.41; P = .003) between state-level negative personal freedom (defined in terms of regulation of personal behavior) and state-level age-adjusted rates of unintentional injury. A conceptual emphasis on positive freedom construed as freedom to pursue a life without risk of unintentional injury could help motivate a conversation to improve public health. PMID:20167883

Injuries, Death, and Disability Associated with 11 Years of Conflict in Baghdad, Iraq: A Randomized Household Cluster Survey.

PubMed

Lafta, Riyadh; Al-Shatari, Sahar; Cherewick, Megan; Galway, Lindsay; Mock, Charles; Hagopian, Amy; Flaxman, Abraham; Takaro, Tim; Greer, Anna; Kushner, Adam; Burnham, Gilbert

2015-01-01

The objective of this study was to characterize injuries, deaths, and disabilities arising during 11 years of conflict in Baghdad. Using satellite imagery and administrative population estimated size for Baghdad, 30 clusters were selected, proportionate to population size estimates. Interviews were conducted during April and May 2014 in 900 households containing 5148 persons. Details about injuries and disabilities occurring from 2003 through May 2014 and resultant disabilities were recorded. There were 553 injuries reported by Baghdad residents, 225 of which were intentional, and 328 unintentional. For intentional injuries, the fatality rate was 39.1% and the disability rate 56.0%. Gunshots where the major cause of injury through 2006 when blasts/explosions became the most common cause and remained so through 2014. Among unintentional injuries, the fatality rate was 7.3% and the disability rate 77.1%. The major cause of unintentional injuries was falls (131) which have increased dramatically since 2008, followed by traffic related injuries (81), which have steadily increased. The proportion of injuries ending in disabilities remained fairly constant through the survey period. Intentional injuries added substantially to the burden of unintentional injuries for the population. For Baghdad, the phases of the Iraqi conflict are reflected in the patterns of injuries and consequent deaths reported. The scale of injuries during conflict is most certainly under-reported. Difficulties recalling injuries in a survey covering 11 years is a limitation, but it is likely that minor injuries were under-reported more than severe injuries. The in- and out-migration of Baghdad populations likely had effects on the events reported which we could not measure or estimate. Damage to the health infrastructure and the flight of health workers may have contributed to mortality and morbidity. Civilian injuries as well as mortality should be measured during conflicts, though not currently done.

Injuries, Death, and Disability Associated with 11 Years of Conflict in Baghdad, Iraq: A Randomized Household Cluster Survey

PubMed Central

Lafta, Riyadh; Al-Shatari, Sahar; Cherewick, Megan; Galway, Lindsay; Mock, Charles; Hagopian, Amy; Flaxman, Abraham; Takaro, Tim; Greer, Anna; Kushner, Adam; Burnham, Gilbert

2015-01-01

Background The objective of this study was to characterize injuries, deaths, and disabilities arising during 11 years of conflict in Baghdad. Methods Using satellite imagery and administrative population estimated size for Baghdad, 30 clusters were selected, proportionate to population size estimates. Interviews were conducted during April and May 2014 in 900 households containing 5148 persons. Details about injuries and disabilities occurring from 2003 through May 2014 and resultant disabilities were recorded. Findings There were 553 injuries reported by Baghdad residents, 225 of which were intentional, and 328 unintentional. For intentional injuries, the fatality rate was 39.1% and the disability rate 56.0%. Gunshots where the major cause of injury through 2006 when blasts/explosions became the most common cause and remained so through 2014. Among unintentional injuries, the fatality rate was 7.3% and the disability rate 77.1%. The major cause of unintentional injuries was falls (131) which have increased dramatically since 2008, followed by traffic related injuries (81), which have steadily increased. The proportion of injuries ending in disabilities remained fairly constant through the survey period. Interpretation Intentional injuries added substantially to the burden of unintentional injuries for the population. For Baghdad, the phases of the Iraqi conflict are reflected in the patterns of injuries and consequent deaths reported. The scale of injuries during conflict is most certainly under-reported. Difficulties recalling injuries in a survey covering 11 years is a limitation, but it is likely that minor injuries were under-reported more than severe injuries. The in- and out-migration of Baghdad populations likely had effects on the events reported which we could not measure or estimate. Damage to the health infrastructure and the flight of health workers may have contributed to mortality and morbidity. Civilian injuries as well as mortality should be measured during conflicts, though not currently done. PMID:26252879

Influence of changing travel patterns on child death rates from injury: trend analysis.

PubMed Central

DiGuiseppi, C.; Roberts, I.; Li, L.

1997-01-01

OBJECTIVES: To examine trends in child mortality from unintentional injury between 1985 and 1992 and to find how changes in modes of travel contributed to these trends. DESIGN: Poisson regression modelling using data from death certificates, censuses, and national travel surveys. SETTING: England and Wales. SUBJECTS: Resident children aged 0-14. MAIN OUTCOME MEASURES: Deaths from unintentional injury and poisoning. RESULTS: Child deaths from injury declined by 34% (95% confidence interval 28% to 40%) per 100,000 population between 1985 and 1992. Substantial decreases in each of the leading causes of death from injury contributed to this overall decline. On average, children walked and cycled less distance and travelled substantially more miles by car in 1992 compared with 1985. Deaths from road traffic accidents declined for pedestrians by 24% per mile walked and for cyclists by 20% per mile cycled, substantially less than the declines per 100,000 population of 37% and 38% respectively. In contrast, deaths of occupants of motor vehicles declined by 42% per mile travelled by car compared with a 21% decline per 100,000 population. CONCLUSIONS: If trends in child mortality from injury continue the government's target to reduce the rate by 33% by the year 2005 will be achieved. A substantial proportion of the decline in pedestrian traffic and pedal cycling deaths, however, seems to have been achieved at the expense of children's walking and cycling activities. Changes in travel patterns may exact a considerable price in terms of future health problems. PMID:9116546

Deaths: leading causes for 2010.

PubMed

Heron, Melonie

2013-12-20

This report presents final 2010 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the Division of Vital Statistics' annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2010. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2010, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Nephritis, nephrotic syndrome and nephrosis; Influenza and pneumonia; and Intentional self-harm (suicide). These 10 causes accounted for 75% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2010 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Necrotizing enterocolitis of newborn. Important variations in the leading causes of infant death are noted for the neonatal and post-neonatal periods. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Firearm Laws and Firearm Homicides: A Systematic Review.

PubMed

Lee, Lois K; Fleegler, Eric W; Farrell, Caitlin; Avakame, Elorm; Srinivasan, Saranya; Hemenway, David; Monuteaux, Michael C

2017-01-01

Firearm homicide is a leading cause of injury death in the United States, and there is considerable debate over the effectiveness of firearm policies. An analysis of the effectiveness of firearm laws on firearm homicide is important to understand optimal policies to decrease firearm homicide in the United States. To evaluate the association between firearm laws and preventing firearm homicides in the United States. We evaluated peer-reviewed articles from 1970 to 2016 focusing on the association between US firearm laws and firearm homicide. We searched PubMed, CINAHL, Lexis/Nexis, Sociological Abstracts, Academic Search Premier, the Index to Legal Periodicals and Books, and the references from the assembled articles. We divided laws into 5 categories: those that (1) curb gun trafficking, (2) strengthen background checks, (3) improve child safety, (4) ban military-style assault weapons, and (5) restrict firearms in public places and leniency in firearm carrying. The articles were assessed using the standardized Guide to Community Preventive Services data collection instrument and 5 additional quality metrics: (1) appropriate data source(s) and outcome measure(s) were used for the study, (2) the time frame studied was adequate, (3) appropriate statistical tests were used, (4) the analytic results were robust, and (5) the disaggregated results of control variables were consistent with the literature. In the aggregate, stronger gun policies were associated with decreased rates of firearm homicide, even after adjusting for demographic and sociologic factors. Laws that strengthen background checks and permit-to-purchase seemed to decrease firearm homicide rates. Specific laws directed at firearm trafficking, improving child safety, or the banning of military-style assault weapons were not associated with changes in firearm homicide rates. The evidence for laws restricting guns in public places and leniency in gun carrying was mixed. The strength of firearm legislation in general, and laws related to strengthening background checks and permit-to-purchase in particular, is associated with decreased firearm homicide rates. High-quality research is important to further evaluate the effectiveness of these laws. Legislation is just 1 part of a multipronged approach that will be necessary to decrease firearm homicides in the United States.

Nonnatural deaths of adolescents and teenagers: Fulton County, Georgia, 1985-2004.

PubMed

Heninger, Michael; Hanzlick, Randy

2008-09-01

Childhood deaths are carefully scrutinized by many different government agencies, fatality review panels, researchers, and other groups. Many such deaths, especially those that involve external causes such as injury and poisoning, are amenable to prevention. Characterizing the causes and circumstances of nonnatural childhood deaths may provide information that is useful for development of prevention strategies and programs. This is a retrospective review of all nonnatural deaths investigated and certified by the Fulton County Medical Examiner involving persons 10 to 19 years of age during the years 1985-2004, inclusive. Cases were identified by searching electronic death investigation files maintained during the study period. Demographic and circumstantial information were tabulated for homicides, suicides, motor-vehicle fatalities, and other accidental deaths, and crude death rates were calculated for each 5-year period during the study. During the 20 year period there were 961 nonnatural deaths among persons 10 to 19 years of age. Most deaths were due to homicide (48%) followed by motor-vehicle fatalities (30%), suicide (12%), and nontraffic accidental fatalities (10%). Black males had the highest death rates among the homicide, suicide, and nontraffic accidental deaths, although the rates for each of these were lower in the most recent 5 year period than the first 5-year period. The number of deaths increased in each category as age increased, and this observation was most marked for homicides and least marked for nontraffic accidental deaths. Firearms were involved in 88% of homicides and 61% of suicides. Most nontraffic accidental deaths were due to water-related accidents, followed by drug and/or alcohol toxicity, fire-related injuries, and accidental firearms injuries. Homicide accounts for almost half of all deaths among persons 10 to 19 years of age. Black males are at particularly high risk for nonnatural death in comparison with other race/sex groups, especially for homicide. If effective firearm fatality prevention strategies and programs could be implemented, data in this study suggests that such a measure alone could cut in half the nonnatural mortality rate in the 10 to 19 year age group in Fulton County. Although homicide and suicide rates have declined, there remains room for improvement in these areas, as is the case for traffic-related and other accidental fatalities.

Effects of the repeal of Missouri's handgun purchaser licensing law on homicides.

PubMed

Webster, Daniel; Crifasi, Cassandra Kercher; Vernick, Jon S

2014-04-01

In the USA, homicide is a leading cause of death for young males and a major cause of racial disparities in life expectancy for men. There are intense debate and little rigorous research on the effects of firearm sales regulation on homicides. This study estimates the impact of Missouri's 2007 repeal of its permit-to-purchase (PTP) handgun law on states' homicide rates and controls for changes in poverty, unemployment, crime, incarceration, policing levels, and other policies that could potentially affect homicides. Using death certificate data available through 2010, the repeal of Missouri's PTP law was associated with an increase in annual firearm homicides rates of 1.09 per 100,000 (+23%) but was unrelated to changes in non-firearm homicide rates. Using Uniform Crime Reporting data from police through 2012, the law's repeal was associated with increased annual murders rates of 0.93 per 100,000 (+16%). These estimated effects translate to increases of between 55 and 63 homicides per year in Missouri.

FiGHTS: a preliminary screening tool for adolescent firearms-carrying.

PubMed

Hayes, D Neil; Sege, Robert

2003-12-01

Adolescent firearms-carrying is a risk factor for serious injury and death. Clinical screening tools for firearms-carrying have not yet been developed. We present the development of a preliminary screening test for adolescent firearms-carrying based on the growing body of knowledge of firearms-related risk factors. A convenience sample of 15,000 high school students from the 1999 National Youth Risk Behavior Survey was analyzed for the purpose of model building. Known risk factors for firearms-carrying were candidates for 2 models predicting recent firearms-carrying. The "brief FiGHTS score" screening tool excluded terms related to sexual behavior, significant substance abuse, or criminal behavior (Fi=fighting, G=gender, H=hurt while fighting, T=threatened, S=smoker). An "extended FiGHTS score," which included 13 items, was developed for more precise estimates. The brief FiGHTS score had a sensitivity of 82%, a specificity of 71%, and an area under the receiver operating characteristic (ROC) curve of 0.84. The extended FiGHTS score had an area under the ROC curve of 0.90. Both models performed well in a validation data set of 55,000 students. The brief and extended FiGHTS scores have high sensitivity and specificity for predicting firearms-carrying and may be appropriate for clinical testing.

Firearm and nonfirearm homicide in 5 South African cities: a retrospective population-based study.

PubMed

Matzopoulos, Richard G; Thompson, Mary Lou; Myers, Jonathan E

2014-03-01

We assessed the effectiveness of South Africa's Firearm Control Act (FCA), passed in 2000, on firearm homicide rates compared with rates of nonfirearm homicide across 5 South African cities from 2001 to 2005. We conducted a retrospective population-based study of 37 067 firearm and nonfirearm homicide cases. Generalized linear models helped estimate and compare time trends of firearm and nonfirearm homicides, adjusting for age, sex, race, day of week, city, year of death, and population size. There was a statistically significant decreasing trend regarding firearm homicides from 2001, with an adjusted year-on-year homicide rate ratio of 0.864 (95% confidence interval [CI] = 0.848, 0.880), representing a decrease of 13.6% per annum. The year-on-year decrease in nonfirearm homicide rates was also significant, but considerably lower at 0.976 (95% CI = 0.954, 0.997). Results suggest that 4585 (95% CI = 4427, 4723) lives were saved across 5 cities from 2001 to 2005 because of the FCA. Strength, timing and consistent decline suggest stricter gun control mediated by the FCA accounted for a significant decrease in homicide overall, and firearm homicide in particular, during the study period.

Middle School Youth Risk Behavior Study, 2003

ERIC Educational Resources Information Center

Whalen, Laura G.; Grunbaum, Jo Anne; Kinchen, Steve; McManus, Tim; Shanklin, Shari L.; Kann, Laura

2005-01-01

In the United States, nearly two-thirds of all deaths among young people 10-14 years of age result from only five causes: motor-vehicle crashes (22.1%), other unintentional injuries (16.7%), cancer (12.9%), suicide (6.8%), and homicide (4.7%). Leading causes of illness and death in all age groups in the United States are related to the following:…

2005 Middle School Youth Risk Behavior Survey

ERIC Educational Resources Information Center

Shanklin, Shari L.; Brener, Nancy; McManus, Tim; Kinchen, Steve; Kann, Laura

2007-01-01

In the United States, nearly two-thirds of all deaths among young people aged 10-14 years result from only five causes: motor-vehicle crashes (23.4%), other unintentional injuries (15.7%), cancer (12.5%), suicide (7.2%), and homicide (5.2%). Across all age groups in the United States, the leading causes of illness and death are related to the…

Rising longitudinal trajectories in suicide rates: The role of firearm suicide rates and firearm legislation.

PubMed

Anestis, Michael D; Selby, Edward A; Butterworth, Sarah E

2017-07-01

Firearms account for approximately half of all US suicide deaths each year despite being utilized in only a small minority of suicide attempts. We examined the extent to which overall suicide rates fluctuated relative to firearm and non-firearm suicide rates across a period of 16years (1999-2015). We further tested the notion of means substitution by examining the association between firearm suicide rates and non-firearm suicide rates. Lastly, we examined the extent to which the presence of specific laws related to handgun ownership previously shown cross-sectionally to be associated with lower suicide rates (universal background checks, mandatory waiting periods) were associated with an attenuated trajectory in suicide rates across the study period. As anticipated, whereas decreases in firearm suicide rates were associated with decreases in overall suicide rates (b=0.46, SE=0.07, p<0.001), decreases in firearm suicides were not associated with off-setting increases in suicides by other methods (b=-0.04, SE=0.05, p=0.36). Furthermore, the absence of universal background check (b=0.12, SE=0.05, p=0.028) and mandatory waiting period (b=0.16, SE=0.06, p=0.008) laws was associated with a more steeply rising trajectory of statewide suicide rates. These results mitigate concerns regarding means substitution and speak to the potential high yield impact of systematically implemented means safety prevention efforts focused on firearms. Copyright © 2017 Elsevier Inc. All rights reserved.

Yes, You Can: Physicians, Patients, and Firearms.

PubMed

Wintemute, Garen J; Betz, Marian E; Ranney, Megan L

2016-08-02

Physicians have unique opportunities to help prevent firearm violence. Concern has developed that federal and state laws or regulations prohibit physicians from asking or counseling patients about firearms and disclosing patient information about firearms to others, even when threats to health and safety may be involved. This is not the case. In this article, the authors explain the statutes in question, emphasizing that physicians may ask about firearms (with rare exceptions), may counsel about firearms as they do about other health matters, and may disclose information to third parties when necessary. The authors then review circumstances under which questions about firearms might be most appropriate if they are not asked routinely. Such circumstances include instances when the patient provides information or exhibits behavior suggesting an acutely increased risk for violence, whether to himself or others, or when the patient possesses other individual-level risk factors for violence, such as alcohol abuse. The article summarizes the literature on current physician practices in asking and counseling about firearms, which are done far less commonly than recommended. Barriers to engaging in those practices, the effectiveness of clinical efforts to prevent firearm-related injuries, and what patients think about such efforts and physicians who engage in them are discussed. Proceeding from the limited available evidence, the authors make specific recommendations on how physicians might counsel their patients to reduce their risk for firearm-related death or serious injury. Finally, the authors review the circumstances under which disclosure of patient information about firearms to third parties is supported by regulations implementing the Health Insurance Portability and Accountability Act.

Comparative mortality among US military personnel in the Persian Gulf region and worldwide during Operations Desert Shield and Desert Storm.

PubMed

Writer, J V; DeFraites, R F; Brundage, J F

1996-01-10

To determine cause-specific mortality rates among US troops stationed in the Persian Gulf region and compare them with those of US troops serving elsewhere during Operations Desert Shield and Desert Storm. Retrospective cohort. US men and women on active duty from August 1, 1990, through July 31, 1991. Deaths occurring among all active-duty US military persons during the 1-year study period. Age-adjusted mortality rates among US troops stationed in the Persian Gulf region were compared with rates projected from mortality rates among troops on active duty elsewhere. A total of 1769 active-duty persons died during the study period, 372 in the Persian Gulf region and 1397 elsewhere. Of the 372 deaths in the Persian Gulf region, 147 (39.5%) occurred as a direct result of combat during the war, 194 (52.2%) resulted from injuries not incurred in battle, and 30 (8%) resulted from illness. Twenty-three of the deaths due to illness were considered unexpected or cardiovascular deaths. Based on age-adjusted mortality rates observed among US troops on active duty outside the Persian Gulf region, 165 deaths from unintentional injury and 32 deaths from illness (20 of which were unexpected or cardiovascular) would have been anticipated among Persian Gulf troops. Except for deaths from unintentional injury, US troops in the Persian Gulf region did not experience significantly higher mortality rates than US troops serving elsewhere. There were no clusters of unexplained deaths. The number and circumstances of nonbattle deaths among Persian Gulf troops were typical for the US military population.

American Indian and Alaska Native Infant and Pediatric Mortality, United States, 1999–2009

PubMed Central

Gachupin, Francine C.; Holman, Robert C.; MacDorman, Marian F.; Cheek, James E.; Holve, Steve; Singleton, Rosalyn J.

2014-01-01

Objectives. We described American Indian/Alaska Native (AI/AN) infant and pediatric death rates and leading causes of death. Methods. We adjusted National Vital Statistics System mortality data for AI/AN racial misclassification by linkage with Indian Health Service (IHS) registration records. We determined average annual death rates and leading causes of death for 1999 to 2009 for AI/AN versus White infants and children. We limited the analysis to IHS Contract Health Service Delivery Area counties. Results. The AI/AN infant death rate was 914 (rate ratio [RR] = 1.61; 95% confidence interval [CI] = 1.55, 1.67). Sudden infant death syndrome, unintentional injuries, and influenza or pneumonia were more common in AI/AN versus White infants. The overall AI/AN pediatric death rates were 69.6 for ages 1 to 4 years (RR = 2.56; 95% CI = 2.38, 2.75), 28.9 for ages 5 to 9 years (RR = 2.12; 95% CI = 1.92, 2.34), 37.3 for ages 10 to 14 years (RR = 2.22; 95% CI = 2.04, 2.40), and 158.4 for ages 15 to 19 years (RR = 2.71; 95% CI = 2.60, 2.82). Unintentional injuries and suicide occurred at higher rates among AI/AN youths versus White youths. Conclusions. Death rates for AI/AN infants and children were higher than for Whites, with regional disparities. Several leading causes of death in the AI/AN pediatric population are potentially preventable. PMID:24754619

Suicide and unintentional injury mortality among homeless people: a Danish nationwide register-based cohort study.

PubMed

Feodor Nilsson, Sandra; Hjorthøj, Carsten Rygaard; Erlangsen, Annette; Nordentoft, Merete

2014-02-01

Homeless people have elevated mortality, especially due to external causes. We aimed to examine suicide and unintentional injury mortality levels and identify predictors in the homeless population. A nationwide, register-based cohort study of homeless people aged 16 years and older was carried out using the Danish Homeless Register, 1999-2008. In all, 32 010 homeless people (70.5% men) were observed. For men, the mortality rate was 174.4 [95% confidence interval (CI) = 150.6-198.1] per 100 000 person-years for suicide and 463.3 (95% CI = 424.6-502.0) for unintentional injury. For women, the corresponding rates were 111.4 (95% CI = 81.7-141.1) for suicide and 241.4 (95% CI = 197.6-285.1) for unintentional injury. Schizophrenia spectrum, affective, personality and substance use disorders were strongly associated with increased risk of suicide; the highest risk estimates were found for schizophrenia spectrum disorders among both men [hazard ratio (HR) = 3.1, 95% CI = 2.0-4.9] and women (HR = 15.5, 95% CI = 4.5-54.0). Alcohol and drug use disorders were predictors of death by unintentional injury for both men and women, whereas schizophrenia spectrum disorders and personality disorders were only significant predictors among men; the highest risk estimates were found for drug use disorders among men (HR = 2.2, 95% CI = 1.8-2.8) and women (HR = 3.1, 95% CI = 1.8-5.4). A history of psychiatric admission and emergency room contact were predictors for dying by suicide and unintentional injury. People in the homeless shelter population with a history of a psychiatric disorder constitute a high-risk group regarding the elevated suicide and unintentional injury mortality.

Trends in BB/pellet gun injuries in children and teenagers in the United States, 1985–99

PubMed Central

Nguyen, M; Annest, J; Mercy, J; Ryan, G; Fingerhut, L

2002-01-01

Objective: To characterize national trends in non-fatal BB/pellet gun related injury rates for persons aged 19 years or younger in relation to trends in non-fatal and fatal firearm related injury rates and discuss these trends in light of injury prevention and violence prevention efforts. Setting: The National Electronic Injury Surveillance System (NEISS) includes approximately 100 hospitals with at least six beds that provide emergency services. These hospitals comprise a stratified probability sample of all US hospitals with emergency departments. The National Vital Statistics System (NVSS) is a complete census of all death certificates filed by states and is compiled annually. Methods: National data on BB/pellet gun related injuries and injury rates were examined along with fatal and non-fatal firearm related injuries and injury rates. Non-fatal injury data for all BB/pellet gun related injury cases from 1985 through 1999, and firearm related injury cases from 1993 through 1999 were obtained from hospital emergency department records using the NEISS. Firearm related deaths from 1985 through 1999 were obtained from the NVSS. Results: BB/pellet gun related injury rates increased from age 3 years to a peak at age 13 years and declined thereafter. In contrast, firearm related injury and death rates increased gradually until age 13 and then increased sharply until age 18 years. For persons aged 19 years and younger, BB/pellet gun related injury rates increased from the late 1980s until the early 1990s and then declined until 1999; these injury rates per 100 000 population were 24.0 in 1988, 32.8 in 1992, and 18.3 in 1999. This trend was similar to those for fatal and non-fatal firearm related injury rates per 100 000 which were 4.5 in 1985, 7.8 in 1993, and 4.3 in 1999 (fatal) and 38.6 in 1993 and 16.3 in 1999 (non-fatal). In 1999, an estimated 14 313 (95% confidence interval (CI) 12 025 to 16 601) cases with non-fatal BB/pellet gun injuries and an estimated 12 748 (95% CI 7881–17 615) cases with non-fatal firearm related injuries among persons aged 19 years and younger were treated in US hospital emergency departments. Conclusions: BB/pellet gun related and firearm related injury rates show similar declines since the early 1990s. These declines coincide with a growing number of prevention efforts aimed at reducing injuries to children from unsupervised access to guns and from youth violence. Evaluations at the state and local level are needed to determine true associations. PMID:12226113

Effective trauma center partnerships to address firearm injury: a new paradigm.

PubMed

Richmond, Therese S; Schwab, C William; Riely, Jeaneen; Branas, Charles C; Cheney, Rose; Dunfey, Maura

2004-06-01

Firearm violence is the second leading cause of injury-related death. This study examined the use of local trauma centers as lead organizations in their communities to address firearm injury. Three trauma centers in cities with populations less than 100,000 were linked with a university-based firearm injury research center. A trauma surgeon director and coordinator partnered with communities, recruited and directed advisory boards, established a local firearm injury surveillance system, and informed communities using community-specific profiles. Primary process and outcome measures included completeness of data, development of community-specific profiles, number of data-driven consumer media pieces, number of meetings to inform policy makers, and an analysis of problems encountered. Local trauma centers in smaller communities implemented a firearm injury surveillance system, produced community-specific injury profiles, and engaged community leaders and policy makers to address firearm injury. Community-specific profiles demonstrated consistent firearm suicide rates (6.58-6.82 per 100,000) but variation in firearm homicide rates (1.08-12.5 per 100,000) across sites. There were 63 data-driven media pieces and 18 forums to inform community leaders and policy makers. Completeness of data elements ranged from 57.1% to 100%. Problems experienced were disconnected data sources, multiple data owners, potential for political fallout, limited trauma center data, skills sets of medical professionals, and sustainability. Trauma centers, when provided resources and support, with the model described, can function as lead organizations in partnering with the community to acquire and use community-specific data for local firearm injury prevention.

Confronting Death From Drug Self-Intoxication (DDSI): Prevention Through a Better Definition

PubMed Central

Smith, Gordon S.; Caine, Eric D.; Kapusta, Nestor D.; Hanzlick, Randy L.; Larkin, G. Luke; Naylor, Charles P. E.; Nolte, Kurt B.; Miller, Ted R.; Putnam, Sandra L.; De Leo, Diego; Kleinig, John; Stack, Steven; Todd, Knox H.; Fraser, David W.

2014-01-01

Suicide and other self-directed violence deaths are likely grossly underestimated, reflecting inappropriate classification of many drug intoxication deaths as accidents or unintentional and heterogeneous ascertainment and coding practices across states. As the tide of prescription and illicit drug-poisoning deaths is rising, public health and research needs would be better satisfied by considering most of these deaths a result of self-intoxication. Epidemiologists and prevention scientists could design better intervention strategies by focusing on premorbid behavior. We propose incorporating deaths from drug self-intoxication and investigations of all poisoning deaths into the National Violent Death Reporting System, which contains misclassified homicides and undetermined intent deaths, to facilitate efforts to comprehend and reverse the surging rate of drug intoxication fatalities. PMID:25320874

Firearm and Nonfirearm Homicide in 5 South African Cities: A Retrospective Population-Based Study

PubMed Central

Thompson, Mary Lou; Myers, Jonathan E.

2014-01-01

Objective. We assessed the effectiveness of South Africa’s Firearm Control Act (FCA), passed in 2000, on firearm homicide rates compared with rates of nonfirearm homicide across 5 South African cities from 2001 to 2005. Methods. We conducted a retrospective population-based study of 37 067 firearm and nonfirearm homicide cases. Generalized linear models helped estimate and compare time trends of firearm and nonfirearm homicides, adjusting for age, sex, race, day of week, city, year of death, and population size. Results. There was a statistically significant decreasing trend regarding firearm homicides from 2001, with an adjusted year-on-year homicide rate ratio of 0.864 (95% confidence interval [CI] = 0.848, 0.880), representing a decrease of 13.6% per annum. The year-on-year decrease in nonfirearm homicide rates was also significant, but considerably lower at 0.976 (95% CI = 0.954, 0.997). Results suggest that 4585 (95% CI = 4427, 4723) lives were saved across 5 cities from 2001 to 2005 because of the FCA. Conclusions. Strength, timing and consistent decline suggest stricter gun control mediated by the FCA accounted for a significant decrease in homicide overall, and firearm homicide in particular, during the study period. PMID:24432917

Unintentional injury prevention and the role of occupational therapy in the Solomon Islands: an integrative review.

PubMed

Daufanamae, Barbara U; Franklin, Richard C; Eagers, Jackie

2016-01-01

Unintentional injuries (injuries for which there is no evidence of a predetermined intent) are one of the leading causes of death worldwide, particularly in low- and middle-income countries (LMICs). Although evidence demonstrates unintentional injuries are preventable it is a public health challenge for many LMICs such as the Solomon Islands. Occupational therapists are well placed to contribute to injury prevention, as they have specialised skills to analyse the accessibility and safety of the environments within which people conduct their daily occupations. While the role of occupational therapy in unintentional injury prevention is well known in high-income countries, it is unfamiliar in LMICs, especially in the Solomon Islands. This integrative review aimed to explore the incidence of common unintentional injuries, and the burden in the Solomon Islands; and explore the potential role of occupational therapy in unintentional injury prevention in the Solomon Islands, based on current activities in LMICs. Articles were reviewed from six databases (Medline, CINAHL, OTDBase, OT Seeker, Scopus and PsychInfo). Five articles met the inclusion criteria for the first objective and 15 articles met the inclusion criteria for the second objective. These articles were thematically analysed where themes and codes associated with the research objectives were extracted and analysed. Unintentional injuries in the Solomon Islands reported in the literature included ocular trauma, falls from fruit trees and coconut palms, and road traffic crashes. Burden of injury reported was mostly associated with loss of productivity. Occupational therapists undertook rehabilitative, biomechanical, neurodevelopmental and educational roles in LMIC, focusing on tertiary and secondary injury prevention. This integrative review suggests that there is limited information regarding injury in the Solomon Islands. However, evidence is available in LMICs to suggest that occupational therapy services can play a potential significant role in unintentional injury prevention, demonstrating a need for establishing injury prevention within the occupational therapy role in the Solomon Islands.

The Hidden Tragedy of Rivers: A Decade of Unintentional Fatal Drowning in Australia.

PubMed

Peden, Amy E; Franklin, Richard C; Leggat, Peter A

2016-01-01

Describe unintentional drowning deaths in rivers, creeks and streams (rivers) in Australia and identify risk factors to inform prevention. This study is a cross-sectional, total population audit of all unintentional fatal drownings in Australian rivers between 1-July-2002 and 30-June-2012 using Australian coronial data. A modified Bonferroni test has been applied, deeming statistical significance p<0.03 and p<0.04 respectively. Rivers (n = 770; 26.6%) were the leading location among the 2,892 people who died from unintentional fatal drowning. This is a rate of 0.37/100,000 people / annum. Within river drowning deaths common groups include; males (80.4%), adults (85.3%), adults who have consumed alcohol (25.5%), people who fell in (21.3%), people involved in non-aquatic transport incidents (18.2%) and locals (74.0%). Children were 1.75 times more likely than adults (p<0.04) to drown in rivers as a result of a fall and adults 1.50 times more likely to drown in rivers as a result of watercraft incidents when compared to children. When compared to males, females were 2.27 and 4.45 times respectively more likely to drown in rivers as a result of incidents involving non-aquatic transport (p<0.04) and being swept away by floodwaters (p<0.04). Males were 2.66 and 4.27 times respectively more likely to drown in rivers as a result of watercraft incidents (p<0.04) and as a result of jumping in (p<0.04) when compared to females. While rivers are the leading location for drowning in Australia, little is understood about the risks. This study has identified key groups (males, adults, locals) and activities. While males were more likely to drown, the risk profile for females differed.

The American College of Preventive Medicine Policy Recommendations on Reducing and Preventing Firearm-Related Injuries and Deaths.

PubMed

Strong, Bethany L; Ballard, Sarah-Blythe; Braund, Wendy

2016-12-01

The American College of Preventive Medicine Policy Committee makes policy guidelines and recommendations on preventive medicine and public health topics for public health decision makers. After a review of the current evidence available in 2016, the College is providing a consensus-based set of policy recommendations designed to reduce firearm-related morbidity and mortality in the U.S. These guidelines address seven general areas pertaining to the public health threat posed by firearms: gun sales and background checks, assault weapons and high-capacity weapons, mental health, research funding, gun storage laws, and physician counseling. Copyright © 2016 American Journal of Preventive Medicine. All rights reserved.

2005 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel

DTIC Science & Technology

2006-12-01

disease, cancer , or stroke; unintentional injuries were the fifth leading cause of death in the United States in 2000, after heart disease, cancer ...states (National Highway Traffic Safety Administration [NHTSA], 2002). In addition, cancer screening procedures, such as Pap tests, can detect...potentially malignant cell growths early in their development. Thus, although cervical cancer is a major cause of cancer -related deaths among women

A Crime Scene Fabricated as Suicide.

PubMed

Amararatne, Rrg Sriyantha; Vidanapathirana, Muditha

2017-02-01

When ascertaining the manner of death, the forensic pathologist should be careful, because in some instances, attempts are made by the criminals to conceal homicides as suicides. The case under discussion highlights the contribution of the forensic pathologist in the ascertainment of the manner in firearm deaths. The deceased was a poacher and his dead body was found in a cashew land with his shotgun lying over him. The shirt had a roughly circular defect with muzzle mark, and burnt and blackened margin. Beneath that, on front of the left upper chest a 2cm diameter circular, perforated laceration, with muzzle imprint and, burnt and blackened margin was found. Shelving was found at the upper margin. Chest X-ray showed the downward pellet distribution. Cause of death was chest injuries due to pellets discharged from a smooth bore weapon. Length of the upper arm reach was 65cm (25 inches) and the length from the muzzle to the trigger was 79cm (31 inches). In conclusion, it was found to be a fabricated suicide scene and the manner of death was ascertained as homicide. This reiterates that the postmortem investigation of firearm deaths should be performed or conducted under direct supervision of forensic specialist to deliver justice.

A Crime Scene Fabricated as Suicide

PubMed Central

Amararatne, RRG Sriyantha

2017-01-01

When ascertaining the manner of death, the forensic pathologist should be careful, because in some instances, attempts are made by the criminals to conceal homicides as suicides. The case under discussion highlights the contribution of the forensic pathologist in the ascertainment of the manner in firearm deaths. The deceased was a poacher and his dead body was found in a cashew land with his shotgun lying over him. The shirt had a roughly circular defect with muzzle mark, and burnt and blackened margin. Beneath that, on front of the left upper chest a 2cm diameter circular, perforated laceration, with muzzle imprint and, burnt and blackened margin was found. Shelving was found at the upper margin. Chest X-ray showed the downward pellet distribution. Cause of death was chest injuries due to pellets discharged from a smooth bore weapon. Length of the upper arm reach was 65cm (25 inches) and the length from the muzzle to the trigger was 79cm (31 inches). In conclusion, it was found to be a fabricated suicide scene and the manner of death was ascertained as homicide. This reiterates that the postmortem investigation of firearm deaths should be performed or conducted under direct supervision of forensic specialist to deliver justice. PMID:28384886

Teen Suicide and Changing Cause-of-Death Certification, 1953-1987.

ERIC Educational Resources Information Center

Males, Mike

1991-01-01

Examined whether tripling in teenage suicides since 1950s represents increase in suicides or in skill of medical examiners. Examined firearms and poisoning death from 1953-87. Concludes that increase in youth suicide is less dramatic than reported, and suicide increase indicated among youths and adults occurred from 1964-71 and has since…

[Map of homicides by firearms: profile of the victims and the assaults].

PubMed

Trindade, Ruth França Cizino da; Costa, Flávia Azevedo de Mattos Moura; Silva, Patrícia de Paula Alves Costa da; Caminiti, Gustavo Bussi; Santos, Claudia Benedita dos

2015-10-01

Describing the profile of victims and assaults by gunshot, where the outcome was death. An ecological study conducted in the city of Maceió/AL, in 2012. Data were collected from the death statements. The variables studied were: the death circumstances, gender, age, marital status, place, date, time, month and proportion according to the occurring neighborhood. The homicide mortality rate was 65.2 per 100,000 inhabitants, with 130.6 per 100,000 men and 7.8 per 100,000 women. Of the total number of homicides, 93.6% of the victims were men. The age group between 15 and 29 years of age was the most affected, with 68.8%. In 97.6% of cases the death occurred at the site of aggression, 74.1% in the streets. In relation to the date, 54.2% of cases occurred between Friday and Sunday. 59.7% of the homicides were concentrated in seven neighborhoods. The map of violence presented shows heterogeneous areas for the occurrence of assaults with firearms, characterizing the existing urban inequality in violence distribution.

Unintentional childhood poisoning in the Sharon area in Israel: a prospective 5-year study.

PubMed

Uziel, Y; Adler, A; Aharonowitz, G; Franco, S; Fainmesser, P; Wolach, B

2005-04-01

To study the epidemiology and risk factors for unintentional exposure to poisoning among the Jewish and the Arab population in the Sharon area in Israel. We prospectively evaluated visits to the pediatric emergency department because of unintentional poisoning exposure, at the Meir General Hospital. We collected demographic data, substance exposure data, and the clinical outcome of the poisoning. During the 5 years of the study, 502 children were evaluated for unintentional poisoning, 84% Jewish and 16% Arabs; 88.5% occurred in children younger than 5 years, with a peak incidence at the age of 2 years (39.5%). Medications including hormones, vitamins, and antibiotics were the most common cause of exposure. Most children (95%) had no symptoms or abnormal findings on physical examination (84%), and most (85%) were discharged after several hours of observation. However, children of Arab origin presented with severe clinical manifestations because of a high rate of pesticide poisoning. There was 1 death from organic phosphate poisoning. Exposure to poisoning is commonly encountered in children. Pesticides exposure is more common in the Arab community and is usually associated with more severe clinical manifestations. Educational preventive programs are mandatory.

Wounds caused by firearms in El Salvador, 2003-2004: epidemiological issues.

PubMed

Paniagua, Ignacio; Crespin, Emperatriz; Guardado, Ademar; Mauricio, Ana

2005-01-01

This study presents data from hospital records in El Salvador describing the features of 100 patients admitted to a public hospital with firearm wounds. Wounds caused by Firearms (WFA) account for 70 per cent of homicides; 30 per cent of WFA homicides died in hospital. For every death in hospital there are five admissions who need treatment and survive. The typical victim is a young man with reasonable education but poor earning capacities and some family responsibilities, who lives in an urban setting where drugs, alcohol and firearms are commonplace. Extrapolating from this study, an estimated 2,580 people were treated in El Salvador hospitals during 2003; and of these 2,400 were treated in public hospitals at a cost to the state of 7.4 million USD, just over seven per cent of the health budget. Using further extrapolations, the total social costs for WFA morbidity would amount to around 34 million USD. There needs to be greater controls on firearms, public education on their risks and a more unified surveillance system.

[Prehospital emergency care in Mexico City: the opportunities of the healthcare system].

PubMed

Pinet, Luis M

2005-01-01

Unintentional vehicle traffic injuries cause 1.2 million preventable deaths per year worldwide, mostly affecting the population in their productive years of life. In Mexico, unintentional vehicle traffic injuries are one of the main causes of death; in Mexico City they account for 8% of deaths. Prehospital systems are set up to provide hospital medical care to the population, by means of a complex network that includes transportation, communications, resources (material, financial and human), and public participation. These systems may be designed in a variety of ways, depending on availability, capacity and quality of resources, according to specific community needs, always abiding by laws and regulations. In Mexico, several institutions and organizations offer prehospital services without being overseen in terms of coordination, regulation and performance evaluation, despite the high rates of morbidity and mortality due to injuries and preventable conditions amenable to effective therapy during the prehospital period. Prehospital care may contribute to decrease the morbidity and mortality rates of injuries requiring prompt medical care. Emphasis is made on the importance of assessing the performance of prehospital care, as well as on identification of needs for future development.

[Mortality due to pesticide poisoning in Colombia, 1998-2011].

PubMed

Chaparro-Narváez, Pablo; Castañeda-Orjuela, Carlos

2015-08-01

Poisoning due to pesticides is an important public health problem worldwide due its morbidity and mortality. In Colombia, there are no exact data on mortality due to pesticide poisoning. To estimate the trend of mortality rate due to pesticide poisoning in Colombia between 1998 and 2011. We carried out a descriptive analysis with the database reports of death as unintentional poisoning, self-inflicted intentional poisoning, aggression with pesticides, and poisoning with non-identified intentionality, population projections between 1998 and 2011, and rurality indexes. Crude and age-adjusted mortality rates were estimated and trends and Spearman coefficients were evaluated. A total of 4,835 deaths were registered (age-adjusted mortality rate of 2.38 deaths per 100,000 people). Mortality rates were higher in rural areas, for self-inflicted intentional poisoning, in men and in age groups between 15 and 39 years old. The trend has been decreasing since 2002. Municipality mortality rates due to unintentional poisoning and aggression correlated significantly with the rurality index in less rural municipalities. Mortality rates due to pesticide poisoning presented a mild decrease between 1998 and 2011. It is necessary to adjust and reinforce the measures conducive to reducing pesticide exposure in order to avoid poisoning and reduce mortality.

Agricultural and horticultural chemical poisonings: mortality and morbidity in the United States.

PubMed

Klein-Schwartz, W; Smith, G S

1997-02-01

To provide a comprehensive analysis of morbidity and mortality from poisoning by agricultural and horticultural chemicals in the United States. Descriptive analysis of national mortality data, National Hospital Discharge Survey data, and American Association of Poison Control Centers national data for 1985 through 1990. There were 341 fatalities from agricultural and horticultural chemicals over the 6-year period, of which 64% were suicides, 28% were unintentional, and 8% were of undetermined intent. There were 25,418 hospitalizations; 78% were reported to be unintentional. Both deaths and hospitalizations occurred more frequently in males, and rates were higher in nonwhites than in whites. There were 338,170 poison exposures reported to poison centers for fungicides, herbicides, pesticides/insecticides, and rodenticides. Life-threatening manifestations or long-term sequelae occurred in 782 cases, and 97 deaths were reported. Pesticides and insecticides accounted for 72% of the poison center cases and 63% of the fatalities. Although they accounted for only 8% of poison exposures, herbicide deaths were disproportionately high (25%). Poisonings with agricultural and horticultural chemicals are an important public health problem. Prevention efforts need to incorporate the fact that many serious cases, such as paraquat poisonings, are suicidal in nature.

Exposure to violence and victimization and the use of violence by adolescents in the United States.

PubMed

Champion, H L; Durant, R H

2001-06-01

Violence by adolescents in the United States is of growing concern. Despite a decrease in the rate of violence and death by firearms, firearm injuries are the second leading cause of death among Americans age 15 to 24 and the third leading cause of death among 10- to 14-year-old children. Although there are many factors associated with the use of violence by youths, exposure to violence and victimization has consistently been a predictor of the use of violence, as well as intentions to use violence, carrying a gun, and having attitudes accepting of the use of violence and aggressive behavior to resolve conflict. Adolescents' families, friends, neighborhoods, schools, and the media provide sources of exposure and victimization related to the use of violence. The cultural transmission of deviant behavior theory establishes a framework for understanding the influence of exposure to violence and victimization from these sources on adolescents' use of violence.

Effective interventions for unintentional injuries: a systematic review and mortality impact assessment among the poorest billion.

PubMed

Vecino-Ortiz, Andres I; Jafri, Aisha; Hyder, Adnan A

2018-05-01

Between 1990 and 2015, the global injury mortality declined, but in countries where the poorest billion live, injuries are becoming an increasingly prevalent cause of death. The vulnerability of this population requires immediate attention from policy makers to implement effective interventions that lessen the burden of injuries in these countries. Our aim was two-fold; first, to review all the evidence on effective interventions for the five main types of unintentional injury; and second, to estimate the potential number of lives saved by effective injury interventions among the poorest billion. For our systematic review we used references in the Disability Control Priorities third edition, and searched PubMed and the Cochrane database for papers published until Sept 10, 2016, using a comprehensive search strategy to find interventions for the five major causes of unintentional injuries: road traffic crashes, falls, drowning, burns, and poisoning. Studies were included if they presented evidence with significant effects sizes for any outcome; no inclusions or exclusions made on the basis of where the study was carried out (ie, low-income, middle-income, or high-income country). Then we used data from the Global Burden of Disease 2015 study and a Monte Carlo simulation technique to estimate the potential annual attributable number of lives saved among the poorest billion by these evidence-based injury interventions. We estimated results for 84 countries where the poorest billion live. From the 513 papers identified, 47 were eligible for inclusion. We identified 11 interventions that had an effect on injury mortality. For road traffic deaths, the most successful interventions in preventing deaths are speed enforcement (>80 000 lives saved per year) and drink-driving enforcement (>60 000 lives saved per year). Interventions potentially most effective in preventing deaths from drowning are formal swimming lessons for children younger than 14 years (>25 000 lives saved per year) and the use of crèches to supervise younger children (younger than 5 years; >10 000 lives saved per year). We did not find sufficient evidence on interventions for other causes of unintentional injuries (poisoning, burns, and falls) to run similar simulations. Based on the little available evidence, key interventions have been identified to prevent lives lost from unintentional injuries among the poorest billion. This Article provides guidance to national authorities on evidence-based priority interventions that can reduce the burden of injuries among the most vulnerable members of the population. We also identify an important gap in knowledge on the effectiveness and the mortality impacts of injury interventions. Partly supported by the Fogarty International Center of the US National Institutes of Health (Chronic Consequences of Trauma, Injuries, Disability Across the Lifespan: Uganda; #D43TW009284). Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Are "goods for guns" good for the community? An update of a community gun buyback program.

PubMed

Green, Jonathan; Damle, Rachelle N; Kasper, Rebecca E; Violano, Pina; Manno, Mariann; Nazarey, Pradeep P; Aidlen, Jeremy T; Hirsh, Michael P

2017-08-01

Gun violence remains a leading cause of death in the United States. Community gun buyback programs provide an opportunity to dispose of extraneous firearms. The purpose of this study was to understand the demographics, motivation, child access to firearms, and household mental illness of buyback participants in hopes of improving the program's effectiveness. A 2015 Injury Free Coalition for Kids gun buyback program which collaborated with local police departments was studied. We administered a 23-item questionnaire survey to gun buyback participants assessing demographic characteristics, motivation for relinquishing firearms, child firearm accessibility, and mental illness/domestic violence history. A total of 186 individuals from Central/Western Massachusetts turned in 339 weapons. Participants received between US $25 and US $75 in gift cards dependent on what type of gun was turned in, with an average cost of $41/gun. A total of 109 (59%) participants completed the survey. Respondents were mostly white (99%), men (90%) and first-time participants in the program (85.2%). Among survey respondents, 54% turned in firearms "for safety reasons." Respondents reported no longer needing/wanting their weapons (47%) and approximately one in eight participants were concerned the firearm(s) were accessible to children. Most respondents (87%) felt the program encouraged neighborhood awareness of firearm safety. Three of every five participants reported that guns still remained in their homes; additionally, 21% where children could potentially access them and 14% with a history of mental illness/suicide/domestic violence in the home. Gun buybacks can provide a low-cost means of removing unwanted firearms from the community. Most participants felt their homes were safer after turning in the firearm(s). In homes still possessing guns, emphasis on secure gun storage should continue, increasing the safety of children and families. The results of this survey also provided new insights into the association between mental illness/suicide and gun ownership. Epidemiological, level III.

Coroner autopsy study of homicides in Rivers State of Nigeria: 11-year review.

PubMed

Obiorah, C C; Amakiri, C N

2014-01-01

As most developing countries, including Nigeria, grapple with economic crisis, poor human capital development and high levels of income inequality, violent crimes - especially homicides - continue to be a cause for concern. We studied the pathology and demographic distribution of homicides in Rivers State of Nigeria expecting that the findings would be useful in formulating preventive strategies. Reports of homicide autopsies in the state for 11 years were retrospectively scrutinized for age, gender, type of weapon, site of injury, circumstances, mechanisms and causes of death. The data were analyzed using SPSS version 17. Homicides constituted 50.5% of the medicolegal autopsies. Although the overall male:female ratio was 12.4 : 1, there was variation with weapon. Deaths by firearm had the highest male:female ratio of 24.6 : 1. The mean and peak ages were 29.2 ± 11.4 and 21-30 years, respectively, while the range was 1 to 96 years. Firearms were the most common weapons, at 68.9%, hemorrhagic shock and head injuries at 61.5% and 28.2% respectively were the most common mechanisms and causes of death. Armed robbery incidents were the most common circumstances, while the head was the most common site of injury at 48.8%. The homicide rate is high in our environment and most homicides are committed during armed robberies using firearms. Improving medical care and providing emergency medical services will reduce cases of deaths from homicides, most of which occur due to manageable hemorrhagic shock. Increasing the drive towards controlling illegal arms acquisition and possession will reduce the present carnage in the state.

Cases of death caused by gas or warning firearms.

PubMed

Rothschild, M A; Maxeiner, H; Schneider, V

1994-01-01

Five cases of lethal injuries caused by gas or warning firearms are discussed. In one suicide case a modified weapon (elongated barrel) and steel bullets were used to fire a shot into the head, the bullets lodged in the skull and lethal bleeding resulted. In the other cases conventional gas weapons without evidence of alteration were used for contact shots; injuries were caused by the effect of propelling powder gases. Two of these cases were suicides (temporal contact shot and back of the neck contact shot), one was an accident (inguinal contact shot with lethal bleeding), and one was an attack by another person with a contact shot against the neck with bilateral tears of the hypopharynx. After successful surgery, a delayed death occurred 12 days later caused by bleeding into the airways from the ruptured external carotid artery.

Unintentional deaths from carbon monoxide in motor vehicle exhaust: West Virginia.

PubMed Central

Baron, R C; Backer, R C; Sopher, I M

1989-01-01

We investigated the circumstances of unintended carbon monoxide deaths from motor vehicle exhaust. Of 64 episodes involving 82 deaths investigated by the West Virginia Office of the Chief Medical Examiner, 1978-84, 50 occurred outdoors in older vehicles with defective exhaust systems and 14 occurred in enclosed or semi-enclosed home garages. Blood alcohol was detected in 50 (68 per cent) of 74 victims tested; 34 had blood alcohol concentrations greater than or equal to 0.10 g/dl. We suggest increasing public awareness of the hazards of motor vehicle exhaust and enforcing vehicle inspection regulations. PMID:2464951

A brief tailored family-centered seat belt intervention for hospitalized trauma patients.

DOT National Transportation Integrated Search

2010-11-01

"Among children 5-19 years, the commonest cause of unintentional injury-related death is : being an occupant/driver in a motor vehicle crash (MVC). In 2006 in the United States, there : were 568,188 injuries among children (0-18) due to MVC. Of these...

The Effectiveness of Alcohol Policies in 4-Year Public Universities

ERIC Educational Resources Information Center

Walter, Gayle T.

2010-01-01

A problem facing American universities is heavy drinking by the student body which results in unintentional injuries and deaths, illegal offenses, sexual assault, altercations, and academic demise. The relationship between the type of alcohol policy enacted on campus and alcohol consumption among undergraduate students attending 4-year public…

Youth in detention and handguns.

PubMed

Callahan, C M; Rivara, F P; Farrow, J A

1993-07-01

The objective of this work was to describe the frequency and correlates of handgun ownership and firearm injury experiences among youth in a detention facility. A convenience sample of 89 males detained in the King County Youth Services Center, a short-term holding facility, voluntarily completed an anonymous survey. Results showed that 59% of the youth reported owning a handgun. Firearm experiences included carrying a gun to school (46%); firing at another person (68% of handgun owners); firearm injury to self (27%); death of a close friend or family member to firearm homicide or suicide (35%). Personal safety far exceeded recreational use of guns as motivation for self-arming (52% versus 4%). Handgun ownership was more common among youth who reported problem behaviors. Adjusting for age and controlling for covariation of the problem behaviors, gang membership [odds ratio (OR) 6.7; 95% confidence interval (CI) 1.7-26.1], committing assault and battery (OR 7.7; 95% CI 2.2-26.8) and selling drugs (OR 3.6; 95% CI 0.99-13.4) were associated with handgun ownership. Our conclusion was that firearm experiences for youth in detention pose health risks equal to or far exceeding other high-risk behaviors in this population.

Repeal of the concealed weapons law and its impact on gun-related injuries and deaths.

PubMed

Ginwalla, Rashna; Rhee, Peter; Friese, Randall; Green, Donald J; Gries, Lynn; Joseph, Bellal; Kulvatunyou, Narong; Lubin, Dafney; O'Keeffe, Terence; Vercruysse, Gary; Wynne, Julie; Tang, Andrew

2014-03-01

Senate Bill 1108 (SB-1108) allows adult citizens to carry concealed weapons without a permit and without completion of a training course. It is unclear whether the law creates a "deterrent factor" to criminals or whether it escalates gun-related violence. We hypothesized that the enactment of SB-1108 resulted in an increase in gun-related injuries and deaths (GRIDs) in southern Arizona. We performed a retrospective cohort study spanning 24 months before (prelaw) and after (postlaw) SB-1108. We collected injury and death data and overall crime and accident trends. Injured patients were dichotomized based on whether their injuries were intentional (iGRIDs) or accidental (aGRIDs). The primary outcome was any GRID. To determine proportional differences in GRIDs between the two periods, we performed χ analyses. For each subgroup, we calculated relative risk (RR). The number of national and state background checks for firearms purchases increased in the postlaw period (national and state p < 0.001); that increase was proportionately reflected in a relative increase in state firearm purchase in the postlaw period (1.50% prelaw vs. 1.59% postlaw, p < 0.001). Overall, victims of events potentially involving guns had an 11% increased risk of being injured or killed by a firearm (p = 0.036) The proportion of iGRIDs to overall city violent crime remained the same during the two periods (9.74% prelaw vs. 10.36% postlaw; RR, 1.06; 95% confidence interval, 0.96-1.17). However, in the postlaw period, the proportion of gun-related homicides increased by 27% after SB-1108 (RR, 1.27; 95% confidence interval, 1.02-1.58). Both nationally and statewide, firearm purchases increased after the passage of SB-1108. Although the proportion of iGRIDs to overall city violent crime remained the same, the proportion of gun-related homicides increased. Liberalization of gun access is associated with an increase in fatalities from guns. Epidemiologic study, level III.

Drug Overdose Deaths Among Adolescents Aged 15-19 in the United States: 1999-2015.

PubMed

Curtin, Sally C; Tejada-Vera, Betzaida; Warmer, Margaret

2017-08-01

Drug overdose deaths in the United States are a pressing public health challenge (1–3). In particular, drug overdoses involving opioids have increased since 1999 (1). This report focuses specifically on drug overdose deaths for older adolescents aged 15–19. In 2015, 772 drug overdose deaths occurred in this age group. Rates for 1999–2015 are presented and trends compared for both females and males. Percent distributions of drug overdose deaths for 2015 by intent (e.g., unintentional, suicide, homicide) are presented. Trends in drug overdose death rates by type of drug involved are also presented. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

[Prelabour uterine torsion complicated by partial abruption and fetal death].

PubMed

Agar, N; Canis, M; Accoceberry, M; Bourdel, N; Lafaye, A-L; Gallot, D

2014-06-01

Uterine torsion is a rare obstetrical complication whose diagnosis remains challenging. We report a case of 180 degrees dextrogyre torsion at 36(+5) weeks of gestation complicated by partial abruption and in utero fetal death. Emergency cesarean section was performed through an unintentional posterior hysterotomy. Literature reports a few similar cases. Vertical hysterotomy should be advised in this context avoiding incision on lateral sides associated with increased risk of vascular or ureteral injury. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The Hidden Tragedy of Rivers: A Decade of Unintentional Fatal Drowning in Australia

PubMed Central

Leggat, Peter A.

2016-01-01

Objective(s) Describe unintentional drowning deaths in rivers, creeks and streams (rivers) in Australia and identify risk factors to inform prevention. Design & Setting This study is a cross-sectional, total population audit of all unintentional fatal drownings in Australian rivers between 1-July-2002 and 30-June-2012 using Australian coronial data. A modified Bonferroni test has been applied, deeming statistical significance p<0.03 and p<0.04 respectively. Results Rivers (n = 770; 26.6%) were the leading location among the 2,892 people who died from unintentional fatal drowning. This is a rate of 0.37/100,000 people / annum. Within river drowning deaths common groups include; males (80.4%), adults (85.3%), adults who have consumed alcohol (25.5%), people who fell in (21.3%), people involved in non-aquatic transport incidents (18.2%) and locals (74.0%). Children were 1.75 times more likely than adults (p<0.04) to drown in rivers as a result of a fall and adults 1.50 times more likely to drown in rivers as a result of watercraft incidents when compared to children. When compared to males, females were 2.27 and 4.45 times respectively more likely to drown in rivers as a result of incidents involving non-aquatic transport (p<0.04) and being swept away by floodwaters (p<0.04). Males were 2.66 and 4.27 times respectively more likely to drown in rivers as a result of watercraft incidents (p<0.04) and as a result of jumping in (p<0.04) when compared to females. Conclusion(s) While rivers are the leading location for drowning in Australia, little is understood about the risks. This study has identified key groups (males, adults, locals) and activities. While males were more likely to drown, the risk profile for females differed. PMID:27517313

Police shootings against civilians in Portugal: Contextual, forensic medical and judicial characterization.

PubMed

Rodrigues, Ezequiel; Faria, Paula; Santos, Agostinho; Fraga, Sílvia

2015-07-01

The aim of this study was to analyse the circumstances, the forensic assessment and the legal assessment of police shootings of civilians, according to the severity of the victim's injuries. Sixty-nine cases tried in Portuguese criminal courts were analysed. Of the 32 cases that resulted in death, 16 were on the public thoroughfare and 13 were in the victim's vehicle or in third-party vehicles. The majority of the lethal cases occurred when the region of the body hit was the thorax/abdomen. The firearm most frequently used was a semi-automatic 9 mm pistol. In cases resulting in death police officers involved were convicted whilst those involved in non-lethal cases were acquitted. The results of this study can be taken into account by Portuguese authorities for the implementation of policies that will allow the restriction of firearms use by police officers to situations of imminent danger of death or serious injury and that will make it possible to avoid shooting at fleeing civilians. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

A Forensic Epidemiological Study of Homicide in Isfahan Province and Review of the Literature.

PubMed

Karimi, Jalal; Koehler, Steven A; Karimi, Roya; Soleymanpour, Ali; Mohammad, Kazem; Holakouie-Naieni, Kourosh

2017-09-01

The epidemic of deaths by homicide affects every society around the world and represents a major public health crisis. Detailed information on the characteristics of homicides victims from Islamic countries is limited. This article presents forensic epidemiological data on homicides in Isfahan, Iran, during 2013-2015. Isfahan has a population of more than 5 million and 69,387 deaths with 246 homicides between 2013 and 2015. Most victims were male (73%), between the ages of 15 to 29 years (39.5%), married (54%), and employed (54%). The relationship between the actor and the victims showed that 12% were married, 15% friends, 25% strangers, and 47% others or unknown. The most frequent method of homicides was by stabbing (45%), followed by firearms (23%), strangulation (14%), and blunt force trauma (7%). The top 3 methods among males were stabbing, firearms, and strangulation, whereas among females, it was stabbing, strangulation, and by other methods. There was no significant effect on homicide rates by month, weekday, or temperature. Investigators examining deaths in Muslin countries must understand and adjust for the culture, norms, and religious ideology.

A novel hunting accident. Discharge of a firearm by a hunting dog.

PubMed

Baker, A M; Keller, G; Garcia, D

2001-09-01

The authors report the case of a 21-year-old man who was killed while duck hunting when a shotgun accidentally discharged, shooting him in the head. The loaded weapon, which had been lying on the ground with the safety off and the muzzle pointed toward a river a few feet away, discharged when a hunting dog stepped on the trigger. Scene investigation confirmed that the victim had been standing in the river, planting decoys, with his head approximately level with the adjacent bank. Autopsy examination and ballistic testing confirmed a range of fire consistent with the witness' statements. Examination of the weapon in question documented a light trigger pull but no mechanical defects. The authors review the epidemiology and causality of hunting accidents and discuss the various safety rules that were violated in this highly unusual case. The importance of a complete death investigation, including autopsy, when dealing with a firearm death is emphasized.

Preventing Unintentional Injuries in the Home Using the Health Impact Pyramid

ERIC Educational Resources Information Center

Mack, Karin A.; Liller, Karen D.; Baldwin, Grant; Sleet, David

2015-01-01

Injuries continue to be the leading cause of death for the first four decades of life. These injuries result from a confluence of behavioral, physical, structural, environmental, and social factors. Taken together, these illustrate the importance of taking a broad and multileveled approach to injury prevention. Using examples from fall, fire,…

Safety Awareness: Empowering Students to be Technologically Literate

ERIC Educational Resources Information Center

Lazaros, Edward J.; Shackelford, Ray

2009-01-01

The Home Safety Council (2006) reports that home injuries make up one third of injuries in the United States. As the Home Safety Council (2006) reported, "the top five leading causes of unintentional home injury or death are falls, poisoning, fire/burn, choking/suffocation, and drowning." Because the home is separate from the school…

Youth Risk Behavior Surveillance--United States, 1999. CDC Surveillance Summaries.

ERIC Educational Resources Information Center

MMWR: Morbidity and Morality Weekly Report, 2000

2000-01-01

In the United States, approximately three-fourths of all deaths among persons aged 10-24 years result from only four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from this 1999 national Youth Risk Behavior Survey demonstrate that numerous high school students engage in behaviors that increase the…

Youth Risk Behavior Surveillance--United States, 2005

ERIC Educational Resources Information Center

Eaton, Danice K.; Kann, Laura; Kinchen, Steve; Ross, James; Hawkins, Joseph; Harris, William A.; Lowry, Richard; McManus, Tim; Chyen, David; Shanklin, Shari; Lim, Connie; Grunbaum, Jo Anne; Wechsler, Howell

2006-01-01

In the United States, 71% of all deaths among persons aged 10-24 years result from 4 causes: motor vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2005 national Youth Risk Behavior Survey (YRBS) indicated that during the 30 days preceding the survey, many high school students engaged in behaviors that…

Games that ''Work'': Using Computer Games to Teach Alcohol-Affected Children about Fire and Street Safety

ERIC Educational Resources Information Center

Coles, Claire D.; Strickland, Dorothy C.; Padgett, Lynne; Bellmoff, Lynnae

2007-01-01

Unintentional injuries are a leading cause of death and disability for children. Those with developmental disabilities, including children affected by prenatal alcohol exposure, are at highest risk for injuries. Although teaching safety skills is recommended to prevent injury, cognitive limitations and behavioral problems characteristic of…

[Recommendations for the prevention of poisoning].

PubMed

Mintegi, S; Esparza, M J; González, J C; Rubio, B; Sánchez, F; Vila, J J; Yagüe, F; Benítez, M T

2015-12-01

Poisoning is the fifth leading cause of death from unintentional injury in the WHO European region, while Spain is in the group with a lower rate. Most involuntary poisonings occur in young children while they are at the home, due to unintentional ingestion of therapeutic drugs or household products. Of these, a large percentage is stored in non-original containers and/or within reach of children. In this article, the Committee on Safety and Non-Intentional Injury Prevention in Childhood of the Spanish Association of Pediatrics provides a series of recommendations, educational as well as legal, to prevent such cases. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Electrical injury from subway third rails: serious injury associated with intermediate voltage contact.

PubMed

Rabban, J; Adler, J; Rosen, C; Blair, J; Sheridan, R

1997-09-01

Railway and subway-associated electrical trauma is rare and typically involves high voltage (> 20,000) arc injuries. Not all rail systems utilize such high voltage. We report 16 cases of electrical trauma due to 600 V direct contact with subway 'third' rails. A case series of injured patients presenting to Shriners Burns Institute, Boston or Massachusetts General Hospital between 1970 and 1995 was retrospectively analyzed. A total of 16 cases was identified. Among seven subway workers, the mechanism of rail contact was unintentional by a tool, a hand or by falling; no deaths occurred. Among nine non-occupational victims, injuries involved suicide attempts, unintentional falls, or risk-taking behavior. This group suffered greater burn severity, operative procedures, and complications; three deaths occurred. This is the largest report series of direct electrical trauma from a subway third rail. The high morbidity and mortality from this 600 V contact suggests that the traditional classification of low voltage (< 1000 V) exposure can be subdivided to reflect the serious and lethal potential of intermediate range exposures compared to household range exposures (0-220 V).

Suicide Means among Decedents Aged 50+ Years, 2005-2014: Trends and Associations with Sociodemographic and Precipitating Factors.

PubMed

Choi, Namkee G; DiNitto, Diana M; Marti, C Nathan; Kaplan, Mark S; Conwell, Yeates

2017-12-01

To examine 1) temporal trends between 2005 and 2014 in the three most frequently used suicide means (firearms, hanging/suffocation, alcohol/drug/medicine overdose) by decedents aged 50+ years and 2) associations of suicide means with sociodemographic and precipitating factors. The National Violent Death Reporting System, 2005-2014, provided data (N = 46,857). Suicide means were identified from ICD-10 codes for underlying cause of death and coroner/medical examiner (CME) reports. Precipitating factors are based on either CME or law enforcement report. Age-group (50-64 and 65+ years) and gender-separate logistic regression analyses were used to examine study questions. In the 50-64 years age group, each advancing year (i.e., from 2005 to 2014) was associated with a 1% decrease in the odds of firearm use and a 6% increase in the odds of hanging/suffocation among men; a 9% increase in the odds of hanging/suffocation among women; and a 4% decrease in the odds of overdose among each gender. In the 65+ years age group, each advancing year was associated with a 4% increase in the odds of overdose among men. Physical health was a significant factor for firearm use among men (adjusted odds ratio: 1.47; 95% CI: 1.39-1.55) only. Regardless of gender and age, mental health and substance abuse problems and prior suicide attempts were associated with hanging/suffocation and overdose. Firearm use decreased among men aged 50-64 years between 2005 and 2014, but its use did not change among the other gender by age groups. With rapidly growing numbers of older adults, routine suicide risk assessments, firearm safety monitoring, and interventions to improve quality of life are needed. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone

PubMed Central

Dhalla, Irfan A.; Mamdani, Muhammad M.; Sivilotti, Marco L.A.; Kopp, Alex; Qureshi, Omar; Juurlink, David N.

2009-01-01

Introduction Opioid-related mortality appears to be increasing in Canada. We examined the true extent of the problem and the impact of the introduction of long-acting oxycodone. Methods We examined trends in the prescribing of opioid analgesics in the province of Ontario from 1991 to 2007. We reviewed all deaths related to opioid use between 1991 and 2004. We linked 3271 of these deaths to administrative data to examine the patients’ use of health care services before death. Using time-series analysis, we determined whether the addition of long-acting oxycodone to the provincial drug formulary in January 2000 was associated with an increase in opioid-related mortality. Results From 1991 to 2007, annual prescriptions for opioids increased from 458 to 591 per 1000 individuals. Opioid-related deaths doubled, from 13.7 per million in 1991 to 27.2 per million in 2004. Prescriptions of oxycodone increased by 850% between 1991 and 2007. The addition of long-acting oxycodone to the drug formulary was associated with a 5-fold increase in oxycodone-related mortality (p < 0.01) and a 41% increase in overall opioid-related mortality (p = 0.02). The manner of death was deemed unintentional by the coroner in 54.2% and undetermined in 21.9% of cases. Use of health care services in the month before death was common: for example, of the 3066 patients for whom data on physician visits were available, 66.4% had visited a physician in the month before death; of the 1095 patients for whom individual-level prescribing data were available, 56.1% had filled a prescription for an opioid in the month before death. Interpretation Opioid-related deaths in Ontario have increased markedly since 1991. A significant portion of the increase was associated with the addition of long-acting oxycodone to the provincial drug formulary. Most of the deaths were deemed unintentional. The frequency of visits to a physician and prescriptions for opioids in the month before death suggests a missed opportunity for prevention. PMID:19969578

Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs – a retrospective study, 1992–2009

PubMed Central

2013-01-01

Background Drowning deaths constitute a significant proportion of unnatural deaths globally. In Sweden and other high-income countries, drowning deaths have decreased. This study investigates the epidemiology and current trends of unintentional, intentional, and undetermined drowning deaths with emphasis on the presence of alcohol and other drugs. Methods During an 18-years period, 5,125 drowning deaths were autopsied in Sweden. Data on cases including toxicological analysis on alcohol, pharmaceutical drugs, and illicit drugs were obtained from the National Board of Forensic Medicine. Results During the study period, the annual incidence of drowning deaths in Sweden was 3.1/100,000 inhabitants and decreased on average by about 2% each year (p<0.001). The highest incidence was found among males and in middle/older age groups. The incidence increased 3% for each year of age. Children/adolescents (≤18 years) constituted 5% of all drowning deaths. Of all drowned females in the study, 55% (847/1,547) committed suicide, which was a significantly higher proportion compared with males (21%, 763/3,578) (p<0.001). In total, 38% (1,656/4,377) of tested drowned persons had alcohol in their blood and the mean concentration was 1.8 g/l. In the unintentional drowning group, intentional drowning group, and the undetermined group, the proportion of alcohol positive was 44%, 24%, and 45%, respectively. One or several psychoactive drugs were present in the blood in 40% (1,688 /4,181) of all tested persons and in 69% (965/1,394) of tested persons who died from suicidal drowning. The most common drug was benzodiazepines (21%, 891/4,181). Illicit drugs were detected in 10% (82/854) of tested persons. Conclusion Presence of alcohol and drugs were frequent and may have contributed to the drowning deaths. The incidence of drowning deaths significantly decreased during the study period. Males and the middle/older age groups had a higher incidence compared to females and children. Suicidal drowning was common especially among women. Alcohol and drugs are significant contributors in drowning deaths in Sweden and should be considered as part of a comprehensive prevention program. PMID:23497055

Surveillance for traumatic brain injury-related deaths--United States, 1997-2007.

PubMed

Coronado, Victor G; Xu, Likang; Basavaraju, Sridhar V; McGuire, Lisa C; Wald, Marlena M; Faul, Mark D; Guzman, Bernardo R; Hemphill, John D

2011-05-06

Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Approximately 53,000 persons die from TBI-related injuries annually. During 1989-1998, TBI-related death rates decreased 11.4%, from 21.9 to 19.4 per 100,000 population. This report describes the epidemiology and annual rates of TBI-related deaths during 1997-2007. January 1, 1997-December 31, 2007. Data were analyzed from the CDC multiple-cause-of-death public-use data files, which contain death certificate data from all 50 states and the District of Columbia. During 1997-2007, an annual average of 53,014 deaths (18.4 per 100,000 population; range: 17.8-19.3) among U.S. residents were associated with TBIs. During this period, death rates decreased 8.2%, from 19.3 to 17.8 per 100,000 population (p = 0.001). TBI-related death rates decreased significantly among persons aged 0-44 years and increased significantly among those aged ≥75 years. The rate of TBI deaths was three times higher among males (28.8 per 100,000 population) than among females (9.1). Among males, rates were highest among non-Hispanic American Indian/Alaska Natives (41.3 per 100,000 population) and lowest among Hispanics (22.7). Firearm- (34.8%), motor-vehicle- (31.4%), and fall-related TBIs (16.7%) were the leading causes of TBI-related death. Firearm-related death rates were highest among persons aged 15-34 years (8.5 per 100,000 population) and ≥75 years (10.5). Motor vehicle-related death rates were highest among those aged 15-24 years (11.9 per 100,000 population). Fall-related death rates were highest among adults aged ≥75 years (29.8 per 100,000 population). Overall, the rates for all causes except falls decreased. Although the overall rate of TBI-related deaths decreased during 1997-2007, TBI remains a public health problem; approximately 580,000 persons died with TBI-related diagnoses during this reporting period in the United States. Rates of TBI-related deaths were higher among young and older adults and certain minority populations. The leading external causes of this condition were incidents related to firearms, motor vehicle traffic, and falls. Accurate, timely, and comprehensive surveillance data are necessary to better understand and prevent TBI-related deaths in the United States. CDC multiple-cause-of-death public-use data files can be used to monitor the incidence of TBI-related deaths and assist public health practitioners and partners in the development, implementation, and evaluation of programs and policies to reduce and prevent TBI-related deaths in the United States. Rates of TBI-related deaths are higher in certain population groups and are primarily related to specific external causes. Better enforcement of existing seat belt laws, implementation and increased coverage of more stringent helmet laws, and the implementation of existing evidence-based fall-related prevention interventions are examples of interventions that can reduce the incidence of TBI in the United States.

QuickStats: Age-Adjusted Death Rates* for Males Aged 15-44 Years, by the Five Leading Causes of Death(†) - United States, 1999 and 2014.

PubMed

2016-08-12

The age-adjusted death rate for males aged 15-44 years was 10% lower in 2014 (156.6 per 100,000 population) than in 1999 (174.1). Among the five leading causes of death, the age-adjusted rates for three were lower in 2014 than in 1999: cancer (from 17.1 to 12.8; 25% decline), heart disease (20.1 to 17.0; 15% decline), and homicide (15.7 to 13.8; 12% decline). The age-adjusted death rates for two of the five causes were higher in 2014 than in 1999: suicide (20.1 to 22.5; 12% increase), and unintentional injuries (from 48.7 to 51.0; 5% increase).

Risk profile for drowning deaths in children in the Indian state of Bihar: results from a population-based study.

PubMed

Dandona, Rakhi; Kumar, G Anil; George, Sibin; Kumar, Amit; Dandona, Lalit

2018-05-19

We report on incidence of drowning deaths and related contextual factors in children from a population-based study in the Indian state of Bihar which estimated the causes of death using verbal autopsy (VA). Interviews were conducted for deaths in 1-14 years population that occurred from January 2012 to March 2014 in 109 689 households (87.1% participation) in 1017 clusters representative of the state. The Population Health Metrics Research Consortium shortened VA questionnaire was used for interview and cause of death was assigned using the SmartVA automated algorithm. The annualised unintentional drowning death incidence, activity prior to drowning, the body of water where drowning death had occurred and contextual information are reported. The survey covered 224 077 children aged 1-14 years. Drowning deaths accounted for 7.2%, 12.5% and 5.8% of all deaths in 1-4, 5-9 and 10-14 years age groups, respectively. The adjusted incidence of drowning deaths was 14.3 (95% CI 14.0 to 14.7) per 100 000 children, with it being higher in urban (16.1, 95% CI 14.8 to 17.3) areas. Nearly half of the children drowned in a river (5.9, 95% CI 5.6 to 6.1) followed by in a pond (2.8, 95% CI 2.6 to 2.9). Drowning death incidence was the highest while playing (5.1, 95% CI 4.9 to 5.4) and bathing (4.0, 95% CI 3.8 to 4.2) with the former accounting for more deaths in 1-4 years age group. Sixty per cent of children were already dead when found. None of these deaths were reported to the civil registration system to obtain death certificate. The findings from this large representative sample of children document the magnitude of and variations in unintentional drowning deaths in Bihar. Urgent targeted drowning interventions are needed to address the risk in children. Gross under-reporting of drowning deaths in children in India needs attention. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Regulation of firearm dealers in the United States: an analysis of state law and opportunities for improvement.

PubMed

Vernick, Jon S; Webster, Daniel W; Bulzacchelli, Maria T; Mair, Julie Samia

2006-01-01

Firearms were associated with 30, 136 deaths in the United States in 2003. Most guns are initially sold to the public through a network of retail dealers. Licensed firearm dealers are an important source of guns for criminals and gun traffickers. Just one percent of licensed dealers were responsible for more than half of all guns traced to crime. Federal law makes it difficult for ATF to inspect and revoke the licenses of problem gun dealers. State licensing systems, however, are a greatly under-explored opportunity for firearm dealer oversight. We identify and categorize these state systems to identify opportunities for interventions to prevent problem dealers from supplying guns to criminals, juveniles, or gun traffickers. Just seventeen states license gun dealers. Twenty-three states permit routine inspections of dealers but only two mandate that those inspections occur on a regular basis. Twenty-six states impose record-keeping requirements for gun sales. Only thirteen states require some form of store security measures to minimize firearm theft. We conclude with recommendations for a comprehensive system of state licensing and oversight of gun dealers. Our findings can be useful for the coalition of more than fifty U.S. mayors that recently announced it would work together to combat illegal gun trafficking.

Pediatricians' involvement in gun injury prevention.

PubMed

Olson, L M; Christoffel, K K; O'Connor, K G

2007-04-01

Injuries from small arms are of concern internationally. The health perspective is an emerging aspect of international work to reduce these injuries. This aspect has been evident in US firearm injury prevention work for over a decade, exhibited by strong statements from the American Academy of Pediatrics (AAP) to remove firearms from children's environments. To assess trends among US pediatricians related to firearm injury prevention counseling practices and attitudes toward gun legislation. National random sample, mailed surveys of AAP members: (1) 1994 (response rate = 68.9%, n = 982); (2) 2000 (response rate = 62.4%, n = 922). chi(2) Tests were used to assess bivariate relationships and logistic regression to assess multivariate relationships regarding counseling practices. Respondents in both years believed that violence prevention should be a priority for pediatricians (91.4% and 92.0%) and reported always or sometimes recommending handgun removal from the home (46.2% and 55.9%, respectively). In 2000, 74% of the respondents were comfortable discussing firearm safety; fewer thought they had sufficient training (32.7%) or time (27.5%) to discuss firearms. In 1994 and 2000, the likelihood of counseling on handgun removal was positively related to recent experience treating a gun injury, female sex and not owning a gun. In both years, >80% of pediatricians thought that gun control legislation or regulations would reduce injury and death. US pediatricians continue to adopt policies promoting gun injury prevention. The practices and attitudes of pediatricians may be important for public education strategies regarding firearm injury prevention in the US and internationally.

Disease and injury in California with projections to the year 2007. Implications for medical education.

PubMed Central

Ragland, D R; Buffler, P A; Reingold, A L; Syme, S L; Buffler, M L

1998-01-01

In this article, as part of an evaluation of the future of medical education in California, we characterize the distribution of disease and injury in California; identify major factors that affect the epidemiology of disease and injury in California, and project the burden of disease and injury for California's population to the year 2007. Our goal is to elucidate the major causes of illness and disability at present and in the near future in order to focus state resources on the interventions likely to have the greatest impact. Data from various governmental agencies were utilized; the base year, 1993, is the most recent year with sufficient information available when this report was prepared. Several major risk factors have decreased, including smoking (30% decline from 1984 to 1993) and drinking and driving. However, hypertension prevalence has not changed, and overweight has increased dramatically. Poverty continues to burden about 15% of Californians, with poverty highest among children. During 1993, 220,271 Californians died, with 3 major causes accounting for 61% of these deaths: coronary heart disease (31%), cancer (23%), and stroke (7%). In terms of potential years of life lost (years lost before age 65), the most important causes of death in 1993 were unintentional injury (756 years lost/100,000 population), cancer (632 years), and the acquired immunodeficiency syndrome (AIDS; 491 years). Mortality rates were highest among blacks and lowest among Asians. Overall mortality in California has been declining for decades; in just 1 decade, from 1980 to 1991, mortality declined from 780 to 680 deaths per 100,000 population. Several major causes of death have declined, including coronary heart disease, stroke, unintentional injury, cirrhosis, and suicide, while others have increased, for example, chronic obstructive lung disease and diabetes mellitus. Death from AIDS increased dramatically in the past decade, but is leveling off, and death from cancer is beginning to decline. Rates for overall mortality and morbidity, and for most specific conditions, should continue to decline. A projected 28% population increase by 2007 will yield a corresponding increase in the absolute level of disease cases and death; a disproportionate increase in younger and older groups will yield increased conditions affecting young (unintentional injury, AIDS) and older (heart disease, cancer, stroke, diabetes mellitus) people. Californians should experience overall improved health in coming years, reaping benefits of reduced environmental and behavioral risk factors as well as improved medical treatment and rehabilitation. Coordinated strategies for health promotion, disease prevention, delivery of medical treatment, and rehabilitation are needed to maintain and improve present levels of health across the life span. Images Figure 5. Figure 6. Figure 7. Figure 8. Figure 22. Figure 25. Figure 26. PMID:9614796

Alcohol and Other Drug Use at Historically Black Colleges and Universities. Infofacts/Resources

ERIC Educational Resources Information Center

Kapner, Daniel Ari

2008-01-01

The "culture of drinking" on U.S. college and university campuses has gained widespread national attention. Researchers cite the disturbing consequences of drinking on campus each year--1,700 college student deaths from alcohol-related causes; 600,000 unintentional injuries; 700,000 assaults; and 100,000 cases of sexual assault and acquaintance…

Let's Go Under! Teaching Water Safety Skills Using a Behavioral Treatment Package

ERIC Educational Resources Information Center

Levy, Kimberly M.; Ainsleigh, Susan A.; Hunsinger-Harris, Melissa L.

2017-01-01

Drowning is a leading cause of unintentional death among children worldwide. Children with autism spectrum disorder (ASD) are at higher risk for incidents of drowning then their non-disabled peers. Mastering water safety skills, such as underwater submersion, has been associated with a decreased risk for incidents of drowning. Using a combined…

Youth Risk Behavior Survey of Middle School Students Attending Bureau Funded Schools, 2000.

ERIC Educational Resources Information Center

Everett, Sherry; Sussman, Michele; Ranslow, Steve; Shaughnessy, Lana

This youth risk behavior survey was completed by 7,667 students at 127 Bureau of Indian Affairs (BIA) middle schools. The document is organized around the six categories of behavior that contribute substantially to the leading causes of death, illness, and social problems in the United States: unintentional and intentional injuries; tobacco use;…

Health and Safety: Involving Community Workers in Early Childhood Classrooms

ERIC Educational Resources Information Center

Wallinga, Charlotte; Coleman, Mick; Bales, Diane

2007-01-01

Dramatic improvements have been made in the lives of children over the last century. Even so, many health and safety challenges remain unresolved. For example, unintentional injuries claim the lives of more children each year than any other cause of death. In addition, a panel of pediatricians reported that the incidence of childhood obesity…

Fraternity and Sorority Members and Alcohol and Other Drug Use. Infofacts/Resources

ERIC Educational Resources Information Center

Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention, 2008

2008-01-01

The "culture of drinking" on U.S. college campuses has recently gained widespread national attention. A report by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) notes the disturbing consequences of drinking on campus each year: 1,700 college student deaths from alcohol-related causes; more than 500,000 unintentional injuries; more…

Peer Tutoring to Prevent Firearm Play: Acquisition, Generalization, and Long-term Maintenance of Safety Skills

PubMed Central

Jostad, Candice M; Miltenberger, Raymond G; Kelso, Pamela; Knudson, Peter

2008-01-01

Hundreds of accidental injuries and deaths to children occur annually in the United States as a result of firearm play. Behavioral skills training (BST) and in situ training have been found to be effective in teaching children the skills to use if they find a firearm, but training requires substantial time and effort. The current study examined the use of peers as tutors as a potential way to decrease the time and resources needed to teach these safety skills to youngsters. Peer trainers conducted BST and in situ training with other children. Children taught by the peer trainers acquired the safety skills and demonstrated them in naturalistic situations in which the skills were needed. Furthermore, all of the peer trainers acquired and maintained the skills. These results support the use of peer tutoring for teaching safety skills to other children. PMID:18468285

International travelers and unintentional fatal drowning in Australia--a 10 year review 2002-12.

PubMed

Peden, Amy E; Franklin, Richard C; Leggat, Peter A

2016-02-01

. Drowning deaths of travelers are commonly reported in the media, creating a perception that they are at a higher risk of drowning than residents. This may be true, due in part to unfamiliarity with the risks posed by the hazard, however there is limited information about drowning deaths of travelers in Australia. This study aims to identify the incidence of drowning among international travelers in Australia and examine the risk factors to inform prevention strategies. . Data on unintentional fatal drowning in Australian waterways of victims with a residential postcode from outside Australia were extracted from the Royal Life Saving Society-Australia National Fatal Drowning Database. . Between 1 July 2002 and 30 June 2012 drowning deaths among people known to be international travelers accounted for 4.3% (N = 123) of the 2870 drowning deaths reported in Australian waterways. Key locations for drowning deaths included beaches (39.0%), ocean/harbour (22.0%) and swimming pools (12.2%). Leading activities prior to drowning included swimming (52.0%), diving (17.9%) and watercraft incidents (13.0%). . International travelers pose a unique challenge from a drowning prevention perspective. The ability to exchange information on water safety is complicated due to potential language barriers, possible differences in swimming ability, different attitudes to safety in the traveler's home country and culture, a lack of opportunities to discuss safety, a relaxed attitude to safety which may result in an increase in risk taking behaviour and alcohol consumption. . Prevention is vital both to reduce loss of life in the aquatic environment and promote Australia as a safe and enjoyable holiday destination for international travelers. © International Society of Travel Medicine, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Computed tomographic evaluation to determine efficacy of euthanasia of yearling feedlot cattle by use of various firearm-ammunition combinations.

PubMed

Thomson, Daniel U; Wileman, Benjamin W; Rezac, Darrel J; Miesner, Matt D; Johnson-Neitman, Jennifer L; Biller, David S

2013-11-01

To evaluate with CT the efficacy of various combinations of firearms and ammunitions to penetrate and disrupt the brain tissue of cadaveric heads of feedlot steers. 42 fresh cadaveric heads of 12- to 18-month-old Bos taurus steers. For each of 7 combinations of firearms and ammunitions (.22-caliber rifle firing a long rifle 30-grain plated lead solid- or hollow-point round, .223-caliber carbine firing a 50-grain ballistic-tip round, 9-mm pistol firing a 124-grain total metal jacket round, .45-caliber automatic Colt pistol [ACP] firing a 230-grain full metal jacket round, and 12-gauge shotgun firing a 2.75-inch 1.25-ounce No. 4 birdshot shell or a 1-ounce rifled slug), 6 cadaveric heads were shot at an identical distance (3 m), angle, and anatomic location. Heads were scanned with third-generation CT, and images were evaluated to determine extent of penetration, projectile fragmentation, cranial fracture, and likelihood of instantaneous death (≥ 30% destruction of brain tissue or a brainstem lesion). RESULTS-41 of 42 skulls were penetrated by the projectile. Instantaneous death was considered a likely consequence for 83% (25/30) of heads shot with a rifle-fired .22-caliber solid-point round, pistol-fired .45-caliber ACP round, carbine-fired .223-caliber round, and shotgun-fired birdshot and slug. Of the 18 heads shot with pistol-fired 9-mm and .45-caliber ACP rounds and rifle-fired .22-caliber hollow-point rounds, only 6 had brainstem lesions. CONCLUSIONS AND CLINICAL RELEVANCE-Results suggested that gunshots delivered by all firearm-ammunition combinations except rifle-fired .22-caliber hollow-point rounds and pistol-fired 9-mm rounds were viable options for euthanasia of feedlot cattle.

Deaths resulting from the use of firearms by police against motor vehicles: Study of cases in Porto, Portugal.

PubMed

Rodrigues, Ezequiel; Faria, Paula; Santos, Agostinho; Fraga, Sílvia

2016-04-01

The objective of this study was to investigate the terminal ballistics of police shootings in which the bullets went through any motor vehicle structure before fatally wounding the occupants. 6 cases that occurred in Porto district between 1998 and 2013 were studied. The firearms used were 7.65 mm (n = 1) or 9 mm (n = 3) calibre semi-automatic pistols and 9 mm calibre submachine guns (n = 2); the bullets were full metal jacket type. The metal jacket of the collected projectiles was totally or partially destroyed in 3 cases. It exhibited a deformed structure in all cases. The trajectories of the bullets in the vehicles were always more or less linear, even when initial impact was at an oblique angle. The entry holes in the victims' bodies were larger or much larger in size than the calibre of the bullets. They were located, with the exception of one of the cases, in the left half of the body. The trajectories in the victims' bodies were from front to back, in one case, and from back to front in all others. Exit wounds were only found in two cases. Death occurred immediately after the victim was shot only in one case, despite a vital structure has been hit in all cases. The cases studied support the idea that the use of firearms against vehicles with the sole intention of immobilisation entails uncontrollable danger to the lives of the occupants, and especially when done by police forces not specifically trained for that purpose. Therefore, such use of firearms should be avoided. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

To treat or not to treat a newborn child with severe brain damage? A cross-sectional study of physicians' and the general population's perceptions of intentions.

PubMed

Rydvall, Anders; Juth, Niklas; Sandlund, Mikael; Domellöf, Magnus; Lynøe, Niels

2014-02-01

Ethical dilemmas are common in the neonatal intensive care setting. The aim of the present study was to investigate the opinions of Swedish physicians and the general public on treatment decisions regarding a newborn with severe brain damage. We used a vignette-based questionnaire which was sent to a random sample of physicians (n = 628) and the general population (n = 585). Respondents were asked to provide answers as to whether it is acceptable to discontinue ventilator treatment, and when it actually is discontinued whether or not it was acceptable to use drugs which hasten death unintentionally or intentionally. The response rate was 67 % of physicians and 46 % of the general population. A majority of both physicians [56 % (CI 50-62)] and the general population [53 % (CI 49-58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient's symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. The study indicated that physicians and the general population have similar opinions regarding discontinuing life-sustaining treatment and providing effective drugs which might unintentionally hasten death but seem to have different views on intentions. The results might be helpful to physicians wanting to examine their own intentions when providing adequate treatment at the end of life.

Carbon monoxide-related deaths in Ankara between 2001 and 2011.

PubMed

Uysal, Cem; Celik, Safa; Duzgun Altuntas, Aynur; Kandemir, Eyup; Kaya, Mehmet; Karapirli, Mustafa; Sezer, Sevilay; Akyol, Omer

2013-02-01

The aim of the present study was to describe the epidemiology of unintentional carbon monoxide (CO) poisonings (between 2001 and 2011) in Ankara, Turkey. Data were collected from the records of Ankara Branch of Council of Forensic Medicine and the licensed official institutes and hospitals for medico-legal autopsies. A total of 10,720 medico-legal autopsy reports were obtained and reviewed by the authors. Among 622 fatal poisoning cases during the period, 380 deaths were due to unintentional CO poisoning. The mean CO saturation of the groups was 55.4 ± 13.4 (% saturation). The minimum and maximum levels of CO in blood was 3.6 and 86.5 (% saturation), respectively. Of all the fatal poisonings determined by Ankara Branch of Council of Forensic Medicine, CO poisoning was the most common mortality cause (61.1%). Among the cases, 301 (79.2%) were found to be death in their houses, 43 (11.3%) in hospitals, 15 (3.9%) in their workplaces and 11 (2.9%) in some public places such as park and garden. Most of the cases were from the capital city of Turkey, Ankara (n = 203, 53.4%). When we compared the cities according to their population, it was realized that the highest death rate due to CO poisoning was in Kirikkale (12.3/100,000), followed by Karabuk (8.3/100,000), Cankiri (7.8/100,000) and Kirsehir (5.0/100,000). These findings add new data to the pool of knowledge in terms of the need of safety, proper heating system instructions and more education on CO poisoning in Turkey.

Child injury control: trends, themes, and controversies.

PubMed

Johnston, Brian D; Ebel, Beth E

2013-01-01

Injury is a major cause of morbidity and mortality among US children, and an important driver of health status globally. Despite its enormous burden, injury is preventable. Over the last 10 years, significant progress has been made in the reduction of unintentional injury among US children. However, aggregate trends mask important disparities by age group, region, and injury mechanism. Basic and translation research is needed to develop and test prevention strategies to address these new or recalcitrant problems. Motor vehicle occupant injury has fallen to historic lows, but challenges remain in protecting novice drivers and managing the distraction of new technologies. Injury to pedestrians has also declined, but likely as a result of decreased exposure as fewer children walk. This calls for a broader public health perspective to promote activity while enhancing safety. Deaths due to drowning are common and illustrate the difficulty in measuring and promoting appropriate supervision. Environmental modification and use of protective products may be a more appropriate response. Concussion in sport is another challenging issue: public health laws promote identification and appropriate management of concussed athletes, but less progress has been made on primary prevention of these injuries. Unintentional poisoning is on the rise, attributable to misuse of, and overdose with, prescription opioids. Injury deaths to infants are also increasing. This trend is driven in part by better death investigation that classifies more sleep-related deaths as suffocation events. Finally, we examine a sample of cross-cutting themes and controversies in injury control that might be amenable to empiric evaluation. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Motor vehicle and fall related deaths among older Americans 1990-98: sex, race, and ethnic disparities.

PubMed

Stevens, J A; Dellinger, A M

2002-12-01

To examine differences in motor vehicle and fall related death rates among older adults by sex, race, and ethnicity. Annual mortality tapes for 1990-98 provided demographic data including race and ethnicity, date, and cause of death. Trend analyses were conducted using Poisson regression. From 1990-98, overall motor vehicle related death rates remained stable while death rates from unintentional falls increased. Motor vehicle and fall related death rates were higher among men. Motor vehicle related death rates were higher among people of color while fall related death rates were higher among whites. Among whites, fall death rates increased significantly during the study period, with an annual relative increase of 3.6% for men and 3.2% for women. The risk of death from motor vehicle and fall related injuries among older adults differed by sex, race and ethnicity, results obscured by simple age and sex specific death rates. This study found important patterns and disparities in these death rates by race and ethnicity useful for identifying high risk groups and guiding prevention strategies.

[Mortality as a result of accidental and intentional injuries in the Federal District from 1970 to 1986].

PubMed

Híjar-Medina, M C

1990-01-01

This article presents the results of a retrospective analysis of unintentional and intentional injury mortality in México City for the period 1970-1986. The mortality rates and trends were obtained out of 73,197 registered deaths, (according to the 9th revision of the International Disease Classification). Deaths due to the earthquakes of 1985 were not included. The trend of mortality is undefined (r = -0.430). The most important causes of death were: traffic accidents, homicides, and others accidents. Males accounted 77 per cent of the deaths. The most affected age groups were 15-19 and 20-24 years. The potential years of life lost were analyzed. This study provides information for the prevention and control of injuries and for future research in this field.

Suicide Rates and Methods in Active Duty Military Personnel, 2005 to 2011: A Cohort Study.

PubMed

Anglemyer, Andrew; Miller, Matthew L; Buttrey, Samuel; Whitaker, Lyn

2016-08-02

Suicide prevention programs have become ubiquitous among military units; identifying temporal trends and nonclinical factors associated with the chosen suicide methods may help improve suicide prevention strategies. To calculate suicide rates of active duty military personnel and identify those who are at risk for firearm-specific suicide. Retrospective cohort study. Military units in the United States. All active duty enlisted U.S. military personnel from 2005 to 2011. Suicide rates per 100 000 were calculated for each branch. Adjusted odds ratios for firearm-specific suicide were calculated with 95% CIs. 1455 military personnel committed suicide from 2005 to 2011. From 2006 to 2011, the rates were highest among army personnel (19.13 to 29.44 cases per 100 000). Among suicides with a known cause of death, 62% were attributed to firearms. The results of this study also suggest that among army personnel or marines who committed suicide, those with infantry or special operations job classifications were more likely than those in noninfantry positions to use a firearm. Results are generalizable only to enlisted personnel and reflect only stateside suicides. Data regarding previous psychiatric illness, deployment history, and firearms ownership were lacking. These results may help inform policymakers and advisors about differences in risks of suicide and violent suicide among the armed services and may help guide efforts to prevent self-harm within the military. None.

Characteristics, Classification, and Prevention of Child Maltreatment Fatalities.

PubMed

McCarroll, James E; Fisher, Joscelyn E; Cozza, Stephen J; Robichaux, Renè J; Fullerton, Carol S

2017-01-01

Preventing child maltreatment fatalities is a critical goal of the U.S. society and the military services. Fatality review boards further this goal through the analysis of circumstances of child deaths, making recommendations for improvements in practices and policies, and promoting increased cooperation among the many systems that serve families. The purpose of this article is to review types of child maltreatment death, proposed classification models, risk and protective factors, and prevention strategies. This review is based on scientific and medical literature, national reports and surveys, and reports of fatality review boards. Children can be killed soon after birth or when older through a variety of circumstances, such as with the suicide of the perpetrator, or when the perpetrator kills the entire family. Death through child neglect may be the most difficult type of maltreatment death to identify as neglect can be a matter of opinion or societal convention. These deaths can occur as a result of infant abandonment, starvation, medical neglect, drowning, home fires, being left alone in cars, and firearms. Models of classification for child maltreatment deaths can permit definition and understanding of child fatalities by providing reference points that facilitate research and enhance clinical prediction. Two separate approaches have been proposed: the motives of the perpetrator and the circumstances of death of the child victim. The latter approach is broader and is founded on an ecological model focused on the nature and circumstances of death, child victim characteristics, perpetrator characteristics, family and environmental circumstances, and service provision and need. Many risk factors for maternal and paternal filicide have been found, but most often included are young maternal age, no prenatal care, low education level, mental health problems, family violence, and substance abuse. Many protective factors can be specified at the individual, family, and community level. Early interventions for children and families are facilitated by the increased awareness of service providers who understand the risk and protective factors for intentional and unintentional child death. There is currently no roadmap for the prevention of child maltreatment death, but increased awareness and improved fatality review are essential to improving policies and practices. Prevention strategies include improving fatality review recommendations, using psychological autopsies, serious case reviews, and conducting research. We recommend a public health approach to prevention, which includes a high level of collaboration between agencies, particularly between the military and civilian. The adoption of a public health model can promote better prevention strategies at individual, family, community, and societal levels to address and improve practices, policies, and public attitudes and beliefs about child maltreatment. The process of making recommendations on the basis of fatality review is important in terms of whether they will be taken seriously. Recommendations that are too numerous, impractical, expensive, lack relevance, and are out of step with social norms are unlikely to be implemented. They can be helpful if they are limited, focused, lead to definitive action, and include ways of measuring compliance. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Pediatricians’ involvement in gun injury prevention

PubMed Central

Olson, L M; Christoffel, K K; O’Connor, K G

2007-01-01

Background: Injuries from small arms are of concern internationally. The health perspective is an emerging aspect of international work to reduce these injuries. This aspect has been evident in US firearm injury prevention work for over a decade, exhibited by strong statements from the American Academy of Pediatrics (AAP) to remove firearms from children’s environments. Objectives: To assess trends among US pediatricians related to firearm injury prevention counseling practices and attitudes toward gun legislation. Design: National random sample, mailed surveys of AAP members: (1) 1994 (response rate  = 68.9%, n = 982); (2) 2000 (response rate  = 62.4%, n = 922). χ2 Tests were used to assess bivariate relationships and logistic regression to assess multivariate relationships regarding counseling practices. Results: Respondents in both years believed that violence prevention should be a priority for pediatricians (91.4% and 92.0%) and reported always or sometimes recommending handgun removal from the home (46.2% and 55.9%, respectively). In 2000, 74% of the respondents were comfortable discussing firearm safety; fewer thought they had sufficient training (32.7%) or time (27.5%) to discuss firearms. In 1994 and 2000, the likelihood of counseling on handgun removal was positively related to recent experience treating a gun injury, female sex and not owning a gun. In both years, >80% of pediatricians thought that gun control legislation or regulations would reduce injury and death. Conclusions: US pediatricians continue to adopt policies promoting gun injury prevention. The practices and attitudes of pediatricians may be important for public education strategies regarding firearm injury prevention in the US and internationally. PMID:17446249

The health consequences of child mental health problems and parenting styles: unintentional injuries among European schoolchildren.

PubMed

Keyes, Katherine M; Susser, Ezra; Pilowsky, Daniel J; Hamilton, Ava; Bitfoi, Adina; Goelitz, Dietmar; Kuijpers, Rowella C W M; Lesinskiene, Sigita; Mihova, Zlatka; Otten, Roy; Kovess, Viviane

2014-10-01

Unintentional injury is the leading cause of death for schoolchildren. We assessed the association between externalizing psychopathology, parenting style, and unintentional injury in European children in the community. Data were drawn from the School Children Mental Health in Europe project and included 4517 schoolchildren across seven diverse European regions. Past-year injuries serious enough to seek medical attention were reported by mothers. Child mental health problems were assessed using validated measures and reported by the mothers, teachers, and children. Parenting styles were based on The Parenting Scale and the Parent Behaviors and Attitudes Questionnaire. Children with attention-deficit/hyperactivity symptoms and oppositional defiant symptoms had a higher risk of injury compared to other children whether based on parent report (OR=1.47, 95% C.I. 1.2-1.9), teacher report (OR=1.36, 95% C.I. 1.1-1.7), or parent and teacher report combined (OR=1.53, 95% C.I. 1.1-2.1). Children who self-reported oppositional symptoms also had higher risk of injury (OR=1.6, 95% C.I. 1.1-2.4). Low-caring behavior of parents increased the risk of injury (OR=1.4, 95% C.I. 1.1-1.9). Unintentional injury is a potential adverse health consequence of child externalizing problems. Interventions to improve parent-child relationships and prevention as well as focused treatment for externalizing problems may reduce the burden of injury. Copyright © 2014 Elsevier Inc. All rights reserved.

The health consequences of child mental health problems and parenting styles: Unintentional injuries among European schoolchildren☆,☆☆

PubMed Central

Keyes, Katherine M.; Susser, Ezra; Pilowsky, Daniel J.; Hamilton, Ava; Bitfoi, Adina; Goelitz, Dietmar; Kuijpers, Rowella C.W.M.; Lesinskiene, Sigita; Mihova, Zlatka; Otten, Roy; Kovess, Viviane

2015-01-01

Objective Unintentional injury is the leading cause of death for schoolchildren. We assessed the association between externalizing psychopathology, parenting style, and unintentional injury in European children in the community. Methods Data were drawn from the School Children Mental Health in Europe project and included 4517 schoolchildren across seven diverse European regions. Past year injuries serious enough to seek medical atten tion were reported by mothers. Child mental health problems were assessed using validated measures and re ported by the mothers, teachers, and children. Parenting styles were based on The Parenting Scale and the Parent Behaviors and Attitudes Questionnaire. Results. Children with attention deficit/hyperactivity symptoms and oppositional defant symptoms had a higher risk of injury compared to other children whether based on parent report (OR = 1.47, 95% C.I. 1.2 1.9), teacher report (OR = 1.36, 95% C.I. 1.1 1.7), or parent- and teacher-report combined (OR = 1.53, 95% C.I. 1.1 2.1). Children who self reported oppositional symptoms also had higher risk of injury (OR = 1.6, 95% C.I. 1.1 2.4). Low caring behavior of parents increased the risk of injury (OR = 1.4, 95% C.I. 1.1-1.9). Conclusion Unintentional injury is a potential adverse health consequence of child externalizing problems. Interventions to improve parent child relationships and prevention as well as focused treatment for externaliz ing problems may reduce the burden of injury. PMID:25073079

Influence of Sports' Programs and Club Activities on Alcohol Use Intentions and Behaviors among Adolescent Males

ERIC Educational Resources Information Center

Leaver-Dunn, Deidre; Turner, Lori; Newman, Brian M.

2007-01-01

In the United States, more than 70 percent of all deaths among youth and young adults each year are related to four causes: motor vehicle crashes, other unintentional injuries, homicide, and suicide. Alcohol misuse and abuse contribute to each of these behaviors. Alcohol is the most frequently consumed mind-altering substance among…

Trends in the Prevalence of Behaviors that Contribute to Unintentional Injury. National YRBS: 1991-2011

ERIC Educational Resources Information Center

Centers for Disease Control and Prevention, 2011

2011-01-01

The national Youth Risk Behavior Survey (YRBS) monitors priority health risk behaviors that contribute to the leading causes of death, disability, and social problems among youth and adults in the United States. The national YRBS is conducted every two years during the spring semester and provides data representative of 9th through 12th grade…

Measures of Child Well-Being in Utah, 2001. A Pledge to Our Children. Utah KIDS COUNT.

ERIC Educational Resources Information Center

Haven, Terry, Ed.

This KIDS COUNT report details statewide trends in the well-being of Utah's children. The statistical portrait is based on 26 indicators of children's well-being: (1) prenatal care; (2) low birth weight infants; (3) infant mortality; (4) child injury deaths; (5) unintentional injuries; (6) untreated tooth decay; (7) immunization rates; (8) suicide…

College Student Assessment of the Signs of Alcohol Poisoning: To Dream the Impossible Dream

ERIC Educational Resources Information Center

Misch, Donald A.

2011-01-01

In 2005 there were 1,825 alcohol-related unintentional injury deaths (e.g., vehicular accidents, falls, drowning, burns, suffocation, and gunshot wounds) among college students from 18 to 24 years of age. Of these, 468 college students died from alcohol-related, nontraffic injuries. Unfortunately, there is no good estimate of the number of college…

Unintentional Injuries in Preschool Age Children: Is There a Correlation With Parenting Style and Parental Attention Deficit and Hyperactivity Symptoms.

PubMed

Acar, Ethem; Dursun, Onur Burak; Esin, İbrahim Selcuk; Öğütlü, Hakan; Özcan, Halil; Mutlu, Murat

2015-08-01

Unintentional injuries are the leading cause of death among children. Previous research has shown that most of the injuries occur in and around the home. Therefore, parents have a key role in the occurrence and prevention of injuries. In this study, we examined the relationship among home injuries to children and parental attention deficit hyperactivity disorder (ADHD) symptoms, parental attitudes, and children's behavioral problems.Forty children who were admitted to the emergency department because of home injuries constitute the study group. The control group also consisted of 40 children, who were admitted for mild throat infections. The parents filled out questionnaires assessing parental ADHD, child behavioral problems, and parenting attitudes.Scores were significantly higher for both internalizing disorders and externalizing disorders in study groups. We also found that ADHD symptoms were significantly higher among fathers of injured children compared with fathers of control groups. Democratic parenting was also found to correlate with higher numbers of injuries.Parenting style, as well as the psychopathology of both the parents and children, is important factors in children's injuries. A child psychiatrist visit following an emergency procedure may help to prevent further unintentional injuries to the child.

Unintentional fall-related mortality in the elderly: comparing patterns in two countries with different demographic structure

PubMed Central

Majdan, Marek; Mauritz, Walter

2015-01-01

Objectives Falls are among the major external causes of unintentional injury and injury-related mortality in the elderly. The aim of this study was to compare the patterns of unintentional fall-related mortalities in two countries with different demographic structure: Slovakia and Austria in 2003–2010. Methods A study was conducted using death certificate data, trends of fall-related mortality in the elderly (over 65 years) in Austria and Slovakia were compared. Crude and age-standardised mortality rates were calculated. Rate ratios were used to quantify differences based on age, sex and country. The role of demographic structure and population ageing was considered. Results The annual average crude mortality for Slovakia was 28.82, for Austria 54.19 per 100 000 person-years. Increasing rates were observed towards higher age in both countries. Males had higher mortality than females (1.18 times higher in Austria, 2.4 higher in Slovakia). In ages over 75 years rates were significantly higher in Austria, compared to Slovakia. Injuries to head (in males) and hip (in females) were most commonly the underlying cause of death. The proportion of populations over 65 and over 80 and rate of their increase were higher in Austria than in Slovakia. Conclusions We conclude that higher proportions of the elderly population of Austria could have contributed to the higher fall-related mortality rates compared to Slovakia, especially in females over 80 years. Our study quantified the differences between two countries with different structure of the elderly population and these findings could be used in planning future needs of health and social services and to plan prevention in countries where a rapid increase in age of the population can be foreseen. PMID:26270950

The postman always rings twice: two cases of shotgun deaths associated with an unconventional home security alarm system.

PubMed

Asirdizer, Mahmut; Turkmen, Nursel; Akan, Okan; Yavuz, Mehmet Sunay

2014-06-01

Injury and death cases caused by booby traps are not common in forensic medicine practice. Besides, installation of booby traps including firearms is generally for suicidal and rarely for homicidal purposes. Although few patents were described about home security alarm system that were created by firearms in the United States, 1 sample of injury with a similar unconventional mechanism of home safety system was reported by Asirdizer and Yavuz in 2009. In the published case report, the story of an electrical technician who was invited to a summer house by the homeowner to check the home security alarm system was reported. In the so-called report, he was stated to be injured by the shotgun attached to the unconventional home security alarm system while checking the system. As a result, the homeowner was convicted of a possible intent to cause a life-threatening injury to the technician.The so-called homeowner and his wife died by the same shotgun attached to the same unconventional home security alarm system 4 years on from the first event. In the present case report, we have aimed to present the findings of the crime scene and the autopsies of these unusual 2 deaths and to discuss individual and legal factors in paving the way for the deaths of 2 people.

Leading Causes of Death Contributing to Decrease in Life Expectancy Gap Between Black and White Populations: United States, 1999-2013.

PubMed

Kochanek, Kenneth D; Anderson, Robert N; Arias, Elizabeth

2015-11-01

Life expectancy at birth has increased steadily since 1900 to a record 78.8 years in 2013. But differences in life expectancy between the white and black populations still exist, despite a decrease in the life expectancy gap from 5.9 years in 1999 to 3.6 years in 2013. Differences in the change over time in the leading causes of death for the black and white populations have contributed to this decrease in the gap in life expectancy. Between 1999 and 2013, the decrease in the life expectancy gap between the black and white populations was mostly due to greater decreases in mortality from heart disease, cancer, HIV disease, unintentional injuries, and perinatal conditions among the black population. Similarly, the decrease in the gap between black and white male life expectancy was due to greater decreases in death rates for HIV disease, cancer, unintentional injuries, heart disease, and perinatal conditions in black males. For black females, greater decreases in diabetes death rates, combined with decreased rates for heart disease and HIV disease, were the major causes contributing to the decrease in the life expectancy gap with white females. The decrease in the gap in life expectancy between the white and black populations would have been larger than 3.6 years if not for increases in death rates for the black population for aortic aneurysm, Alzheimer’s disease, and maternal conditions. For black males, the causes that showed increases in death rates over white males were hypertension, aortic aneurysm, diabetes, Alzheimer’s disease, and kidney disease, while the causes that showed increases in death rates for black females were Alzheimer’s disease, maternal conditions, and atherosclerosis. This NCHS Data Brief is the second in a series of data briefs that explore the causes of death contributing to differences in life expectancy between detailed ethnic and racial populations in the United States. The first data brief focused on the racial differences in life expectancy for a single year, 2010 (3). All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

The National Violent Death Reporting System: an exciting new tool for public health surveillance.

PubMed

Steenkamp, M; Frazier, L; Lipskiy, N; Deberry, M; Thomas, S; Barker, L; Karch, D

2006-12-01

The US does not have a unified system for surveillance of violent deaths. This report describes the National Violent Death Reporting System (NVDRS), a system for collecting data on all violent deaths (homicides, suicides, accidental firearms deaths, deaths of undetermined intent, and deaths from legal intervention, excluding legal executions) in participating states. The NVDRS centralizes data from many sources, providing a more comprehensive picture of violent deaths than would otherwise be available. The NVDRS collects data on victims, suspects, and circumstances related to the violent deaths. Currently, 17 US states participate in the NVDRS; the intention is for the NVDRS to become a truly national system, representing all 50 states, the District of Columbia, and the US territories. This report describes the history of the NVDRS, provides an overview of how the NVDRS functions, and describes future directions.

Potentially Preventable Deaths Among the Five Leading Causes of Death - United States, 2010 and 2014.

PubMed

García, Macarena C; Bastian, Brigham; Rossen, Lauren M; Anderson, Robert; Miniño, Arialdi; Yoon, Paula W; Faul, Mark; Massetti, Greta; Thomas, Cheryll C; Hong, Yuling; Iademarco, Michael F

2016-11-18

Death rates by specific causes vary across the 50 states and the District of Columbia.* Information on differences in rates for the leading causes of death among states might help state health officials determine prevention goals, priorities, and strategies. CDC analyzed National Vital Statistics System data to provide national and state-specific estimates of potentially preventable deaths among the five leading causes of death in 2014 and compared these estimates with estimates previously published for 2010. Compared with 2010, the estimated number of potentially preventable deaths changed (supplemental material at https://stacks.cdc.gov/view/cdc/42472); cancer deaths decreased 25% (from 84,443 to 63,209), stroke deaths decreased 11% (from 16,973 to 15,175), heart disease deaths decreased 4% (from 91,757 to 87,950), chronic lower respiratory disease (CLRD) (e.g., asthma, bronchitis, and emphysema) deaths increased 1% (from 28,831 to 29,232), and deaths from unintentional injuries increased 23% (from 36,836 to 45,331). A better understanding of progress made in reducing potentially preventable deaths in the United States might inform state and regional efforts targeting the prevention of premature deaths from the five leading causes in the United States.

Unintentional injury outcomes secondary to pedestrian traffic crashes: a descriptive analysis from a major medical center.

PubMed

Ifesanya, Adeleke O; Afuwape, Dolapo; Okoje, Victoria N; Agunloye, Atinuke; Odole, Olusola; Okolo, Clement A; Alonge, Temitope O

2009-01-01

An environment in which traffic regulations are not strictly enforced often is characterized by carnage from motor vehicular crashes resulting in severe injuries with unacceptably high mortality. The descriptive demographics and injury characteristics of pedestrian road crash victims presenting to a tertiary medical center in southwestern Nigeria are presented in order to provide baseline epidemiology as a first step in determining areas of potential mitigation for care of unintentional injuries. Consecutive pedestrian road traffic crash patients treated in the Accident and Emergency Department of a tertiary hospital were prospectively reviewed from March 2007 to February 2008 to determine baseline demographics and clinical outcomes. A total of 184 patients with a mean value of the ages of 31.4 years were studied; 27% of the patients were <11 years of age. The male to female ratio was 1.6:1. Fifty-four percent of the victims were struck by automobiles and 29% were struck by motorcycles. Sixty-five percent were struck while crossing common thoroughfares. Head injury was sustained in 61% of patients. The mortality rate was 31.0% (n = 57). The clinical course leading to death showed 22.8% of the patients who died initially experienced hemorrhagic shock, 17.5% suffered a severe head injury, and 17.5% suffered aspiration. Autopsy confirmed brainstem herniation in 28.1% of the patients who died. The average interval between injury and death was 5.5 +/-13.6 days (range: 0-77 days). In this setting, three out of every ten patients experiencing pedestrian vehicular trauma will die before leaving the hospital. The elderly are most at risk, with two-thirds of victims dying from injuries sustained. This raises serious questions about the prehospital- and hospital-based emergency services for vehicular road crash victims in this environment, and confirms the World Health Organization findings that Africa has the highest rate overall for unintentional injury deaths. A system-wide program must be put in place that addresses proven prevention measures across all sectors of the community.

The Preventive Effect of Strict Gun Control Laws on Suicide and Homicide.

ERIC Educational Resources Information Center

Lester, David; Murrell, Mary E.

1982-01-01

Examined state gun control laws and used a multidimensional scaling technique to study the relationship of strictness and death rates. Results showed states with stricter laws had lower suicide rates by firearms but higher rates by other means. No effect on homicide was found. (JAC)

Dependence of the firearm-related homicide rate on gun availability: a mathematical analysis.

PubMed

Wodarz, Dominik; Komarova, Natalia L

2013-01-01

In the USA, the relationship between the legal availability of guns and the firearm-related homicide rate has been debated. It has been argued that unrestricted gun availability promotes the occurrence of firearm-induced homicides. It has also been pointed out that gun possession can protect potential victims when attacked. This paper provides a first mathematical analysis of this tradeoff, with the goal to steer the debate towards arguing about assumptions, statistics, and scientific methods. The model is based on a set of clearly defined assumptions, which are supported by available statistical data, and is formulated axiomatically such that results do not depend on arbitrary mathematical expressions. According to this framework, two alternative scenarios can minimize the gun-related homicide rate: a ban of private firearms possession, or a policy allowing the general population to carry guns. Importantly, the model identifies the crucial parameters that determine which policy minimizes the death rate, and thus serves as a guide for the design of future epidemiological studies. The parameters that need to be measured include the fraction of offenders that illegally possess a gun, the degree of protection provided by gun ownership, and the fraction of the population who take up their right to own a gun and carry it when attacked. Limited data available in the literature were used to demonstrate how the model can be parameterized, and this preliminary analysis suggests that a ban of private firearm possession, or possibly a partial reduction in gun availability, might lower the rate of firearm-induced homicides. This, however, should not be seen as a policy recommendation, due to the limited data available to inform and parameterize the model. However, the model clearly defines what needs to be measured, and provides a basis for a scientific discussion about assumptions and data.

The First-aid Advice and Safety Training (FAST) parents programme for the prevention of unintentional injuries in preschool children: a protocol.

PubMed

Mytton, Julie A; Towner, Elizabeth Ml; Kendrick, Denise; Stewart-Brown, Sarah; Emond, Alan; Ingram, Jenny; Blair, Peter S; Powell, Jane; Mulvaney, Caroline; Thomas, James; Deave, Toity; Potter, Barbara

2014-02-01

Unintentional injury is the leading cause of preventable death in children in the UK, and 0-4-year-olds frequently attend emergency departments following injuries in the home. Parenting programmes designed to support parents, promote behaviour change and enhance parent-child relationships have been shown to improve health outcomes in children. It is not known whether group-based parenting programmes have the potential to prevent unintentional injuries in preschool children. A study to develop a group-based parenting programme to prevent unintentional home injuries in preschool children, and assess the feasibility of evaluation through a cluster-randomised controlled trial. The intervention, designed for parents of children who have sustained a medically attended injury, will be developed with two voluntary sector organisations. The feasibility study will assess ability to recruit parents, deliver the programme and follow-up participants. Participants will complete questionnaires at baseline, 3 months and 6 months, and report injuries in their preschool children using a tool designed and validated for this study. Qualitative methods will assess user and deliverer perceptions of the programme. This study will develop the first group-based parenting programme to prevent injuries in preschool children, and design tools for parent-reported injury outcomes. A key challenge will be to recruit parents to participate in a manner that is non-stigmatising, and does not result in feelings of guilt or belief that they are perceived to be a bad parent. The findings will be used to prepare a trial to assess the effectiveness and cost-effectiveness of the intervention.

Injury hospitalizations due to unintentional falls among the Aboriginal population of British Columbia, Canada: incidence, changes over time, and ecological analysis of risk markers, 1991-2010.

PubMed

Jin, Andrew; Lalonde, Christopher E; Brussoni, Mariana; McCormick, Rod; George, M Anne

2015-01-01

Aboriginal people in British Columbia (BC) have higher injury incidence than the general population. Our project describes variability among injury categories, time periods, and geographic, demographic and socio-economic groups. This report focuses on unintentional falls. We used BC's universal health care insurance plan as a population registry, linked to hospital separation and vital statistics databases. We identified Aboriginal people by insurance premium group and birth and death record notations. We identified residents of specific Aboriginal communities by postal code. We calculated crude incidence and Standardized Relative Risk (SRR) of hospitalization for unintentional fall injury, standardized for age, gender and Health Service Delivery Area (HSDA), relative to the total population of BC. We tested hypothesized associations of geographic, socio-economic, and employment-related characteristics with community SRR of injury by linear regression. During 1991 through 2010, the crude rate of hospitalization for unintentional fall injury in BC was 33.6 per 10,000 person-years. The Aboriginal rate was 49.9 per 10,000 and SRR was 1.89 (95% confidence interval 1.85-1.94). Among those living on reserves SRR was 2.00 (95% CI 1.93-2.07). Northern and non-urban HSDAs had higher SRRs, within both total and Aboriginal populations. In every age and gender category, the HSDA-standardized SRR was higher among the Aboriginal than among the total population. Between 1991 and 2010, crude rates and SRRs declined substantially, but proportionally more among the Aboriginal population, so the gap between the Aboriginal and total population is narrowing, particularly among females and older adults. These community characteristics were associated with higher risk: lower income, lower educational level, worse housing conditions, and more hazardous types of employment. Over the years, as socio-economic conditions improve, risk of hospitalization due to unintentional fall injury has declined among the Aboriginal population. Women and older adults have benefited more.

Injury Hospitalizations Due to Unintentional Falls among the Aboriginal Population of British Columbia, Canada: Incidence, Changes over Time, and Ecological Analysis of Risk Markers, 1991-2010

PubMed Central

2015-01-01

Background Aboriginal people in British Columbia (BC) have higher injury incidence than the general population. Our project describes variability among injury categories, time periods, and geographic, demographic and socio-economic groups. This report focuses on unintentional falls. Methods We used BC’s universal health care insurance plan as a population registry, linked to hospital separation and vital statistics databases. We identified Aboriginal people by insurance premium group and birth and death record notations. We identified residents of specific Aboriginal communities by postal code. We calculated crude incidence and Standardized Relative Risk (SRR) of hospitalization for unintentional fall injury, standardized for age, gender and Health Service Delivery Area (HSDA), relative to the total population of BC. We tested hypothesized associations of geographic, socio-economic, and employment-related characteristics with community SRR of injury by linear regression. Results During 1991 through 2010, the crude rate of hospitalization for unintentional fall injury in BC was 33.6 per 10,000 person-years. The Aboriginal rate was 49.9 per 10,000 and SRR was 1.89 (95% confidence interval 1.85-1.94). Among those living on reserves SRR was 2.00 (95% CI 1.93-2.07). Northern and non-urban HSDAs had higher SRRs, within both total and Aboriginal populations. In every age and gender category, the HSDA-standardized SRR was higher among the Aboriginal than among the total population. Between 1991 and 2010, crude rates and SRRs declined substantially, but proportionally more among the Aboriginal population, so the gap between the Aboriginal and total population is narrowing, particularly among females and older adults. These community characteristics were associated with higher risk: lower income, lower educational level, worse housing conditions, and more hazardous types of employment. Conclusions Over the years, as socio-economic conditions improve, risk of hospitalization due to unintentional fall injury has declined among the Aboriginal population. Women and older adults have benefited more. PMID:25793298

Gun orientation in self-inflicted craniomaxillofacial gunshot wounds: risk factors associated with fatality.

PubMed

Johnson, J; Markiewicz, M R; Bell, R B; Potter, B E; Dierks, E J

2012-08-01

The purpose of this study was to evaluate whether orientation of a firearm predicts survival, and to identify risk factors associated with fatality in subjects with self-inflicted craniomaxillofacial gunshot wounds. A retrospective cohort study design was used. The primary predictor variable was orientation of the weapon, defined as in the coronal (lateral) or sagittal (anterior-posterior) trajectory pattern. The primary outcome variable was death for subjects on arrival or during their hospital stay. Other covariates measured include demographic, firearm-related, and psychosocial variables. Risk factors for fatality were identified using multivariate logistic regression. Of the 92 subjects that met study inclusion criteria, 47 (67.2) held the firearm in the coronal position. In the full multivariate model, coronal gun orientation (OR=7.7, 95% CI: 2.0, 30.1, p=0.003) and the absence of a psychiatric diagnosis were associated with an increased risk of fatality (OR=0.1, 95% CI: 0.04, 0.5, p=0.002). Coronal firearm orientation was associated with an increased risk of fatality following self-inflicted craniomaxillofacial gunshot injuries. A patient with a documented psychiatric disorder was not found to be more likely to succumb to this type of injury. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Trap gun: an unusual firearm, aimed at wild animals but causing a silent epidemic of human fatalities.

PubMed

Kodikara, Sarathchandra; Kudagama, Muditha

2014-03-01

Among a variety of uncommon firearms of different origin used worldwide, the trap gun used in Sri Lanka is underreported. This is an illegal, locally made, smooth-bore, long-barreled, muzzle-loading firearm with a victim-activated simple trigger mechanism. It is mainly used to protect crops and livestock from the potential harm by wild animals. Trap gun is mounted horizontally on pegs of sticks fixed to the ground. Miscellaneous metal pieces are used as ammunition. A small metal container filled with powdered matchstick heads/firecrackers covered by the striker surface of the matchstick box is used as the percussion cap. A metal hammer is set to hit the percussion cap. Through a lever mechanism, the hammer is kept under tension. The lever mechanism is connected to a trigger cord, which runs across the animal path. The first passerby, a human being or a wild animal, who accidentally trips the trigger cord and activates the trigger mechanism is critically injured. This characteristically damages the lower limbs of the human being. This communication highlights a death due to trap gun injury. The injury pattern caused by trap gun could overlap with that of shotgun and rifled firearm. A meticulous autopsy could sort it out.

Background Checks for all Gun Buyers and Gun Violence Restraining Orders: State Efforts to Keep Guns from High-Risk Persons.

PubMed

Vernick, Jon S; Alcorn, Ted; Horwitz, Joshua

2017-03-01

There were more than 36,000 firearm-related deaths in the U.S. in 2015. Under federal law, a background check is required only for gun purchases from licensed dealers. Research suggests that some persons prohibited from owning a gun turn to private sellers, including those identified online, to attempt to obtain a firearm. State-level approaches to make it more difficult for high-risk persons to purchase or possess firearms include universal background check (UBC) and gun violence restraining order (GVRO) laws. UBC laws, on the books in 18 states as of the end of 2016, can reduce both homicide and suicide rates. After Colorado adopted a UBC law in 2013, the number of background checks conducted by private sellers for sales occurring at places other than gun shows steadily increased. GVRO laws give law enforcement and families the authority to petition a court to temporarily remove firearms from an individual who presents a danger to himself or others during times of crisis, regardless of whether that person has been diagnosed with a mental illness. California enacted a GVRO law in 2014. Data are emerging to suggest the effectiveness of GVRO-type laws at averting suicides and providing an entryway to services.

Causes and Disparities in Death Rates Among Urban American Indian and Alaska Native Populations, 1999-2009.

PubMed

Jacobs-Wingo, Jasmine L; Espey, David K; Groom, Amy V; Phillips, Leslie E; Haverkamp, Donald S; Stanley, Sandte L

2016-05-01

To characterize the leading causes of death for the urban American Indian/Alaska Native (AI/AN) population and compare with urban White and rural AI/AN populations. We linked Indian Health Service patient registration records with the National Death Index to reduce racial misclassification in death certificate data. We calculated age-adjusted urban AI/AN death rates for the period 1999-2009 and compared those with corresponding urban White and rural AI/AN death rates. The top-5 leading causes of death among urban AI/AN persons were heart disease, cancer, unintentional injury, diabetes, and chronic liver disease and cirrhosis. Compared with urban White persons, urban AI/AN persons experienced significantly higher death rates for all top-5 leading causes. The largest disparities were for diabetes and chronic liver disease and cirrhosis. In general, urban and rural AI/AN persons had the same leading causes of death, although urban AI/AN persons had lower death rates for most conditions. Urban AI/AN persons experience significant disparities in death rates compared with their White counterparts. Public health and clinical interventions should target urban AI/AN persons to address behaviors and conditions contributing to health disparities.

The economic cost of firearm-related injuries in the United States from 2006 to 2010.

PubMed

Lee, Jarone; Quraishi, Sadeq A; Bhatnagar, Saurabha; Zafonte, Ross D; Masiakos, Peter T

2014-05-01

Estimates of the number of firearm-related injuries widely vary. Although focus has been primarily on deaths, the societal cost of caring for victims of these injuries is largely unknown. Our goal was to estimate the economic impact of nonfatal, firearm-related injuries in the United States based on recent, publically available data. We queried several national registries for hospital and emergency department (ED) discharges from 2006 to 2010 to estimate the annual incidence of firearm-related injuries. The cost of direct medical services and lost productivity from firearm-related injuries were extrapolated from recently published estimates. To identify potentially important trends, we compared the economic impact and payor mix for firearm-related injuries in 2006 with those in 2010. During the 5-year analytic period, we identified 385,769 (SE = 29,328) firearm-related ED visits resulting in 141,914 (SE = 14,243) hospital admissions, costing more than $88 billion (SE = $8.0 billion). Between 2006 and 2010, there was a decrease in the rate of hospital visits from 6.65 per 10,000 visits in 2006 to 5.76 per 10,000 visits in 2010 (P < .001). Similarly, the rate of hospital admissions and ED visits without admission decreased from 2.58 per 10,000 to 1.96 per 10,000 (P < .001) and 4.08 per 10,000 to 3.79 per 10,000 (P < .001). Regression of the economic costs from 2006 to 2010, adjusted for Consumer Price Index, showed no change (P = .15). There was a decrease in the proportion of Uninsured between 2006 and 2010 from 51.6% to 46.78% (P < .001). Firearm-related injuries are a major economic burden to not only the American health care system but also to American society. The incidence of these injuries has decreased slightly from 2006 to 2010, with no change in the economic burden. Research aimed at understanding the associated financial, social, health, and disability-related issues related to firearm injuries is necessary and would likely enhance our knowledge of the causes of these events, and may accelerate development of interventions and policies to decrease the staggering medical and societal cost of gun violence. Copyright © 2014 Mosby, Inc. All rights reserved.

Strategies and policies to address the opioid epidemic: A case study of Ohio.

PubMed

Penm, Jonathan; MacKinnon, Neil J; Boone, Jill M; Ciaccia, Antonio; McNamee, Cameron; Winstanley, Erin L

To describe the strategies and policies implemented in Ohio to improve opioid safety and to discuss the role that pharmacists can play in implementing, promoting, and enhancing the effectiveness of these policies. Ohio has the fifth highest rate of drug overdose deaths (24.6 deaths per 100,000) in the United States. Unintentional drug overdose has become the leading cause of injury-related death in Ohio. In 2015, there were 3050 overdose deaths in Ohio, and in 2014 there were an estimated 12,847 overdose events reversed by emergency medical services with naloxone. Not applicable. In 2011, the Governor's Cabinet Opiate Action Team was created to implement a multifaceted strategy, in part (1) to promote the responsible use of opioids, (2) to reduce the supply of opioids, and (3) to support overdose prevention and expand access to naloxone. Innovations to assist these goals include the development of Ohio guidelines on the responsible use of opioids, mandatory use of Ohio's prescription drug monitoring program, closing pill mills, promotion of drug take-back programs and increased access to naloxone and public health campaigns. Not applicable. Since the development of the Governor's Cabinet Opiate Action Team, there were 81 million fewer doses of opioids dispensed to Ohio patients in 2015 compared with 782 million doses dispensed in 2011. As such, the proportion of unintentional drug overdose deaths involving prescription opioids has reduced from 45% in 2011 to 22% in 2015. Strong political support was crucial in Ohio to facilitate the rapid implementation opioid overdose prevention programs and the promotion of public awareness campaigns. However, the misuse and abuse of prescription opioids are complex problems requiring a comprehensive and multifaceted approach. Pharmacists are identified as a crucial component of the state strategy to addressing opioid abuse by promoting responsible prescribing and adopting prevention practices. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Youth Risk Behavior Surveillance--United States, 2003. Morbidity and Mortality Weekly Report. Surveillance Summaries. Volume 53, Number SS-2

ERIC Educational Resources Information Center

Grunbaum, Jo Anne; Kann, Laura; Kinchen, Steve; Ross, James; Hawkins, Joseph; Lowry, Richard; Harris, William A.; McManus, Tim; Chyen, David; Collins, Janet

2004-01-01

In the United States, 70.8% of all deaths among youth and young adults aged 10-24 years result from only four causes: motor-vehicle crashes (32.3%), other unintentional injuries (11.7%), homicide (15.1%), and suicide (11.7%). Substantial morbidity and social problems also result from the approximately 870,000 pregnancies that occur each year among…

Flying bullets and speeding cars: analysis of child injury deaths in the Palestinian Territory.

PubMed

Shaheen, A; Edwards, P

2008-01-01

Despite the fact that children account for over half the Palestinian population, little attention has been paid to the problem of child injuries. We examined the types of injury mortality in children aged 0-19 years in the West Bank and Gaza Strip (Palestinian Territory) and compared these with similar data for children in Israel and England and Wales. We used data from death certificates covering 2001-2003. Death rates per 100 000 children per year were estimated. The leading cause of injury mortality in Palestinian children was accidents caused by firearms missiles (9.6). In comparison, transport accidents were the leading cause of death in children in both Israel (5.0) and England and Wales (3.5).

Drugs and other chemicals involved in fatal poisoning in England and Wales during 2000 – 2011.

PubMed

Handley, S A; Flanagan, R J

2014-01-01

Fatal poisoning data can reveal trends in the poisons encountered, which can help guide prescribing practices and product safety and other legislation, and more recently has helped to monitor the use of emerging drugs of abuse ( ‘ legal highs ’ ). We searched Mortality Statistics – Injury and poisoning, Series DH4 (2000 – 2005), Mortality Statistics – Deaths registered in England and Wales, Series DR (2006 – 2011), and the Office for National Statistics drug poisoning database for information on fatal poisoning during 2000 – 2011. We also searched the Pubmed database for ‘ fatal ’ and ‘ poisoning ’ and ‘ England ’ and ‘ Wales ’ : this search yielded seven papers that gave relevant information on deaths reported during 2000 – 2011 that were not superseded by later publications. DEATHS FROM POISONING: The annual number of deaths from poisoning fell from 2000 (3092) to 2010 (2749), before increasing to 3341 in 2011. This increase was due in part to a change in the ICD coding relating to alcohol poisoning, suggesting that such deaths had been under-recorded previously. Although fatalities from dextropropoxyphene declined (287 in 2004 and 18 in 2011) following the withdrawal of co-proxamol (paracetamol [acetaminophen] and dextropropoxyphene [propoxyphene] mixture) during 2005 – 2007, deaths involving codeine and most notably tramadol (836 deaths during 2000 – 2011) increased. Deaths from paracetamol poisoning either alone, or with alcohol reached 89 in 2011, the lowest annual figure since 1974. However, in reality there has been no marked downward trend since 1999 despite reductions in pack size, continued publicity as to the dangers of paracetamol overdose, and improved liver failure treatment, including transplantation. The annual number of deaths from antidepressants remained relatively stable (median: 397, range: 335 – 469). Although the number of deaths from dosulepin [dothiepin] decreased (186 in 2000 and 49 in 2011), the number of deaths involving selective serotonin reuptake inhibitors increased (50 in 2000 and 127 in 2011). Although annual numbers of deaths involving diamorphine/morphine (88% unintentional) declined, deaths involving methadone (89% unintentional) increased and the total annual number of deaths from these drugs showed little change (2000: 1061, 2011: 995). Deaths involving amfetamine/metamfetamine remained relatively constant at about 50 annually, and whilst cocaine-related deaths fell by 48% during 2008 – 2011, and deaths involving MDMA and related compounds fell by 69% over this same period, deaths involving ‘ legal highs ’ , notably γ -hydroxybutrate/ γ -butyrolactone and ketamine, increased. Alterations in the availability of paracetamol and of prescription drugs such as dextropropoxyphene and dosulepin have not been accompanied by decreases in the number of deaths from poisoning. Despite intense media and other interest, the annual number of deaths (250 – 300) involving ‘ recreational ’ drugs remains small in relation to the 1000 or so deaths a year from diamorphine and/or methadone.

Method overtness, forensic autopsy, and the evidentiary suicide note: A multilevel National Violent Death Reporting System analysis.

PubMed

Rockett, Ian R H; Caine, Eric D; Stack, Steven; Connery, Hilary S; Nolte, Kurt B; Lilly, Christa L; Miller, Ted R; Nelson, Lewis S; Putnam, Sandra L; Nestadt, Paul S; Jia, Haomiao

2018-01-01

Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary suicide note is more likely to accompany suicides by drug-intoxication and by other poisoning, as less violent and less forensically overt methods, than suicides by firearm and hanging/suffocation; and (2) performance of a forensic autopsy attenuates any observed association between overtness of method and the reported presence of a note. This multilevel (individual/county), multivariable analysis employed a generalized linear mixed model (GLMM). Representing the 17 states participating in the United States National Violent Death Reporting System throughout 2011-2013, the study population comprised registered suicides, aged 15 years and older. Decedents totaled 32,151. The outcome measure was relative odds of an authenticated suicide note. An authenticated suicide note was documented in 31% of the suicide cases. Inspection of the full multivariable model showed a suicide note was more likely to manifest among drug intoxication (adjusted odds ratio [OR], 1.70; 95% CI, 1.56, 1.85) and other poisoning suicides (OR, 2.12; 1.85, 2.42) than firearm suicides, the referent. Respective excesses were larger when there was no autopsy or autopsy status was unknown (OR, 1.86; 95% CI, 1.61, 2.14) and (OR, 2.25; 95% CI, 1.86, 2.72) relative to the comparisons with a forensic autopsy (OR, 1.62, 95% CI, 1.45, 1.82 and OR, 2.01; 95% CI, 1.66, 2.43). Hanging/suffocation suicides did not differ from the firearm referent given an autopsy. Suicide requires substantial affirmative evidence to establish manner of death, and affirmation of drug intoxication suicides appears to demand an especially high burden of proof. Findings and their implications argue for more stringent investigative standards, better training, and more resources to support comprehensive and accurate case ascertainment, as the foundation for developing evidence-based suicide prevention initiatives.

Artefact in forensic medicine: non-missile penetrating injury.

PubMed

Patel, F

1994-12-01

Gunshot wounds are well characterised in forensic textbooks and atypical or unusual ballistic characteristics feature regularly in forensic literature. Forensic practitioners receive continuing education in recognising a variety of gunshot wounds which are created by bullet missiles. Awareness of a non-missile penetrating injury mimicking a gunshot wound is also relevant to forensic medical examiners or others who are likely to attend a scene of death. In this case, which involved self-stabbing with a metal nail, a homicidal firearm death investigation was instigated because of a misinterpretation by crime scene investigators.

Firearm Homicide and Other Causes of Death in Delinquents: A 16-Year Prospective Study

PubMed Central

Jakubowski, Jessica A.; Abram, Karen M.; Olson, Nichole D.; Stokes, Marquita L.; Welty, Leah J.

2014-01-01

BACKGROUND: Delinquent youth are at risk for early violent death after release from detention. However, few studies have examined risk factors for mortality. Previous investigations studied only serious offenders (a fraction of the juvenile justice population) and provided little data on females. METHODS: The Northwestern Juvenile Project is a prospective longitudinal study of health needs and outcomes of a stratified random sample of 1829 youth (657 females, 1172 males; 524 Hispanic, 1005 African American, 296 non-Hispanic white, 4 other race/ethnicity) detained between 1995 and 1998. Data on risk factors were drawn from interviews; death records were obtained up to 16 years after detention. We compared all-cause mortality rates and causes of death with those of the general population. Survival analyses were used to examine risk factors for mortality after youth leave detention. RESULTS: Delinquent youth have higher mortality rates than the general population to age 29 years (P < .05), irrespective of gender or race/ethnicity. Females died at nearly 5 times the general population rate (P < .05); Hispanic males and females died at 5 and 9 times the general population rates, respectively (P < .05). Compared with the general population, significantly more delinquent youth died of homicide and its subcategory, homicide by firearm (P < .05). Among delinquent youth, racial/ethnic minorities were at increased risk of homicide compared with non-Hispanic whites (P < .05). Significant risk factors for external-cause mortality and homicide included drug dealing (up to 9 years later), alcohol use disorder, and gang membership (up to a decade later). CONCLUSIONS: Delinquent youth are an identifiable target population to reduce disparities in early violent death. PMID:24936005

The Source of Methadone in Overdose Deaths in Western Virginia in 2004

PubMed Central

Weimer, Melissa B.; Korthuis, P. Todd; Behonick, George S.; Wunsch, Martha J.

2011-01-01

Objectives Methadone-related overdose deaths increased in the United States by 468% from 1999 to 2005. Current studies associate the nonmedical use of methadone with methadone-related deaths. This study describes medical examiner cases in rural Virginia in 2004 with methadone identified by toxicology and compares cases according to source of methadone. Methods In 2004, all intentional and unintentional poisoning deaths from the Office of The Chief Medical Examiner, Western District of Virginia, were reviewed to identify cases in which methadone was a direct or contributing cause of death. The Virginia Prescription Monitoring Program was reviewed for prescription opioids in the name of these identified decedents. Decedent participation in local opioid treatment programs (OTP) was also assessed. Results The source of methadone in the 61 methadone-related overdose deaths was mostly nonprescribed (67%), although 28% of decedents were prescribed methadone for analgesia. Only 5% of decedents were actively enrolled in an OTP. The majority of deaths were attributed to polysubstance overdose. Conclusions The majority of methadone overdose deaths in this study were related to illicit methadone use, rather than prescribed or OTP uses. Interventions to decrease methadone-related deaths should focus on reduction of nonprescription use of methadone. PMID:21844834

Previous Traumatic Life Events versus Course and Effectiveness of PTSD Therapy in Veterans of Polish Military Contingents

DTIC Science & Technology

2011-04-01

complaining of a continuous emotional tension remaining for several months. Sleep problems, memories of the Iraq deployment were recurring in his dreams...tension and insomnia. When his sleep was pharmaceutically rectified, unbearable nightmares occurred. Despite this at the forum of the therapeutical...by local Death Squads. The memories included also brutal scenes of women being raped and whose children were killed. Unintentionally he devoted his

Unintentional Pediatric Cocaine Exposures Result in Worse Outcomes than Other Unintentional Pediatric Poisonings.

PubMed

Armenian, Patil; Fleurat, Michelle; Mittendorf, George; Olson, Kent R

2017-06-01

Unintentional pediatric cocaine exposures are rare but concerning due to potentially serious complications such as seizures, dysrhythmias, and death. The objectives were to assess the demographic and clinical characteristics of pediatric cocaine exposures reported to the California Poison Control System. This is a retrospective study of all confirmed pediatric (< 6 years of age) cocaine exposures reported to the California Poison Control System from January 1, 1997-September 30, 2010. Case narratives were reviewed for patient demographics, exposure details, clinical effects, therapy, hospitalization, and final outcome. Of the 86 reported pediatric cocaine exposures, 36 had positive urine drug testing and were included in the study cohort. The median age at presentation was 18 months (range: 0-48 months), and 56% were male (n = 20). The most common clinical manifestations were tachycardia and seizures. The most common disposition was admission to an intensive care unit (n = 14; 39%). Eleven cases (31%) were classified as having a major effect as per American Association of Poison Control Centers case coding guidelines. One child presented in asystole with return of spontaneous circulation after cardiopulmonary resuscitation and multiple vasoactive medications. The proportion of cocaine exposures with serious (moderate or major) outcomes (66.7%; 95% confidence interval 50.3-79.8%) was higher than other pediatric poisonings reported to the American Association of Poison Control Centers during the study period (0.88%; 95% confidence interval 0.87-0.88). Although pediatric cocaine exposures are rare, they result in more severe outcomes than most unintentional pediatric poisonings. Practitioners need to be aware of the risk of recurrent seizures and cardiovascular collapse associated with cocaine poisoning. Copyright © 2017 Elsevier Inc. All rights reserved.

Injuries to Children and Adolescents. Matrix No. 13.

ERIC Educational Resources Information Center

Robertson, Leon S.

Injuries are the leading causes of death for non-infant children and adolescents. Motor vehicles, drownings, fires, firearms, and poisons, in that order, are the major categories of fatal injury for the child population as a whole. Recognition that the agents of injury are the major forms of energy (mechanical, thermal, chemical) has led to an…

Fatal occupational injuries.

PubMed

Baker, S P; Samkoff, J S; Fisher, R S; Van Buren, C B

1982-08-13

Deaths resulting from work-related injuries during a one-year period in Maryland were identified and reviewed. Of 148 workers killed, all but two were male. Transportation vehicles were involved in 41% of the deaths, with road vehicles accounting for 25% of the total. Other major groups involved nonroad land vehicles (16%) and firearms, primarily handguns (11%). Two thirds of the workers died at the scene or were dead on arrival at the hospital. Head injuries were the most common cause of death. Eleven percent of the workers tested had blood alcohol concentrations of 0.08% by weight or greater. The majority of the deaths involved either hazards that are not addressed by the Occupational Safety and Health Act of 1970 or workers in categories that are excluded by law from regulation under this act.

Associations between active shooter incidents and gun ownership and storage among families with young children in the United States.

PubMed

Morrissey, Taryn W

2017-07-01

The presence of firearms and their unsafe storage in the home can increase risk of firearm-related death and injury, but public opinion suggests that firearm ownership is a protective factor against gun violence. This study examined the effects of a recent nearby active shooter incident on gun ownership and storage practices among families with young children. A series of regression models, with data from the nationally representative Early Childhood Longitudinal Study-Birth Cohort merged with the FBI's Active Shooter Incidents data collected in 2003-2006, were used to examine whether household gun ownership and storage practices differed in the months prior to and following an active shooter incident that occurred anywhere in the United States or within the same state. Approximately one-fifth of young children lived in households with one or more guns; of these children, only two-thirds lived in homes that stored all guns in locked cabinets. Results suggest that the experience of a recent active shooter incident was associated with an increased likelihood of storing all guns locked, with the magnitude dependent on the temporal and geographic proximity of the incident. The severity of the incident, defined as the number of fatalities, predicted an increase in storing guns locked. Findings suggest that public shootings change behaviors related to firearm storage among families with young children. Copyright © 2017 Elsevier Inc. All rights reserved.

Twenty-three years (1993-2015) of homicide trends in the Transkei region of South Africa.

PubMed

Banwari, Meel

2018-01-01

Background Transkei is regarded as a rural part of South Africa. It was one of the black homelands where rigorous apartheid was practised. The incidence of firearm-related deaths used to be very high, but after the implementation of the Firearm Control Act in 2002, the trend changed. However, the murder rate is still a major public-health problem in this region of South Africa. Objective The aim of this study was to investigate 23 years (1993-2015) of homicide trends in the Transkei region of South Africa. Method A review of records of medico-legal autopsies performed at Mthatha Forensic Pathology Laboratory from 1993 to 2015 was undertaken. Results Between 1993 and 2015, the number of autopsies performed on people who had died unnatural deaths was 24,693. The records of 12,618 (51%) autopsies on victims of homicide between 1993 and 2015 were available for study. The average rate of murder was 85/100,000 of the population in this region. Of these deaths, on average 34/100,000 were caused by sharp-edged instruments, 30/100,000 by gunshot wounds and 21/100,000 by blunt trauma. The rate of murder of males was significantly higher than that of females, with a ratio of 5.7:1, and over the period of 23 years covered by this study, the incidence was highest (30.5/100,000) in the young age group between 21 and 30 years. Conclusion The rate of homicide is very high in the Transkei region of South Africa. It needs urgent intervention to curb unnecessary deaths.

Causes and Disparities in Death Rates Among Urban American Indian and Alaska Native Populations, 1999–2009

PubMed Central

Espey, David K.; Groom, Amy V.; Phillips, Leslie E.; Haverkamp, Donald S.; Stanley, Sandte L.

2016-01-01

Objectives. To characterize the leading causes of death for the urban American Indian/Alaska Native (AI/AN) population and compare with urban White and rural AI/AN populations. Methods. We linked Indian Health Service patient registration records with the National Death Index to reduce racial misclassification in death certificate data. We calculated age-adjusted urban AI/AN death rates for the period 1999–2009 and compared those with corresponding urban White and rural AI/AN death rates. Results. The top-5 leading causes of death among urban AI/AN persons were heart disease, cancer, unintentional injury, diabetes, and chronic liver disease and cirrhosis. Compared with urban White persons, urban AI/AN persons experienced significantly higher death rates for all top-5 leading causes. The largest disparities were for diabetes and chronic liver disease and cirrhosis. In general, urban and rural AI/AN persons had the same leading causes of death, although urban AI/AN persons had lower death rates for most conditions. Conclusions. Urban AI/AN persons experience significant disparities in death rates compared with their White counterparts. Public health and clinical interventions should target urban AI/AN persons to address behaviors and conditions contributing to health disparities. PMID:26890168

Booster seat or seat belt? Motor vehicle injuries and child restraint laws in preschool and early school-age children.

PubMed

Angulo-Vazquez, Vicki; De Santis, Joseph P

2005-01-01

Despite numerous interventions to reduce motor vehicle injuries and deaths in children living in the United States, unintentional motor vehicle injuries continue to be the leading cause of death of U.S. children. Even though child restraint laws have been enacted, many children 5 to 9 years of age continue to be injured in motor vehicle crashes. These injuries are related to the improper use of child restraints. Reasons for injuries in this age group were explored by a review of the current literature. Nurses have a unique role in educating families about proper restraint and in contributing to the evidence base for practice.

Dependence of the Firearm-Related Homicide Rate on Gun Availability: A Mathematical Analysis

PubMed Central

Wodarz, Dominik; Komarova, Natalia L.

2013-01-01

In the USA, the relationship between the legal availability of guns and the firearm-related homicide rate has been debated. It has been argued that unrestricted gun availability promotes the occurrence of firearm-induced homicides. It has also been pointed out that gun possession can protect potential victims when attacked. This paper provides a first mathematical analysis of this tradeoff, with the goal to steer the debate towards arguing about assumptions, statistics, and scientific methods. The model is based on a set of clearly defined assumptions, which are supported by available statistical data, and is formulated axiomatically such that results do not depend on arbitrary mathematical expressions. According to this framework, two alternative scenarios can minimize the gun-related homicide rate: a ban of private firearms possession, or a policy allowing the general population to carry guns. Importantly, the model identifies the crucial parameters that determine which policy minimizes the death rate, and thus serves as a guide for the design of future epidemiological studies. The parameters that need to be measured include the fraction of offenders that illegally possess a gun, the degree of protection provided by gun ownership, and the fraction of the population who take up their right to own a gun and carry it when attacked. Limited data available in the literature were used to demonstrate how the model can be parameterized, and this preliminary analysis suggests that a ban of private firearm possession, or possibly a partial reduction in gun availability, might lower the rate of firearm-induced homicides. This, however, should not be seen as a policy recommendation, due to the limited data available to inform and parameterize the model. However, the model clearly defines what needs to be measured, and provides a basis for a scientific discussion about assumptions and data. PMID:23923062

Unintentional drowning mortality, by age and body of water: an analysis of 60 countries.

PubMed

Lin, Ching-Yih; Wang, Yi-Fong; Lu, Tsung-Hsueh; Kawach, Ichiro

2015-04-01

To examine unintentional drowning mortality by age and body of water across 60 countries, to provide a starting point for further in-depth investigations within individual countries. The latest available three years of mortality data for each country were extracted from WHO Health Statistics and Information Services (updated at 13 November 2013). We calculated mortality rate of unintentional drowning by age group for each country. For countries using International Classification of Disease 10 (ICD-10) detailed 3 or 4 Character List, we further examined the body of water involved. A huge variation in age-standardised mortality rate (deaths per 100 000 population) was noted, from 0.12 in Turkey to 9.19 in Guyana. Of the ten countries with the highest age-standardised mortality rate, six (Belarus, Lithuania, Latvia, Russia, Ukraine and Moldova) were in Eastern Europe and two (Kazakhstan and Kyrgyzstan) were in Central Asia. Some countries (Japan, Finland and Greece) had a relatively low rank in mortality rate among children aged 0-4 years, but had a high rank in mortality rate among older adults. On the contrary, South Africa and Colombia had a relatively high rank among children aged 0-4 years, but had a relatively low rank in mortality rate among older adults. With regard to body of water involved, the proportion involving a bathtub was extremely high in Japan (65%) followed by Canada (11%) and the USA (11%). Of the 13 634 drowning deaths involving bathtubs in Japan between 2009 and 2011, 12 038 (88%) were older adults aged 65 years or above. The percentage involving a swimming pool was high in the USA (18%), Australia (13%), and New Zealand (7%). The proportion involving natural water was high in Finland (93%), Panama (87%), and Lithuania (85%). After considering the completeness of reporting and quality of classifying drowning deaths across countries, we conclude that drowning is a high-priority public health problem in Eastern Europe, Central Asia, Japan (older adults involving bathtubs), and the USA (involving swimming pools). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Undertriage of Firearm-Related Injuries in a Major Metropolitan Area

PubMed Central

Lale, Allison; Krajewski, Allison

2017-01-01

Importance National anatomic triage criteria prescribe specific transport rules for injured patients. However, there is limited information about patients with firearm-related injuries undertriaged to nondesignated facilities (ie, hospitals without specialized trauma teams or units), including what clinical outcomes are achieved and how many are transferred to a higher level of care. Without these data, it is difficult to make informed regional or national policy decisions about triage practices. Undertriage of firearm-related injuries is a good model for evaluating the undertriage of patients with trauma because the anatomic triage criteria for patients with firearm-related injuries are simple. Objective To evaluate the prevalence, spatial distribution, and clinical outcomes of undertriage of firearm-related injuries. Design, Setting, and Participants This study is a retrospective analysis of firearm-related injuries in residents of Cook County, Illinois, from January 1, 2009, to December 31, 2013. Outpatient and inpatient hospital databases were used. Participants included patients with International Classification of Diseases, Ninth Revision, Clinical Modification firearm-related cause-of-injury codes. Data were collected all at once in August 2014. Data analysis took place from March 12, 2015, to February 1, 2016. Main Outcomes and Measures Undertriaged cases were defined as patients who met the national anatomic triage criteria for transfer to higher-level trauma center care. Spatial distribution, injury severity, and clinical outcomes, including death, were analyzed. Results Of the 9886 patients included in this analysis, 8955 (90.6%) were male, 7474 (75.6%) were African American, and 5376 (54.4%) were aged 15 to 24 years.In Cook County, Illinois, where there are 19 trauma centers, 2842 of 9886 (28.7%) firearm-related injuries were initially treated in nondesignated facilities. Among the 4934 cases with firearm-related injury who met the anatomic triage criteria, 884 (17.9%) received initial treatment at a nondesignated facility and only 92 (10.4%) were transferred to a designated trauma center. Significant spatial clustering was identified on the west side of Chicago and in the southern parts of Chicago and Cook County. In the multivariable models, patients treated in nondesignated facilities were less likely to die than were patients treated in designated trauma centers. Conclusions and Relevance Undertriage of firearm-related injuries was much more prevalent than expected. Although the likelihood of dying during hospitalization was greater among patients treated in designated trauma centers, these patients were substantially in worse condition across all measures of injury severity. A smaller proportion of patients treated in designated trauma centers died during the first 24 hours of hospitalization. This study highlights the need for better regional coordination, especially with interhospital transfers, as well as the importance of assessing the distribution of emergency medical services resources to make the trauma care system more effective and equitable. PMID:28114435

Retrospective case series analysis of characteristics and trends in unintentional pharmaceutical drug poisoning by methadone, opioid analgesics, antidepressants and benzodiazepines in Clark County, NV 2009-13.

PubMed

Bruno, Tamara; Pharr, Jennifer R

2017-06-01

Poisoning has become the leading cause of injury death in the USA-with opioid analgesic involved in more fatal poisonings than any other drug, including cocaine and heroin. The epidemic of prescription drug poisonings is a public health concern. This study aimed to define potential high-risk groups for unintentional prescription drug poisoning by methadone, opioid analgesics, antidepressants or benzodiazepines. A hospital-based retrospective case series analysis of admissions related to prescription drug poisonings associated with methadone, opioid analgesics, antidepressants or benzodiazepines for hospitals in Clark County, Nevada between 2009 and 2013 was employed. There were 7414 admissions with a primary diagnosis of an unintentional poisoning due to methadone, opioid analgesics, antidepressants or benzodiazepines. Women had the highest rate of admissions particularly in the 45-54 age group. Higher rates of admissions were also found among non-Hispanic whites, single and uninsured populations. There were concerning increases in admissions among 65+ and Native American/Alaskan Native subgroups in 2013. Benzodiazepines and opioid analgesics were the most prevalent drug categories for prescription drug poisoning admissions. Public health professionals can utilize hospital data to identify populations at risk and in need of targeted interventions. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

"Violence" in medicine: necessary and unnecessary, intentional and unintentional.

PubMed

Shapiro, Johanna

2018-06-11

We are more used to thinking of medicine in relation to the ways that it alleviates the effects of violence. Yet an important thread in the academic literature acknowledges that medicine can also be responsible for perpetuating violence, albeit unintentionally, against the very individuals it intends to help. In this essay, I discuss definitions of violence, emphasizing the importance of understanding the term not only as a physical perpetration but as an act of power of one person over another. I next explore the paradox of a healing profession that is permeated with violence sometimes necessary, often unintentional, and almost always unrecognized. Identifying the construct of "physician arrogance" as contributory to violence, I go on to identify different manifestations of violence in a medical context, including violence to the body; structural violence; metaphoric violence; and the practice of speaking to or about patients (and others in the healthcare system in ways that minimize or disrespect their full humanity. I further suggest possible explanations for the origins of these kinds of violence in physicians, including the fear of suffering and death in relation to vicarious trauma and the consequent concept of "killing suffering"; as well as why patients might be willing to accept such violence directed toward them. I conclude with brief recommendations for attending to root causes of violence, both within societal and institutional structures, and within ourselves, offering the model of the wounded healer.

Epidemiology of Unintentional Child Injuries in the Makwanpur District of Nepal: A Household Survey

PubMed Central

Pant, Puspa Raj; Towner, Elizabeth; Ellis, Matthew; Manandhar, Dharma; Pilkington, Paul; Mytton, Julie

2015-01-01

Secondary sources of information indicate that the proportion of child deaths due to injuries is increasing in Nepal. This study aimed to describe the epidemiology of unintentional injuries in children, explore risk factors and estimate the burden faced by families and the community in the Makwanpur district. We conducted a household survey in Makwanpur, covering 3441 households. Injuries that occurred during the 12 months before the survey and required treatment or caused the child to be unable to take part in usual activities for three or more days were included. We identified 193 cases of non-fatal unintentional child injuries from 181 households and estimated an annual rate of non-fatal injuries of 24.6/1000 children; rates for boys were double (32.7/1000) that for girls (16.8/1000). The rates were higher among the children of age groups 1–4 years and 5–9 years. Falls were the most common cause of non-fatal child injuries followed by burns in preschool children and road traffic injuries were the most likely cause in adolescence. Mean period of disability following injury was 25 days. The rates and the mechanisms of injury vary by age and gender. Falls and burns are currently the most common mechanisms of injury amongst young children around rural homes. PMID:26633439

The chronic pain initiative and community care of North Carolina.

PubMed

Lancaster, Michael; McKee, Jerry; Mahan, Amelia

2013-01-01

The rate of unintentional deaths from opioid poisoning has reached epidemic proportions. One model of successful intervention is Project Lazarus, an integrated-care pilot program in Wilkes County, North Carolina. Community Care of North Carolina, supported by a grant of $1.3 million from the Kate B. Reynolds Charitable Trust and matching funds of $1.3 million from the North Carolina Office of Rural Health and Community Care, is now expanding the Project Lazarus approach statewide.

Competency‐based strategies for injury control and prevention curriculums in undergraduate medical education

PubMed Central

Phelan, Mary Beth; Falimirski, Mark E; Simpson, Deborah E; Czinner, Mary L; Hargarten, Stephen W

2007-01-01

Injury, including unintentional injury and intentional injury, is the leading cause of death in people aged ⩽44 years. Doctors often treat acute injuries, assist in the rehabilitation process and provide injury prevention guidance to patients. Current undergraduate medical school curriculums lack content and consistency in providing training in this area. A matrix to show the integration of injury control and prevention principles into existing undergraduate medical school curriculums is proposed. PMID:17296681

Human disturbances of waterfowl: causes, effects, and management

USGS Publications Warehouse

Korschgen, C.E.; Dahlgren, R.B.

1992-01-01

Human disturbances of waterfowl can be intentional or unintentional. They may result from overt or directed activities or may be ancillary to activities not initially thought to be of concern to birds. Some of these disturbances are manifested by alertness, fright (obvious or inapparent), flight, swimming, disablement, or death. Therefore, persons responsible for waterfowl management areas should be aware of the problems from human disturbance and should design management and facilities that increase public appreciation of waterfowl.

Temporal trends, gender, and geographic distributions in child and youth injury rates in Sweden.

PubMed

Ekman, R; Svanström, L; Långberg, B

2005-02-01

Sweden has the lowest child injury mortality rate in the world, 5.2/100 000 for children under 15. This paper describes temporal trends in Sweden, as well as gender related and geographic differences. The Swedish Cause-of-Death Register (1987-2001) and the Hospital Patient Register (1987-2002) were used to compare rates for the country as a whole and for discharges aged 0-20 by municipality, using the SEATS time series analysis program. There was a decrease in the rate of fatal unintentional injuries from 7 to 4 per 100 000 for girls and from 16 to 10 per 100 000 for boys since 1987. The gap between girls and boys was reduced and boys now have almost the same mortality rate as girls for violence related deaths. Road and other unintentional injuries show a general decrease whereas the pattern for falls varies by age and sex. Self inflicted injuries increased for both sexes, but more for girls. Substantial differences in injury rates between municipalities were also found-up to six times for girls and eight times for boys. Substantial declines in injury fatalities over time were found, but these were different for boys and girls. There remain substantial differences between municipalities. These data, published in a child injury atlas, have prompted substantial interest among media and the authorities.

The Sandy Hook Elementary School shooting as tipping point: "This Time Is Different".

PubMed

Shultz, James M; Muschert, Glenn W; Dingwall, Alison; Cohen, Alyssa M

2013-01-01

Among rampage shooting massacres, the Sandy Hook Elementary School shooting on December 14, 2012 galvanized public attention. In this Commentary we examine the features of this episode of gun violence that has sparked strong reactions and energized discourse that may ultimately lead toward constructive solutions to diminish high rates of firearm deaths and injuries in the United States.

The Sandy Hook Elementary School shooting as tipping point

PubMed Central

Shultz, James M; Muschert, Glenn W; Dingwall, Alison; Cohen, Alyssa M

2013-01-01

Among rampage shooting massacres, the Sandy Hook Elementary School shooting on December 14, 2012 galvanized public attention. In this Commentary we examine the features of this episode of gun violence that has sparked strong reactions and energized discourse that may ultimately lead toward constructive solutions to diminish high rates of firearm deaths and injuries in the United States. PMID:28228989

Wound ballistics: recognizing wound potential. Part 1: Characteristics of missiles and weapons.

PubMed

Dufresne, G W

1995-01-01

In the United States the number of firearm-related deaths in 1989 was almost equal to the number of motor vehicle-related deaths. Trauma nurses could not imagine themselves caring for motor vehicle crash victims without any understanding of speed, vehicle damage, or collision angles. Gunshot wounds are becoming nearly as frequent as motor vehicle crashes, but the mechanism of injury for a gunshot wound is not as widely understood. This article explains the basics of wound ballistics, emergent care of the gunshot wound victim, and medicolegal concerns for the trauma nurse.

Injury deaths among Finnish residents travelling abroad.

PubMed

Lunetta, Philippe

2010-09-01

The increasing international mobility raises the possibility of foreign nationals dying abroad. Here, a descriptive, retrospective and population-based study of deaths abroad among Finnish residents from 1969 to 2007 is presented. The data were collected from the Statistics Finland data based on certificates of cause of death issued after repatriation of the corpse and after review of medical documents or a medico-legal autopsy. The frequency of injury deaths, proportional mortality rates (PMRs) and mortality risk estimates (MREs) were measured. During the study period, 6894 Finnish residents died abroad. Spain, Sweden and Thailand were the top three destination countries for number of deaths, accounting together for 40.3% of all the deaths. Cardiovascular diseases were the most common cause of deaths. The overall injury deaths represented 26.7% of all deaths abroad and occurred at a higher proportion than in Finland (PMR: 3.3). The most common injury deaths were traffic accident and drowning, which together represented more than 50% of all unintentional injury deaths. High PMRs were found for traffic accidents in Russia, Germany and the US and for drowning in Spain, Portugal, Greece and Turkey. The MRE for injury deaths was 73.5 per 100,000 person-years of exposure. Finnish travellers abroad are a population subgroup with a high risk of injury death. Common travel health interventions must be backed by actions to prevent injuries abroad, particularly traffic accident and drowning.

Socioeconomic factors affecting infant sleep-related deaths in St. Louis.

PubMed

Hogan, Cathy

2014-01-01

Though the Back to Sleep Campaign that began in 1994 caused an overall decrease in sudden infant death syndrome (SIDS) rates, racial disparity has continued to increase in St. Louis. Though researchers have analyzed and described various sociodemographic characteristics of SIDS and infant deaths by unintentional suffocation in St. Louis, they have not simultaneously controlled for contributory risk factors to racial disparity such as race, poverty, maternal education, and number of children born to each mother (parity). To determine whether there is a relationship between maternal socioeconomic factors and sleep-related infant death. This quantitative case-control study used secondary data collected by the Missouri Department of Health and Senior Services between 2005 and 2009. The sample includes matched birth/death certificates and living birth certificates of infants who were born/died within time frame. Descriptive analysis, Chi-square, and logistic regression. The controls were birth records of infants who lived more than 1 year. Chi-square and logistic regression analyses confirmed that race and poverty have significant relationships with infant sleep-related deaths. The social significance of this study is that the results may lead to population-specific modifications of prevention messages that will reduce infant sleep-related deaths. © 2013 Wiley Periodicals, Inc.

Trends in cause specific mortality across occupations in Japanese men of working age during period of economic stagnation, 1980-2005: retrospective cohort study.

PubMed

Wada, Koji; Kondo, Naoki; Gilmour, Stuart; Ichida, Yukinobu; Fujino, Yoshihisa; Satoh, Toshihiko; Shibuya, Kenji

2012-03-06

To assess the temporal trends in occupation specific all causes and cause specific mortality in Japan between 1980 and 2005. Longitudinal analysis of individual death certificates by last occupation before death. Data on population by age and occupation were derived from the population census. Government records, Japan. Men aged 30-59. Age standardised mortality rate for all causes, all cancers, cerebrovascular disease, ischaemic heart disease, unintentional injuries, and suicide. Age standardised mortality rates for all causes and for the four leading causes of death (cancers, ischaemic heart disease, cerebrovascular disease, and unintentional injuries) steadily decreased from 1980 to 2005 among all occupations except for management and professional workers, for whom rates began to rise in the late 1990s (P<0.001). During the study period, the mortality rate was lowest in other occupations such as production/labour, clerical, and sales workers, although overall variability of the age standardised mortality rate across occupations widened. The rate for suicide rapidly increased since the late 1990s, with the greatest increase being among management and professional workers. Occupational patterns in cause specific mortality changed dramatically in Japan during the period of its economic stagnation and resulted in the reversal of occupational patterns in mortality that have been well established in western countries. A significant negative effect on the health of management and professional workers rather than clerks and blue collar workers could be because of increased job demands and more stressful work environments and could have eliminated or even reversed the health inequality across occupations that had existed previously.

Risk factors associated with unintentional house fire incidents, injuries and deaths in high-income countries: a systematic review.

PubMed

Turner, Samantha L; Johnson, Rhodri D; Weightman, Alison L; Rodgers, Sarah E; Arthur, Geri; Bailey, Rowena; Lyons, Ronan A

2017-04-01

To identify the distinguishing risk factors associated with unintentional house fire incidents, injuries and deaths. Systematic review. A range of bibliographical databases and grey literature were searched from their earliest records to January 2016. To ensure the magnitude of risk could be quantified, only those study types which contained a control group, and undertook appropriate statistical analyses were included. A best evidence synthesis was conducted instead of a meta-analysis due to study heterogeneity. Eleven studies investigating a variety of risk factors and outcomes were identified. Studies ranged from medium to low quality with no high quality studies identified. Characteristics commonly associated with increased risk of house fire incidents, injuries and fatalities included: higher numbers of residents, male, children under the age of 5 years, non-working households, smoking, low income, non-privately owned properties, apartments and buildings in poor condition. Several risk factors were only associated with one outcome (eg, living alone was only associated with increased risk of injurious fires), and households with older residents were at increased risk of injurious fires, but significantly less likely to experience a house fire in the first place. This best evidence synthesis indicates that several resident and property characteristics are associated with risk of experiencing house fire incidents, injuries or death. These findings should be considered by the Fire and Rescue Services and others with a role in fire prevention. Future research should adopt robust, standardised study designs to permit meta-analyses and enable stronger conclusions to be drawn. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

North Carolina's Operation Medicine Drop: Results From One of the Nation's Largest Drug Disposal Programs.

PubMed

Fleming, Eleanor; Proescholdbell, Scott; Sachdeva, Nidhi; Alexandridis, Apostolos A; Margolis, Lewis; Ransdell, Kelly

2016-01-01

In 2013, a total of 1,085 North Carolina residents died due to unintentional poisoning; 91% of these deaths were attributed to medications or drugs (over-the-counter, prescription, or illicit). Proper disposal of unused, unneeded, and/or expired medications is an essential part of preventing these unintentional deaths, as well as averting the other adverse consequences of these drugs on the environment and population health. Operation Medicine Drop is a medication take-back program coordinated by Safe Kids North Carolina, a county-level, coalition-based injury prevention organization. The Operation Medicine Drop program and event registration system were used to review and validate the number of events, the counties where the events were held, and the number of unit doses (pills) collected from March 2010 to June 2014. SAS version 9.4 was used to generate basic counts and frequencies of events and doses, and ArcGIS version 10.0 was used to create the map. From March 2010 to June 2014, Operation Medicine Drop held 1,395 events with 245 different participating law enforcement agencies in 91 counties in North Carolina, and it collected 69.6 million unit doses of medication. More than 60 local Safe Kids North Carolina community coalitions had participated as of June 2014. Every year, Operation Medicine Drop has witnessed increases in events, participating agencies, participating counties, and the number of doses collected. Operation Medicine Drop is an excellent example of a successful and ongoing collaboration to improve public health. Medication take-back programs may play an important role in preventing future overdose deaths in North Carolina. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Parent and Metabolite Opioid Drug Concentrations in Unintentional Deaths Involving Opioid and Benzodiazepine Combinations*†‡

PubMed Central

Fields, Marcia D.; Abate, Marie A.; Hu, Lan; Long, D. Leann; Blommel, Matthew L.; Haikal, Nabila A.; Kraner, James C.

2016-01-01

Effects of benzodiazepines on postmortem opioid parent and parent/metabolite blood concentration ratios were determined for fentanyl-, hydrocodone-, methadone-, or oxycodone-related accidental deaths. These opioids are partially metabolized by the CYP3A4 enzyme system, which is also affected by diazepam and alprazolam. Opioid/metabolite combinations examined were as follows: fentanyl/norfentanyl, hydrocodone/dihydrocodeine, methadone/EDDP, and oxycodone/oxymorphone. Parent opioid concentrations were analyzed for 877 deaths. Parent/metabolite concentration ratios were analyzed for 349 deaths, excluding cases with co-intoxicants present known to interfere with opioid elimination. Alprazolam in combination with diazepam significantly decreased median hydrocodone concentrations by 48% (p = 0.01) compared to hydrocodone alone. The methadone parent/metabolite concentration ratio was reduced by 35% in the presence of diazepam compared to methadone alone (p = 0.03). Benzodiazepines did not statistically significantly affect fentanyl or oxycodone concentrations. Possible factors affecting opioid concentrations and possible toxicity development, including any differential effects on specific opioids, should continue to be explored. PMID:26223761

Do black lives matter in public health research and training?

PubMed

Rosenberg, Molly; Ranapurwala, Shabbar I; Townes, Ashley; Bengtson, Angela M

2017-01-01

To examine whether investments made in public health research align with the health burdens experienced by white and black Americans. In this cross-sectional study of all deaths in the United States in 2015, we compared the distribution of potential years of life lost (PYLL) across 39 causes of death by race and identified key differences. We examined the relationship between cause-of-death-specific PYLL and key indicators of public health investment (federal funding and number of publications) by race using linear spline models. We also compared the number of courses available at the top schools of public health relevant to the top causes of death contributor to PYLL for black and white Americans. Homicide was the number one contributor to PYLL among black Americans, while ischemic heart disease was the number one contributor to PYLL among white Americans. Firearm-related violence accounted for 88% of black PYLL attributed to homicide and 71% of white PYLL attributed to homicide. Despite the high burden of PYLL, homicide research was the focus of few federal grants or publications. In comparison, ischemic heart disease garnered 341 grants and 594 publications. The number of public health courses available relevant to homicide (n = 9) was similar to those relevant to ischemic heart disease (n = 10). Black Americans are disproportionately affected by homicide, compared to white Americans. For both black and white Americans, the majority of PYLL due to homicide are firearm-related. Yet, homicide research is dramatically underrepresented in public health research investments in terms of grant funding and publications, despite available public health training opportunities. If left unchecked, the observed disproportionate distribution of investments in public health resources threatens to perpetuate a system that disadvantages black Americans.

Frequency of forensic toxicological analysis in external cause deaths among nursing home residents: an analysis of trends.

PubMed

Aitken, Georgia; Murphy, Briony; Pilgrim, Jennifer; Bugeja, Lyndal; Ranson, David; Ibrahim, Joseph Elias

2017-03-01

There is a paucity of research examining the utility of forensic toxicology in the investigation of premature external cause deaths of residents in nursing homes. The aim of this study is to describe the frequency and characteristics of toxicological analysis conducted in external cause (injury-related) deaths amongst nursing home residents in Victoria, Australia. This study was a retrospective cohort study examining external cause deaths among nursing home residents during the period July 1, 2000 to December 31, 2012 in Victoria, Australia, using the National Coronial Information System (NCIS). The variables examined comprised: sex, age group, year-of-death, cause and manner of death. One-third of deaths among nursing home residents in Victoria resulted from external causes (n = 1296, 33.3%) of which just over one-quarter (361, 27.9%) underwent toxicological analysis as part of the medical death investigation. The use of toxicological analysis varied by cause of death with a relatively low proportion conducted in deaths from unintentional falls (n = 286, 24.9%) and choking (n = 36, 40.4%). The use of toxicological analysis decreased as the decedents age increased. Forensic toxicology has the potential to contribute to improving our understanding of premature deaths in nursing home residents however it remains under used and is possibly undervalued.

To prevent child injuries and deaths by firearms.

THOMAS, 111th Congress

Rep. Langevin, James R. [D-RI-2

2018-05-23

House - 05/23/2018 Referred to the Committee on the Judiciary, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee... (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

The Unintentional Injurer: Results From the Boston Youth Survey

PubMed Central

Solnick, Sara J.

2011-01-01

Objectives. We sought to provide additional information about the characteristics of adolescents who were most likely to cause unintentional injury to other people. Methods. In 2008, as part of a randomized survey of high-school students in the Boston Public School system, more than 1800 respondents answered questions about unintentionally causing an injury to someone else in the past year. Results. More than 20% of boys and 13% of girls reported unintentionally injuring another person in the past year. Being male, exercising, participating in organized activities, and having carried a knife were risk factors for unintentionally causing an injury during sports. Using illegal drugs, having friends who are a bad influence, and having carried a knife were risk factors for unintentionally causing an injury not associated with sports. Conclusions. Unintentionally injuring another person is a fairly common event for high-school students. Characteristics differ between adolescents who unintentionally injure others during sports versus those who unintentionally injure others during nonsports activities. Many of the risk factors for causing unintentional injury unrelated to sports are similar to those for intentionally causing injury. PMID:21389291

Unintentional strangulation deaths from the "choking game" among youths aged 6-19 years - United States, 1995-2007.

PubMed

Toblin, Robin L; Paulozzi, Leonard J; Gilchrist, Julie; Russell, Patricia J

2008-01-01

The "choking game" is defined as self-strangulation or strangulation by another person with the hands or a noose to achieve a brief euphoric state caused by cerebral hypoxia. Participants in this activity typically are youths (Andrew & Fallon, 2007). Serious neurologic injury or death can result from engaging in this activity. Recent news media reports have described numerous deaths among youths attributed to the choking game. Because no traditional public health dataset collects data on this practice, CDC used news media reports to estimate the incidence of deaths from the choking game. This report describes the results of that analysis, which identified 82 probable choking-game deaths among youths aged 6-19 years during 1995-2007. Seventy-one (86.6%) of the decedents were male, and the mean age was 13.3 years. Parents, educators, and health-care providers should become familiar with warning signs that youths are playing the choking game (Urkin & Merrick, 2006). Impact of industry: By learning about the risk factors for and warning signs of the choking game, parents, educators, and health-care providers may be able to identify youth at risk for playing the game and prevent future deaths.

Mining for Murder-Suicide: An Approach to Identifying Cases of Murder-Suicide in the National Violent Death Reporting System Restricted Access Database.

PubMed

McNally, Matthew R; Patton, Christina L; Fremouw, William J

2016-01-01

The National Violent Death Reporting System (NVDRS) is a United States Centers for Disease Control and Prevention (CDC) database of violent deaths from 2003 to the present. The NVDRS collects information from 32 states on several types of violent deaths, including suicides, homicides, homicides followed by suicides, and deaths resulting from child maltreatment or intimate partner violence, as well as legal intervention and accidental firearm deaths. Despite the availability of data from police narratives, medical examiner reports, and other sources, reliably finding the cases of murder-suicide in the NVDRS has proven problematic due to the lack of a unique code for murder-suicide incidents and outdated descriptions of case-finding procedures from previous researchers. By providing a description of the methods used to access to the NVDRS and coding procedures used to decipher these data, the authors seek to assist future researchers in correctly identifying cases of murder-suicide deaths while avoiding false positives. © 2015 American Academy of Forensic Sciences.

Fatal occupational injuries of women, Texas 1975-84.

PubMed Central

Davis, H; Honchar, P A; Suarez, L

1987-01-01

A review of Texas death certificates for 1975-84 identified 348 cases of fatal occupational injuries of civilian females. Homicides accounted for 53 per cent and motor vehicle-related injuries accounted for 26 per cent of the deaths. Injuries from firearms caused 70 per cent of the homicides. One hundred thirty-three deaths occurred to women employed in the retail trade industry; of these, 77 per cent resulted from homicide. Women workers in gasoline service stations, food-bakery-and-dairy stores, and eating-and-drinking places had especially high risks of homicide. Texas female heavy-truck drivers had the highest fatal-injury rate, with motor-vehicle-related injuries causing 89 per cent of their deaths. These results indicate that effective strategies to prevent fatal occupational injuries of Texas women will need to address the problems of workplace violence and the hazards posed by motor vehicles. PMID:3674251

Descriptive epidemiology of unintentional residential fire injuries in King County, WA, 1984 and 1985.

PubMed Central

Ballard, J E; Koepsell, T D; Rivara, F P; Van Belle, G

1992-01-01

Although most studies have concentrated on fatal residential fire injuries, which are a leading cause of fatal injuries in the United States, few investigators have examined in detail nonfatal injuries as a consequence of residential fires. This population-based study used the Washington State Fire Incident Reporting System to assess the incidence and descriptive epidemiology of fatal and nonfatal burns or respiratory tract damage resulting from unintentional residential fires. For the 2-year period 1984-85 in King County, WA, the mortality rate due to injury in a residential fire was 0.7 per 100,000 per year, and the incidence of nonfatal injuries was 5.6 per 100,000 per year. Of 17 fatalities, 59 percent of the deaths occurred at the scene of the fire. Of 128 persons with nonfatal injuries, 19 percent were hospitalized; although the 55 percent seen as outpatients and the 26 percent treated by the fire department or paramedics at the fire scene usually had minor injuries, they would not have been captured if only traditional data sources had been employed. Those injured averaged 2.8 days of restricted activity, but the range was from less than 1 day to 1 year. Injuries were more common in the households with a low socioeconomic status and among nonwhites, especially American Indians. Variation in incidence by age, sex, and source of ignition for deaths and nonfatal injuries suggests appropriate targets for future fire injury prevention programs. PMID:1641436

[Homicides involving firearms in Argentina between 1991 and 2006: a multilevel analysis].

PubMed

Zunino, Marina Gabriela; Diez Roux, Ana Victoria; de Souza, Edinilsa Ramos

2012-12-01

The influence of variables at different levels of organization and the effect of time on the occurrence of firearm-related homicides (FRH) in Argentina between 1991 and 2006 was analyzed using multilevel analysis. A three-level Poisson regression model was used. The first level corresponded to the distribution of the number of FRH by sex and age group for each administrative region and (four-year) period; the second corresponded to the variation over time in the interior of each administrative region; the third modeled the variation between administrative regions in accordance with the Level of Urbanization, Percentage of Homes with Unsatisfied Basic Needs and the Percentage of Working Adults. There were 15,067 FRH in persons aged 14 and over between 1991 and 2006 in the 493 administrative regions. The risk of death was higher in males and persons of 15 to 29 years of age; ages above that were associated with a lower risk. The influence of age was greater in central-urban zones and between 1999 and 2002 than during other periods. The level of urbanization was the socioeconomic variable most strongly associated with FRH risk. The risk of death from FRH was 1.6 times higher in central-urban zones compared with non-central zones. In both zones, the risk was highest between 1999 and 2002.

Suicide in Serbia.

PubMed

Ilic, M; Ilic, I

2016-03-15

Suicide remains a significant public health problem worldwide. The aim of this study was to assess the mortality trend of suicide in Serbia for the years 1991-2014. Data on persons who died of suicide and self-inflicted injury (site codes E950-E959 revision 9 and X60-X84 revision 10 of the International Classification of Diseases to classify death, injury and cause of death) were obtained from the Statistical Office of the Republic of Serbia. The age standardized rate was calculated by direct method (per 100,000 persons, using Segi's World population as standard population). Average annual percentage change (AAPC) with the corresponding 95% confidence interval (CI) was computed for trend using the joinpoint regression analysis. Total 33,930 (24,016 men and 9914 women) suicide deaths occurred in Serbia during the observed period, with the average annual age-standardized mortality rate being 12.7 per 100,000 inhabitants (19.5 per 100,000 in men and 6.7 per 100,000 in women). Suicide mortality in all age groups was higher among men than women. In both genders, suicide rates were highest in the oldest age group. Significantly decreased trend in suicide mortality was recorded continuously from 1991 to 2014 (AAPC=-1.9%, 95%CI -2.2 to -1.6). The most frequently used suicide method in both genders was hanging, strangulation or suffocation with 61.2% off all suicides. Changes in mortality rates were significant both for suicide by firearms, air guns and explosives (AAPC=-1.5% (AAPC=-1.5% in men and -3.1%-3.1% in women) and for suicide by hanging, strangulation, and suffocation (AAPC=-1.2% (AAPC=-1.2% in men and -3.0%-3.0% in women). In men, nonsignificant increase in suicide by firearms, air guns and explosives observed during the period 1991-1997 (by +6.1% per year) was followed by a significant decrease until 2014 (by -3.1% per year). The significantly increased mortality in suicide by firearms, air guns, and explosives was observed in older men (aged 40-69 years and 80 years and over). The low rate of autopsies in Serbia, as well as the accuracy, reliability and comparability of the suicide mortality data is always a question. Downward trend in suicide mortality occurred in Serbia in last two decades. However, suicide rates are still very high in Serbia compared with the rates of suicides in developed countries. Particularly worrisome is the increase in mortality in older men, especially due to firearm suicides, air rifles, and explosives. Thus, additional efforts in the prevention of suicide are very important. Copyright © 2015 Elsevier B.V. All rights reserved.

Guns in the Home and the Possibility of Aggressive Tendencies: Exploring a Community Sample of Adolescents in Low-Income Communities.

PubMed

Lian, Brad; Abiero, Beatrice; Kamara, Paula

2017-01-01

Firearm violence has been the second leading cause of death among adolescents and young adults in the United States since 2000 and is a major public health concern. But firearms may be related to less lethal forms of violence as well. Here we examine the relationship between the presence of a gun in the home and several behavioral and psychosocial measures related to aggression and violence among adolescents using data from a community-based survey of nearly 2,000 youths living in low-income neighborhoods. Our results indicate that adolescents living in homes where a gun is present display more aggressive attitudes and behaviors than their counterparts living in homes with no gun present. More research is needed to better understand the mechanisms underlying the relationships, but they may relate to a weapon's effect or social learning.

Block observations of neighbourhood physical disorder are associated with neighbourhood crime, firearm injuries and deaths, and teen births.

PubMed

Wei, Evelyn; Hipwell, Alison; Pardini, Dustin; Beyers, Jennifer M; Loeber, Rolf

2005-10-01

To provide reliability information for a brief observational measure of physical disorder and determine its relation with neighbourhood level crime and health variables after controlling for census based measures of concentrated poverty and minority concentration. Psychometric analysis of block observation data comprising a brief measure of neighbourhood physical disorder, and cross sectional analysis of neighbourhood physical disorder, neighbourhood crime and birth statistics, and neighbourhood level poverty and minority concentration. Pittsburgh, Pennsylvania, US (2000 population=334 563). Pittsburgh neighbourhoods (n=82) and their residents (as reflected in neighbourhood level statistics). The physical disorder index showed adequate reliability and validity and was associated significantly with rates of crime, firearm injuries and homicides, and teen births, while controlling for concentrated poverty and minority population. This brief measure of neighbourhood physical disorder may help increase our understanding of how community level factors reflect health and crime outcomes.

Unusual planned complex suicide committed with a muzzle-loading pistol in combination with subsequent hanging.

PubMed

Ondruschka, Benjamin; Morgenthal, Sylvia; Dreβler, Jan; Bayer, Ronny

2016-11-01

In Germany, suicides by firearms are not very common in contrast to deaths by hanging and intoxications. The use of historical muzzle-loading firearms in the context of suicides is a rarity. Contact shots from muzzle loaders cause an unusual wound morphology with extensive soot soiling. We report the case of a 59-year-old man, who committed a planned complex suicide by shooting into his mouth with a replica percussion gun in combination with hanging. The gunshot injury showed strong explosive effects in the oral cavity with fractures of the facial bones and the skull associated with cerebral evisceration (so-called Krönlein shot). Due to the special constellation of the case with hanging immediately after the shot, external bleeding from the head injuries was only moderate. Therefore, the head injuries could be assessed and partially reconstructed already at the scene.

Deaths due to traumatic brain injury in Austria between 1980 and 2012.

PubMed

Mauritz, Walter; Brazinova, Alexandra; Majdan, Marek; Rehorcikova, Veronika; Leitgeb, Johannes

2014-01-01

To investigate changes in TBI mortality in Austria during 1980-2012 and to identify causes for these changes. Statistik Austria provided data (from death certificates) on all TBI deaths from January 1980-December 2012. Data included year/month of death, age, sex, residency of the cases and mechanism of accident. Data regarding the size of the age groups was obtained from Statistik Austria. Mortality rates (MR; deaths/10(5) population/year) were calculated for male vs. female patients and for different age groups. Changes in mechanisms of TBI were evaluated. The MR decreased from 28.1 to 11.8 deaths/10(5) population/year. Traffic-related TBI deaths decreased from 62% to 9%. This caused a significant decrease in TBI deaths in younger age groups. Fall-related TBI deaths (mostly geriatric cases) remained unchanged. Falls became the leading cause; its rate increased from 22% to 64% of all TBI deaths. Thus, the mean age of fatal TBI cases increased by 20 years and the rate of cases aged <60 years decreased from 71% to 28%. Another important cause was suicide by firearms; its rate increased from 10% to 23% of all TBI deaths. These findings warrant better prevention of falls in the elderly and of suicides.

Mortality salience and symbols of cultural worldview affect the desirability of a stressful job: the ironic consequences of terror management.

PubMed

Wirth-Petrik, Brittney; Guenther, R Kim

2012-12-01

In a study of terror management theory, participants first responded to prompts asking them to imagine their own death or dental pain and later rated the desirability of a generic job described explicitly as extremely stressful. The job description included either an American or foreign company logo. As predicted by terror management theory, the participants shown an American logo ironically desired the stressful job more, having been prompted with reminders of death than with reminders of dental pain. This study is the first to examine terror management theory's prediction of the influence of symbols of cultural worldview on health-related decisions. The authors discuss possible implications of the findings for making unintentionally stress-inducing decisions and for public health campaigns.

47 CFR 15.109 - Radiated emission limits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL RADIO FREQUENCY DEVICES Unintentional Radiators § 15.109... from unintentional radiators at a distance of 3 meters shall not exceed the following values: Frequency... systems used as unintentional radiators or other unintentional radiators that are designed to conduct...

Characteristics of alprazolam-related deaths compiled by a centralized state medical examiner.

PubMed

Shah, Neel A; Abate, Marie A; Smith, Michael J; Kaplan, James A; Kraner, James C; Clay, David J

2012-11-01

Unintentional drug poisoning deaths represent a major health concern, particularly in rural areas. Although alprazolam is frequently detected in drug-related deaths, characterization of its involvement is limited. Our objective was to compare the characteristics of alprazolam-related deaths with nonalprazolam deaths in a predominantly rural state. A comprehensive forensic drug database (FDD) was developed in 2005 to compile demographic, toxicology, and co-morbidity information from all West Virginia (WV) drug-related deaths. All FDD data from 2005 to mid-November 2007 were analyzed. Alprazolam contributed to 204 (17.0%) of the 1,199 drug-related deaths and was identified in 7.2% of the 363 deaths occurring during 2005 and in 27.5% of the 422 deaths entered in the database during 2007. At least one other drug, predominantly an opioid, was identified in 97.5% of the alprazolam cases, with concurrent benzodiazepines also found. Compared to nonalprazolam deaths, alprazolam decedents were significantly more likely to be obese and to have preexisting cardiovascular disease, but were less likely to have documented substance abuse. An alprazolam prescription existed in 52.5% of the alprazolam deaths, with 77.6% having a prescription for all drugs identified. Alprazolam was a contributing cause of death in a substantial and increasing number of drug-related deaths. Prescriptions for alprazolam and the other drugs detected were often present in these cases. Controlled substance monitoring programs should be routinely used as one mechanism to help prevent potential drug misuse/abuse. Our findings provide a baseline for ongoing alprazolam-related death surveillance. Copyright © American Academy of Addiction Psychiatry.

CE: Appropriate Use of Opioids in Managing Chronic Pain.

PubMed

Denenberg, Risa; Curtiss, Carol P

2016-07-01

: Over the past two decades, the use of opioids to manage chronic pain has increased substantially, primarily in response to the recognized functional, emotional, and financial burden associated with chronic pain. Within this same period, unintentional death related to prescription opioids has been identified as a public health crisis, owing in part to such factors as insufficient professional training and medication overprescription, misuse, and diversion. The authors discuss current best practices for prescribing opioids for chronic pain, emphasizing patient assessment and essential patient teaching points regarding safe medication use, storage, and disposal.

Competitive Swimming and Racial Disparities in Drowning

PubMed Central

Myers, Samuel L.; Cuesta, Ana M.; Lai, Yufeng

2018-01-01

This paper provides compelling evidence of an inverse relationship between competitive swimming rates and drowning rates using Centers for Disease Control and Prevention (CDC) data on fatal drowning rates and membership rates from USA Swimming, the governing organization of competitive swimming in the United States. Tobit and Poisson regression models are estimated using panel data by state from 1999–2007 separately for males, females, African Americans and whites. The strong inverse relationship between competitive swimming rates and unintentional deaths through fatal drowning is most pronounced among African Americans males.

Differentiating suicide decedents who died using firearms from those who died using other methods.

PubMed

Anestis, Michael D; Khazem, Lauren R; Anestis, Joye C

2017-06-01

Studies have documented a link between gun ownership and suicide, but little is known about characteristics of those most likely to use a gun in a suicide attempt rather than alternative methods. We examined which factors differentiate suicide decedents who died using a gun from those who died by other methods. We further examined whether such findings are consistent within the subcomponent of our larger sample comprised entirely of gun owning suicide decedents. Data reflect 267 suicide decedents, with data provided by individuals who identified as having lost someone to suicide (loss survivors). Within the full sample, a higher proportion of gun-owning and male suicide decedents died by firearm. Further, individuals who had previously discussed suicide or engaged in one or more non-lethal suicide attempts were less likely to die by suicide using a gun. Within the subsample of gun owning suicide decedents, a greater proportion of decedents who stored guns at home and in unsecure locations died from self-inflected gunshot wounds. These findings add clarity to the relationship between firearm ownership and death by suicide at the individual level. Furthermore, these findings are consistent with the notion that means safety implementation may represent a vital suicide prevention tool. Copyright © 2017. Published by Elsevier B.V.

Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region - United States, 2006-2015.

PubMed

O'Donnell, Julie K; Gladden, R Matthew; Seth, Puja

2017-09-01

Opioid overdose deaths quadrupled from 8,050 in 1999 to 33,091 in 2015 and accounted for 63% of drug overdose deaths in the United States in 2015. During 2010-2015, heroin overdose deaths quadrupled from 3,036 to 12,989 (1). Sharp increases in the supply of heroin and illicitly manufactured fentanyl (IMF) are likely contributing to increased deaths (2-6). CDC examined trends in unintentional and undetermined deaths involving heroin or synthetic opioids excluding methadone (i.e., synthetic opioids)* by the four U.S. Census regions during 2006-2015. Drug exhibits (i.e., drug products) obtained by law enforcement and reported to the Drug Enforcement Administration's (DEA's) National Forensic Laboratory Information System (NFLIS) that tested positive for heroin or fentanyl (i.e., drug reports) also were examined. All U.S. Census regions experienced substantial increases in deaths involving heroin from 2006 to 2015. Since 2010, the South and West experienced increases in heroin drug reports, whereas the Northeast and Midwest experienced steady increases during 2006-2015. † In the Northeast, Midwest, and South, deaths involving synthetic opioids and fentanyl drug reports increased considerably after 2013. These broad changes in the U.S. illicit drug market highlight the urgent need to track illicit drugs and enhance public health interventions targeting persons using or at high risk for using heroin or IMF.

46 CFR 28.580 - Unintentional flooding.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 1 2012-10-01 2012-10-01 false Unintentional flooding. 28.580 Section 28.580 Shipping... INDUSTRY VESSELS Stability § 28.580 Unintentional flooding. (a) Applicability. Except for an open boat that... survive the assumed damage and unintentional flooding described in paragraphs (d) and (e) of this section...

46 CFR 28.580 - Unintentional flooding.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 1 2011-10-01 2011-10-01 false Unintentional flooding. 28.580 Section 28.580 Shipping... INDUSTRY VESSELS Stability § 28.580 Unintentional flooding. (a) Applicability. Except for an open boat that... survive the assumed damage and unintentional flooding described in paragraphs (d) and (e) of this section...

46 CFR 28.580 - Unintentional flooding.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 1 2014-10-01 2014-10-01 false Unintentional flooding. 28.580 Section 28.580 Shipping... INDUSTRY VESSELS Stability § 28.580 Unintentional flooding. (a) Applicability. Except for an open boat that... survive the assumed damage and unintentional flooding described in paragraphs (d) and (e) of this section...

46 CFR 28.580 - Unintentional flooding.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 1 2013-10-01 2013-10-01 false Unintentional flooding. 28.580 Section 28.580 Shipping... INDUSTRY VESSELS Stability § 28.580 Unintentional flooding. (a) Applicability. Except for an open boat that... survive the assumed damage and unintentional flooding described in paragraphs (d) and (e) of this section...

Handgun waiting periods reduce gun deaths

PubMed Central

Luca, Michael; Malhotra, Deepak

2017-01-01

Handgun waiting periods are laws that impose a delay between the initiation of a purchase and final acquisition of a firearm. We show that waiting periods, which create a “cooling off” period among buyers, significantly reduce the incidence of gun violence. We estimate the impact of waiting periods on gun deaths, exploiting all changes to state-level policies in the Unites States since 1970. We find that waiting periods reduce gun homicides by roughly 17%. We provide further support for the causal impact of waiting periods on homicides by exploiting a natural experiment resulting from a federal law in 1994 that imposed a temporary waiting period on a subset of states. PMID:29078268

Handgun waiting periods reduce gun deaths.

PubMed

Luca, Michael; Malhotra, Deepak; Poliquin, Christopher

2017-11-14

Handgun waiting periods are laws that impose a delay between the initiation of a purchase and final acquisition of a firearm. We show that waiting periods, which create a "cooling off" period among buyers, significantly reduce the incidence of gun violence. We estimate the impact of waiting periods on gun deaths, exploiting all changes to state-level policies in the Unites States since 1970. We find that waiting periods reduce gun homicides by roughly 17%. We provide further support for the causal impact of waiting periods on homicides by exploiting a natural experiment resulting from a federal law in 1994 that imposed a temporary waiting period on a subset of states. Copyright © 2017 the Author(s). Published by PNAS.

[Intoxation with paramethoxymethamphetamine].

PubMed

Al-Samarraie, Muhammad S; Vevelstad, Merete; Nygaard, Ilah Le; Bachs, Liliana; Mørland, Jørg

2013-05-07

Since the summer of 2010, there has been an epidemic of deaths related to paramethoxymethamphetamine (PMMA) in Norway. We present a review of the pharmacology and toxicology of the substance. The review is based on a literature search in the databases PubMed, Ovid and MEDLINE. A discretionary selection was made of relevant articles. Paramethoxymethamphetamine and paramethoxyamphetamine (PMA) are two so-called designer amphetamines which appear from time to time on the illegal narcotics market in many countries. They are frequently sold as ecstasy or amphetamine, often mixed with amphetamine or methamphetamine. The substances, known on the street as «Death», have potent serotonergic effects and are associated with significant toxicity. Many deaths have been reported worldwide, even after intake of an «ordinary user dose». The narcotic effect is not very pronounced and the onset is slow, which may lead to unintentional overdosing. In cases of severe intoxation that are apparently related to intake of amphetamine or ecstasy, PMMA/PMA intoxation should be suspected.

Where there's smoking, there's fire: the effects of smoking policies on the incidence of fires in the USA.

PubMed

Markowitz, Sara

2014-11-01

Fires and burns are among the leading causes of unintentional death in the USA. Most of these deaths occur in residences, and cigarettes are a primary cause. In this paper, I explore the relationship between smoking, cigarette policies, and fires. As smoking rates decline, there are fewer opportunities for fires; however, the magnitude of any reduction is in question. Using a state-level panel, I find that increases in cigarette prices are associated with fewer residential fires and deaths. However, laws regulating indoor smoking are associated with more fires; in particular, restaurant and bar smoking bans are associated with an increase in fires at eating and drinking establishments. This increase is important given the growing popularity of smoking bans in the USA and around the world. As workplaces, schools, and businesses ban smoking and remove ashtrays, smokers who continue to smoke are left without safe options for disposal of cigarettes, leading to more opportunities for fires to start. Copyright © 2013 John Wiley & Sons, Ltd.

Why people drink shampoo? Food Imitating Products are fooling brains and endangering consumers for marketing purposes.

PubMed

Basso, Frédéric; Robert-Demontrond, Philippe; Hayek, Maryvonne; Anton, Jean-Luc; Nazarian, Bruno; Roth, Muriel; Oullier, Olivier

2014-01-01

A Food Imitating Product (FIP) is a household cleaner or a personal care product that exhibits food attributes in order to enrich consumption experience. As revealed by many cases worldwide, such a marketing strategy led to unintentional self-poisonings and deaths. FIPs therefore constitute a very serious health and public policy issue. To understand why FIPs are a threat, we first conducted a qualitative analysis on real-life cases of household cleaners and personal care products-related phone calls at a poison control center followed by a behavioral experiment. Unintentional self-poisoning in the home following the accidental ingestion of a hygiene product by a healthy adult is very likely to result from these products being packaged like foodstuffs. Our hypothesis is that FIPs are non-verbal food metaphors that could fool the brain of consumers. We therefore conducted a subsequent functional neuroimaging (fMRI) experiment that revealed how visual processing of FIPs leads to cortical taste inferences. Considered in the grounded cognition perspective, the results of our studies reveal that healthy adults can unintentionally categorize a personal care product as something edible when a food-like package is employed to market nonedible and/or dangerous products. Our methodology combining field (qualitative) and laboratory (behavioral and functional neuroimaging) findings could be of particular relevance for policy makers, as it can help screening products prior to their market release--e.g. the way they are packaged and how they can potentially confuse the mind of consumers--and therefore save lives.

Why People Drink Shampoo? Food Imitating Products Are Fooling Brains and Endangering Consumers for Marketing Purposes

PubMed Central

Basso, Frédéric; Robert-Demontrond, Philippe; Hayek, Maryvonne; Anton, Jean-Luc; Nazarian, Bruno; Roth, Muriel; Oullier, Olivier

2014-01-01

A Food Imitating Product (FIP) is a household cleaner or a personal care product that exhibits food attributes in order to enrich consumption experience. As revealed by many cases worldwide, such a marketing strategy led to unintentional self-poisonings and deaths. FIPs therefore constitute a very serious health and public policy issue. To understand why FIPs are a threat, we first conducted a qualitative analysis on real-life cases of household cleaners and personal care products-related phone calls at a poison control center followed by a behavioral experiment. Unintentional self-poisoning in the home following the accidental ingestion of a hygiene product by a healthy adult is very likely to result from these products being packaged like foodstuffs. Our hypothesis is that FIPs are non-verbal food metaphors that could fool the brain of consumers. We therefore conducted a subsequent functional neuroimaging (fMRI) experiment that revealed how visual processing of FIPs leads to cortical taste inferences. Considered in the grounded cognition perspective, the results of our studies reveal that healthy adults can unintentionally categorize a personal care product as something edible when a food-like package is employed to market nonedible and/or dangerous products. Our methodology combining field (qualitative) and laboratory (behavioral and functional neuroimaging) findings could be of particular relevance for policy makers, as it can help screening products prior to their market release – e.g. the way they are packaged and how they can potentially confuse the mind of consumers – and therefore save lives. PMID:25207971

Determinants of Unintentional Leaks During CPAP Treatment in OSA.

PubMed

Lebret, Marius; Arnol, Nathalie; Martinot, Jean-Benoît; Lambert, Loïc; Tamisier, Renaud; Pepin, Jean-Louis; Borel, Jean-Christian

2018-04-01

Unintentional leakage from the mouth or around the mask may lead to cessation of CPAP treatment; however, the causes of unintentional leaks are poorly understood. The objectives of this study were (1) to identify determining factors of unintentional leakage and (2) to determine the effect of the type of mask (nasal/oronasal) used on unintentional leakage. Seventy-four polysomnograms from patients with OSA syndrome treated with auto-CPAP were analyzed (23 women; 56 ± 13 years; BMI, 32.9 kg/m 2 (range, 29.0-38.0 kg/m 2 ). Polysomnographic recordings were obtained under auto-CPAP, and mandibular behavior was measured with a magnetic sensor. After sleep and respiratory scoring, polysomnographic signals were computed as mean values over nonoverlapping 10-s intervals. The presence/absence of unintentional leakage was dichotomized for each 10-s interval (yes/no). Univariate and multivariate conditional regression models estimated the risk of unintentional leaks during an interval "T" based on the explanatory variables from the previous interval "T-1." A sensitivity analysis for the type of mask was then conducted. The univariate analysis showed that mandibular lowering (mouth opening), a high level of CPAP, body position (other than supine), and rapid eye movement (REM) sleep increased the risk of unintentional leaks and microarousal decreased it. In the multivariate analysis, the same variables remained independently associated with an increased risk of unintentional leakage. The sensitivity analysis showed that oronasal masks reduced the risk of unintentional leaks in cases of mouth opening and REM sleep. Mouth opening, CPAP level, sleep position, and REM sleep independently contribute to unintentional leakage. These results provide a strong rationale for the definition of phenotypes and the individual management of leaks during CPAP treatment. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Individual risk factors associated with general unintentional injuries and the relationship to traumatic dental injuries among children aged 0-15 years in the Swedish BITA study.

PubMed

Oldin, Anna; Lundgren, Jesper; Norén, Jörgen G; Robertson, Agneta

2016-08-01

To investigate general unintentional injuries (GUI) and traumatic dental injuries (TDI) in relation to behavioral and psychosocial strengths and difficulties among Swedish children aged 0-17 years, and to investigate general unintentional injuries in relation to temperament and socioeconomic status among the same children. The study included 2363 children in four different age cohorts aged 3, 7, 11, and 15 years at the study start. Twelve Public Dental Service clinics in Sweden participated, representing different types of demographic areas, both rural and urban. Data were collected from parents and children through an interview, questionnaires, and dental records. Twenty-four percentage (24%) of the children had experienced a serious general unintentional injury (GUI) at some point during their lifetime up until 3 months prior to the study start. Children who were regarded by their parents as being injured more often than other children also had occasions with general unintentional injuries to a greater extent. Most general unintentional injuries occurred at home. Children with incidents of general unintentional injuries had occasions with TDI to a greater extent than children without general unintentional injury. Children, whose mothers had 11 years of school/education or less, were involved in more general unintentional injuries during the 3-month period prior to the study start, compared to children of mothers with higher education level. Children with general unintentional injuries had more traumatic dental injuries. Children who were assessed by their parents as being injured more often than other children also had occasions with general unintentional injuries to a greater extent. Temperament, behavioral and psychosocial strengths and difficulties had different impacts at different ages for experiencing a general unintentional injury. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Farm suicides in New Zealand, 2007-2015: A review of coroners' records.

PubMed

Beautrais, Annette L

2018-01-01

Economic recessions and severe weather events are often associated with increased suicide rates. The Global Dairy Crisis 2015/2016 led to an economic downturn in the New Zealand dairy farming industry and, coupled with droughts in some regions and floods in others, raised fears about increased suicide rates among farmers. However, little was known about suicides in the farming sector. This study reviews characteristics of recent farm-related suicides in New Zealand and assesses the extent to which financial stresses contributed to the deaths. Data were abstracted from coroners' records for a consecutive series of 185 people in farm- and agriculture-related occupations who died by suicide between 2007 and 2015 and for whom coronial inquiries had been completed. Farm suicides were heterogeneous: six distinct risk profiles were identified. Financial stresses made negligible contributions to farm suicides. Overall, risk factors for farm suicides differed little from risk factors for suicide in the general population. However, suicide risk in farmers was exacerbated by ready access to firearms: almost 40% of farm suicides involved firearms, compared to 8% in the general population over the same time. Among farm suicides, young male farm labourers predominated, rather than farm owners or managers. For many young men, relationship losses, acute alcohol intoxication and ready access to a firearm formed a common constellation of risk factors. While coroners' records are variable and do not record specific information about financial stresses and weather events, it was clear that these issues made a negligible contribution to farm suicides. A range of rural suicide prevention initiatives are needed to address various farm suicide risk profiles. In particular, young male labourers often had no contact with health services prior to death, suggesting that rural suicide prevention efforts need to be positioned within community, farming and sports organisations, as well as health and social service providers.

Adolescent femicide: a population-based study.

PubMed

Coyne-Beasley, Tamera; Moracco, Kathryn E; Casteel, Michael J

2003-04-01

Homicide is the third leading cause of deaths for girls aged 11 to 14 years and the second leading cause of death for girls aged 15 to 18 years. However, few studies examine the contextual issues of adolescent femicide, especially among 11- to 14-year-old victims. To obtain quantitative and contextual information about adolescent femicide, and to compare the context of femicide in younger vs older adolescents. Data from the North Carolina medical examiner were analyzed for all 11- to 18-year-old female homicide victims during 1990 to 1995. Police interviews were conducted for 1993 to 1995 cases to determine context, the relationship of victim and perpetrator, and criminal histories. There were 90 victims; 63 were aged 15 to 18 years, 55 were killed with firearms, and 40 were behind in school. Of 37 femicides for which law enforcement interviews were conducted, the most common contexts were altercation (n = 9), broken or desired relationship (n = 8), reckless behavior with a firearm (n = 6), retaliation (n = 5), and drug related (n = 3). Most perpetrators were men (89%; n = 33), were older than their victims (mean age difference, 8 years), and had criminal records (59%; n = 21). Seventy-eight percent of victims (n = 29) were killed by an acquaintance or intimate partner. Femicide contexts differed by age. Younger adolescents (aged 11-14 years) were more likely to be killed by a family member in the context of an argument than by an intimate partner or acquaintance in the context of a broken relationship or reckless behavior with a firearm. Many victims were engaged in high-risk behaviors, including dropping out of school, running away from home, using drugs, and dating much older men with criminal records. Intervention specialists targeting high-risk female adolescents should be aware that this population may also be at increased risk of femicide.

Child injuries in Ethiopia: A review of the current situation with projections.

PubMed

Li, Qingfeng; Alonge, Olakunle; Lawhorn, Collene; Ambaw, Yirga; Kumar, Smita; Jacobs, Troy; Hyder, Adnan A

2018-01-01

Heavy burden of child injuries and lack of policy response in Ethiopia call for an improved understanding of the situation and development of action plans from multiple governmental agencies and stakeholders. A consortium of international and Ethiopian researchers and stakeholders used extensive literature review and mixed analytical methods to estimate and project the burden of fatal and non-fatal child unintentional injuries in Ethiopia from 2015 to 2030. Estimates were derived for children aged 0-14 years. Data sources include a longitudinal study conducted by the Central Statistics Agency of Ethiopia and the World Bank as well as model-based estimates from World Health Organization 2017 and Global Burden of Disease 2016 project. Injuries caused about 25 thousand deaths among 0-14-year olds in Ethiopia in 2015. The leading cause of fatal child unintentional injuries in Ethiopia was road-traffic injuries, followed by fire, heat and hot substances and drowning. The death rate due to injuries among 0-14 years olds was about 50 percent higher in males than females. Rural children were exposed to a greater risk of injury than their urban peers. The longitudinal survey suggests that the incidence rate of child injuries increased during the period 2011-2014. The annual mortality caused by injuries is projected to increase from 10,697 in 2015 to 11,279 in 2020 and 11,989 in 2030 among children under 5 years, an increase of 12 percentage points in 15 years. The number of deaths among 0-14-year olds will be 26,463, 27,807, and 30,364 respectively in 2015, 2020, and 2030. As the first multisectoral collaboration on child injuries in Ethiopia, this study identified gaps in understanding of the burden of child injuries in Ethiopia. In consultation with Ethiopian government and other stakeholders, we propose starting an injury surveillance system at health clinics and hospitals and building an intervention package based on existing platforms.

Child injuries in Ethiopia: A review of the current situation with projections

PubMed Central

Alonge, Olakunle; Lawhorn, Collene; Ambaw, Yirga; Kumar, Smita; Hyder, Adnan A.

2018-01-01

Background Heavy burden of child injuries and lack of policy response in Ethiopia call for an improved understanding of the situation and development of action plans from multiple governmental agencies and stakeholders. Methods A consortium of international and Ethiopian researchers and stakeholders used extensive literature review and mixed analytical methods to estimate and project the burden of fatal and non-fatal child unintentional injuries in Ethiopia from 2015 to 2030. Estimates were derived for children aged 0–14 years. Data sources include a longitudinal study conducted by the Central Statistics Agency of Ethiopia and the World Bank as well as model-based estimates from World Health Organization 2017 and Global Burden of Disease 2016 project. Results Injuries caused about 25 thousand deaths among 0-14-year olds in Ethiopia in 2015. The leading cause of fatal child unintentional injuries in Ethiopia was road-traffic injuries, followed by fire, heat and hot substances and drowning. The death rate due to injuries among 0–14 years olds was about 50 percent higher in males than females. Rural children were exposed to a greater risk of injury than their urban peers. The longitudinal survey suggests that the incidence rate of child injuries increased during the period 2011–2014. The annual mortality caused by injuries is projected to increase from 10,697 in 2015 to 11,279 in 2020 and 11,989 in 2030 among children under 5 years, an increase of 12 percentage points in 15 years. The number of deaths among 0-14-year olds will be 26,463, 27,807, and 30,364 respectively in 2015, 2020, and 2030. Conclusions As the first multisectoral collaboration on child injuries in Ethiopia, this study identified gaps in understanding of the burden of child injuries in Ethiopia. In consultation with Ethiopian government and other stakeholders, we propose starting an injury surveillance system at health clinics and hospitals and building an intervention package based on existing platforms. PMID:29584763

Family process correlates of firearm ownership and firearm storage among families with young children.

PubMed

Martin-Storey, Alexa; Prickett, Kate C; Crosnoe, Robert

2015-01-01

To understand how family relations and dynamics were associated with firearm ownership among US families with 4-year-olds and with firearm storage among those families with firearms, controlling for sociodemographic characteristics of families and states. With representative data from the Early Childhood Longitudinal Study-Birth Cohort (n = 8,100), logistic regression models employed a set of family process variables (e.g., parenting practices, parental stress, maternal depression, and safety behaviors) as (1) predictors of firearm ownership among all families and, (2) as predictors of safe firearm storage among firearm owning families. An estimated 22 % of families with pre-kindergarten age children reported having firearms in their households. Among firearm owning families, 69 % of families kept firearms in a locked cabinet. Comparing families who did and did not report owning firearms, those who did were more likely to report spanking their children. Firearm owning parents who reported higher levels of parenting stress and lower likelihood that their child always wore a helmet when bicycling were also more likely to report unsafe firearm storage practices. Family processes differentiated both firearm owners from non-firearm owners and firearms owners who locked up their firearms from firearm owners who did not. These findings suggest that firearm ownership and firearm safety behaviors likely arise from a more general family context related to child health and safety.

Reducing Potentially Excess Deaths from the Five Leading Causes of Death in the Rural United States

PubMed

Garcia, Macarena C; Faul, Mark; Massetti, Greta; Thomas, Cheryll C; Hong, Yuling; Bauer, Ursula E; Iademarco, Michael F

2017-01-13

In 2014, the all-cause age-adjusted death rate in the United States reached a historic low of 724.6 per 100,000 population (1). However, mortality in rural (nonmetropolitan) areas of the United States has decreased at a much slower pace, resulting in a widening gap between rural mortality rates (830.5) and urban mortality rates (704.3) (1). During 1999–2014, annual age-adjusted death rates for the five leading causes of death in the United States (heart disease, cancer, unintentional injury, chronic lower respiratory disease (CLRD), and stroke) were higher in rural areas than in urban (metropolitan) areas (Figure 1). In most public health regions (Figure 2), the proportion of deaths among persons aged <80 years (U.S. average life expectancy) (2) from the five leading causes that were potentially excess deaths was higher in rural areas compared with urban areas (Figure 3). Several factors probably influence the rural-urban gap in potentially excess deaths from the five leading causes, many of which are associated with sociodemographic differences between rural and urban areas. Residents of rural areas in the United States tend to be older, poorer, and sicker than their urban counterparts (3). A higher proportion of the rural U.S. population reports limited physical activity because of chronic conditions than urban populations (4). Moreover, social circumstances and behaviors have an impact on mortality and potentially contribute to approximately half of the determining causes of potentially excess deaths (5).

27 CFR 70.443 - Firearms and ammunition.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Firearms and ammunition... Cartridges, and Explosives § 70.443 Firearms and ammunition. (a) Commerce in firearms and ammunition. (1) 27... firearms and ammunition, collectors of firearms, and dealers in firearms, (ii) The identification of...

27 CFR 70.443 - Firearms and ammunition.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2014-04-01 2014-04-01 false Firearms and ammunition... Cartridges, and Explosives § 70.443 Firearms and ammunition. (a) Commerce in firearms and ammunition. (1) 27... firearms and ammunition, collectors of firearms, and dealers in firearms, (ii) The identification of...

27 CFR 70.443 - Firearms and ammunition.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2011-04-01 2011-04-01 false Firearms and ammunition... Cartridges, and Explosives § 70.443 Firearms and ammunition. (a) Commerce in firearms and ammunition. (1) 27... firearms and ammunition, collectors of firearms, and dealers in firearms, (ii) The identification of...

27 CFR 70.443 - Firearms and ammunition.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2013-04-01 2013-04-01 false Firearms and ammunition... Cartridges, and Explosives § 70.443 Firearms and ammunition. (a) Commerce in firearms and ammunition. (1) 27... firearms and ammunition, collectors of firearms, and dealers in firearms, (ii) The identification of...

27 CFR 70.443 - Firearms and ammunition.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2012-04-01 2011-04-01 true Firearms and ammunition. 70... Cartridges, and Explosives § 70.443 Firearms and ammunition. (a) Commerce in firearms and ammunition. (1) 27... firearms and ammunition, collectors of firearms, and dealers in firearms, (ii) The identification of...

Witchcraft in Transkei Region of South African: case report.

PubMed

Meel, B L

2009-03-01

Witchcraft and witch-hunt have been practiced widely almost all over the world. It is known as magic in Europe, maleficium (wrong-doing) in Latin America, and superpower in Asia. In Africa those accused of being witches often face execution. A range of accusations are leveled against witches such as causing impotence, turning milk sour, causing disease and death.Three cases are presented here to highlight the issues related to witch craft in Transkei area. The information was given by the next of kin at the time of autopsy. All were elderly women over 50 years of age. The first was related to tuberculosis of the brother of the perpetrator the second, death of the culprit's relative and third the death of culprits brother in Johannesburg. The first and third victims were brutally chopped by axe and in the second it was a firearm injury. The case history, the type of wounds, and medico-legal aspects of death are discussed in these reports. There law related to witchcraft and their implementations to prevent such deaths are discussed.

[Homicides between men aged 15 to 29 years and related factors in the State of Paraná, Brazil, 2002/2004].

PubMed

de Andrade, Selma Maffei; Soares, Darli Antonio; de Souza, Regina Kazue Tanno; Matsuo, Tiemi; de Souza, Hiury Dutra

2011-01-01

Homicides are the main cause of non-natural death in Brazil and studies about them may contribute to their control. The objective of this study was to verify mortality rates due to homicides and legal interventions among young men in the State of Paraná, Brazil, and to identify correlated municipal characteristics. An ecological study was conducted, having the municipalities of the State as units of analysis. Mortality rates of homicides and legal interventions among men from 15 to 29 years of age were calculated for the years 2002-2004 and demographic and social municipal indicators were obtained. Mortality rate in the State was 94.8 per one hundred thousand. The size of the population, the proportion of young people aged 15 to 24 years, the proportion of enrollments in universities and the Gini index were the main indicators correlated to homicide mortality (p<0.0001). Mortality rates were highest in municipalities of metropolitan regions, in those located at the border with Paraguay and in those located in the way between them and the Southeast Region of Brazil. Mortality rates and the proportion of deaths due to firearms increased with the size of the municipality. The greater number of youth and easier access to firearms and illicit drugs in such places may be influencing on these rates.

The increase of firearm mortality and its relationship with the stagnation of life expectancy in Mexico.

PubMed

González-Pérez, Guillermo Julián; Vega-López, María Guadalupe; Flores-Villavicencio, María Elena

2017-09-01

This study analyzes firearms mortality (FA) and their impact on life expectancy in Mexico -compared to other causes of deaths- during the three-year periods 2000-2002 and 2010-2012 and the weight of the different age groups in years of life expectancy lost (YLEL) due to this cause. Based on official death and population data, abridged life tables in Mexico were constructed for the three-year periods studied. Temporary life expectancy and YLEL for aged 15 to 75 by selected causes and age groups were calculated in each three-year period. Among men, FA mortality went from being the cause less YLEL caused in 2000-2002 to be the main cause of YLEL between 15 and 75 years in 2010-2012. Among women, YLEL for FA mortality had a higher relative growth. In both sexes, the greatest increase in YLEL by FA mortality was between 20 and 34 years. Findings indicate that the increase in FA mortality, especially among young people, has substantially contributed to the stagnation of life expectancy in recent years, and even his decline in the case of men. This reflects that violence linked to the FA is not only a security problem but also a collective health problem that must be copied in an interdisciplinary and intersectoral form if it is to increase the life expectancy of the country.

Homicide in Adana, Turkey: a 5-year review.

PubMed

Hilal, Ahmet; Cekin, Nemci; Gülmen, Mete K; Ozdemir, M Hakan; Karanfil, Ramazan

2005-06-01

Violence is a significant public health problem. Thus, so as to prevent this problem, homicide, the severest form of violence depriving a human being of his right to live, deserves a detailed examination. This study is a retrospective research examining the 2951 cases of medicolegal autopsies in Adana during a period of 5 years (1997-2001). Among these cases, 620, which were determined to be homicidal, were taken into the scope of this study. The cases were examined with respect to sex, age groups, the method used during the act of homicide, the number and the localization of the wounds on the body. A total of 620 (21%) of the medicolegal autopsies conducted within this period were homicides. Of these cases, 515 (83.06%) were male and 105 (16.94%) female, and the rate of the males to females was 4.9; 72.74% of the victims were between the ages of 21 and 50. It was seen that 54.83% of the homicides involved firearms, while 35.16% of the victims were stabbed to death with a cutting object. It was also determined that the victims suffered a single wound in 47.35% of firearm-related murders and 29.35% of stabbings resulted in death. Alcohol was found in the blood of 7.58% of the homicide victims, while none had any illicit drugs.

Unintentional Injuries among Psychiatric Outpatients with Major Depressive Disorder.

PubMed

Hung, Ching-I; Liu, Chia-Yih; Yang, Ching-Hui

2016-01-01

No study has investigated the percentages of and factors related to unintentional injuries among psychiatric outpatients with major depressive disorder (MDD). This study aimed to investigate these issues. One-hundred and forty-one outpatients with MDD at baseline were enrolled from psychiatric outpatients by systematic sampling, and 119 subjects attended a one-year follow-up. Self-reported unintentional injuries in the past one year were recorded. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The severity of depression was evaluated by the Hamilton Depression Rating Scale. Other data, including body weight and height, cigarette smoking, headaches, and medications, were collected. Generalized Estimating Equations were used to investigate independent factors related to unintentional injuries. At baseline and follow-up, 40.4% and 27.7% of subjects had experienced at least one unintentional injury in the past one year, respectively. About half of subjects with unintentional injuries needed medical treatment for injuries and had functional impairment due to injuries. A greater severity of depression, cigarette smoking, a higher body mass index, and an older age were independent risk factors related to unintentional injuries. Unintentional injuries that increased the medical burden and functional impairment were common among outpatients with MDD and should not be neglected. Treatment of depression, control of body weight, and quitting cigarettes might be helpful to prevent unintentional injuries.

Pattern of unintentional burns: A hospital based study from Pakistan.

PubMed

Adil, Syed Omair; Ibran, Ehmer-Al; Nisar, Nighat; Shafique, Kashif

2016-09-01

Burns are major cause of morbidity and mortality in developing countries. Better understanding of the nature and extent of injury remains the major and only available way to halt the occurrence of the event. The present study was conducted to determine the prevalence of by self and by other unintentional burn, their comparison and the possible mode of acquisition by obtaining the history of exposure to known risk factors. A cross-sectional questionnaire based survey was conducted in Burns Centre of Civil Hospital Karachi, Pakistan and 324 hospitalized adult patients with unintentional burns were consecutively interviewed during August 2013 to February 2014. Information was collected on socio-demographic profile. The source of burn, affected body part and place of injury acquisition in terms of home, outside or work were also noted. Logistic regression model was conducted using SPSS software. Out of 324 patients, 295 (91%) had unintentional burn by self and 29 (9%) had unintentional burn by others. Male gender were 2.37 times and no schooling were 1.75 times more likely to have self-inflicted unintentional burn. Lower limb and head and neck were less likely to involve in unintentional burn by self. The burden of unintentional burn by self was considerably higher. Male gender and no schooling were found more at risk to have unintentional burn by self. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

State firearm laws, firearm ownership, and safety practices among families of preschool-aged children.

PubMed

Prickett, Kate C; Martin-Storey, Alexa; Crosnoe, Robert

2014-06-01

We investigated how state-level firearms legislation is associated with firearm ownership and storage among families with preschool-aged children. Using 2005 nationally representative data from the Early Childhood Longitudinal Study-Birth Cohort (n = 8100), we conducted multinomial regression models to examine the associations between state-level firearms legislation generally, child access prevention (CAP) firearms legislation specifically, and parental firearm ownership and storage safety practices. Overall, 8% of families with children aged 4 years living in states with stronger firearm laws and CAP laws owned firearms compared with 24% of families in states with weaker firearm laws and no CAP laws. Storage behaviors of firearm owners differed minimally across legislative contexts. When we controlled for family- and state-level characteristics, we found that firearm legislation and CAP laws interacted to predict ownership and storage behaviors, with unsafe storage least likely among families in states with both CAP laws and stronger firearm legislation. Broader firearm legislation is linked with the efficacy of child-specific legislation in promoting responsible firearm ownership.

[Associations of occupational safety atmosphere and behaviors with unintentional injuries].

PubMed

Xiao, Ya-ni; Huang, Zhi-xiong; Huang, Shao-bin; Cao, Xiao-ou; Chen, Xia-ming; Liu, Xu-hua; Chen, Wei-qing

2012-07-01

To evaluate the associations of perception of safety atmosphere at workplace, occupational safety attitude and behaviors with occupational unintentional injury among manufacturing workers. A cross-sectional study was performed and a self-administered questionnaire was used to inquire socio-demographic characteristics, perceived safety atmosphere, occupational safety attitudes, occupational safety behaviors and occupational unintentional injuries among 10585 manufacturing workers selected from 46 enterprises in Guangdong. Structural equation modeling was applied to assess the relationship of the perception of safety atmosphere at workplace, occupational safety attitude, and occupational safety behaviors with occupational unintentional injury. Among 24 pathways supposed in structural equation model, 20 pathways (except for the attitude toward occupational safety, the attitude toward managers' support, the work posture and individual protection) were significantly related to the occupational unintentional injuries. The further analysis indicated that the perceived safety atmosphere might impact the occupational unintentional injuries by the attitude toward occupational safety and occupational safety behaviors. Workers' perception of safety atmosphere indirectly influenced on occupational unintentional injuries through occupational safety attitudes and occupational safety behaviors.

What did you have in mind? Examining the content of intentional and unintentional types of mind wandering

PubMed Central

Seli, Paul; Ralph, Brandon C. W.; Konishi, Mahiko; Smilek, Daniel; Schacter, Daniel L.

2017-01-01

It has recently been argued that researchers should distinguish between mind wandering (MW) that is engaged with and without intention. Supporting this argument, studies have found that intentional and unintentional MW have behavioral/neural differences, and that they are differentially associated with certain variables of theoretical interest. Although there have been considerable inroads made into the distinction between intentional/unintentional MW, possible differences in their content remain unexplored. To determine whether these two types of MW differ in content, we had participants complete a task during which they categorized their MW as intentional or unintentional, and then provided responses to questions about the content of their MW. Results indicated that intentional MW was more frequently rated as being future-oriented and less vague than unintentional MW. These findings shed light on the nature of intentional and unintentional MW and provide support for the argument that researchers should distinguish between intentional and unintentional types. PMID:28371688

Homicide in Brescia County (Northern Italy): a thirty-year review.

PubMed

Verzeletti, Andrea; Russo, Maria Cristina; Bin, Paola; Leide, Anna; De Ferrari, Francesco

2014-02-01

This retrospective study analyses post-mortem examination data of 251 homicide victims recorded by the Brescia Institute of Forensic Medicine between the years 1982 and 2012. The following variables were considered: year, month and day of death; gender, age and nationality of the victim; type of injurious mean; cause of death; homicide-suicides events; multiple murders; scene of death; toxicological data. Victims were usually young (30% was in the 21-30 years class) and males (64%). Although the victims were mostly Italians (73%), from 1990's more and more foreign victims appeared, following the migratory flow that affected Brescia County. The offenders frequently used firearms to kill their victims (41%), in particular for multiple murders. Sharp instruments were used mostly by foreigners. The study also emphasized 20 homicide-suicide events, mostly committed between intimates and family members. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Safe Kids Worldwide: preventing unintentional childhood injuries across the globe.

PubMed

Mickalide, Angela; Carr, Kate

2012-12-01

Unintentional injuries are predictable and preventable. Yet every hour, a child in the United States dies from an unintentional injury. Globally, the number is even more staggering, with nearly 1 million children dying from unintentional injuries each year. Motor vehicle-related injuries, burns, drowning, falls, suffocation or choking, and poisoning are just a few of the unintentional injury risks threatening children. Patient safety requires a three-pronged strategy of behavior change, use of safety devices, and improvement of laws and regulations to ensure that all children lead healthy and productive lives. Copyright © 2012 Elsevier Inc. All rights reserved.

Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death — United States, 2001–2015

PubMed Central

Crosby, Alex E.; Jack, Shane P. D.; Haileyesus, Tadesse; Kresnow-Sedacca, Marcie-jo

2017-01-01

Problem/Condition Suicide is a public health problem and one of the top 10 leading causes of death in the United States. Substantial geographic variations in suicide rates exist, with suicides in rural areas occurring at much higher rates than those occurring in more urban areas. Understanding demographic trends and mechanisms of death among and within urbanization levels is important to developing and targeting future prevention efforts. Reporting Period 2001–2015. Description of System Mortality data from the National Vital Statistics System (NVSS) include demographic, geographic, and cause of death information derived from death certificates filed in the 50 states and the District of Columbia. NVSS was used to identify suicide deaths, defined by International Classification of Diseases, 10th Revision (ICD-10) underlying cause of death codes X60–X84, Y87.0, and U03. This report examines annual county level trends in suicide rates during 2001–2015 among and within urbanization levels by select demographics and mechanisms of death. Counties were collapsed into three urbanization levels using the 2006 National Center for Health Statistics classification scheme. Results Suicide rates increased across the three urbanization levels, with higher rates in nonmetropolitan/rural counties than in medium/small or large metropolitan counties. Each urbanization level experienced substantial annual rate changes at different times during the study period. Across urbanization levels, suicide rates were consistently highest for men and non-Hispanic American Indian/Alaska Natives compared with rates for women and other racial/ethnic groups; however, rates were highest for non-Hispanic whites in more metropolitan counties. Trends indicate that suicide rates for non-Hispanic blacks were lowest in nonmetropolitan/rural counties and highest in more urban counties. Increases in suicide rates occurred for all age groups across urbanization levels, with the highest rates for persons aged 35–64 years. For mechanism of death, greater increases in rates of suicide by firearms and hanging/suffocation occurred across all urbanization levels; rates of suicide by firearms in nonmetropolitan/rural counties were almost two times that of rates in larger metropolitan counties. Interpretation Suicide rates in nonmetropolitan/rural counties are consistently higher than suicide rates in metropolitan counties. These trends also are observed by sex, race/ethnicity, age group, and mechanism of death. Public Health Action Interventions to prevent suicides should be ongoing, particularly in rural areas. Comprehensive suicide prevention efforts might include leveraging protective factors and providing innovative prevention strategies that increase access to health care and mental health care in rural communities. In addition, distribution of socioeconomic factors varies in different communities and needs to be better understood in the context of suicide prevention. PMID:28981481

Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death - United States, 2001-2015.

PubMed

Ivey-Stephenson, Asha Z; Crosby, Alex E; Jack, Shane P D; Haileyesus, Tadesse; Kresnow-Sedacca, Marcie-Jo

2017-10-06

Suicide is a public health problem and one of the top 10 leading causes of death in the United States. Substantial geographic variations in suicide rates exist, with suicides in rural areas occurring at much higher rates than those occurring in more urban areas. Understanding demographic trends and mechanisms of death among and within urbanization levels is important to developing and targeting future prevention efforts. 2001-2015. Mortality data from the National Vital Statistics System (NVSS) include demographic, geographic, and cause of death information derived from death certificates filed in the 50 states and the District of Columbia. NVSS was used to identify suicide deaths, defined by International Classification of Diseases, 10th Revision (ICD-10) underlying cause of death codes X60-X84, Y87.0, and U03. This report examines annual county level trends in suicide rates during 2001-2015 among and within urbanization levels by select demographics and mechanisms of death. Counties were collapsed into three urbanization levels using the 2006 National Center for Health Statistics classification scheme. Suicide rates increased across the three urbanization levels, with higher rates in nonmetropolitan/rural counties than in medium/small or large metropolitan counties. Each urbanization level experienced substantial annual rate changes at different times during the study period. Across urbanization levels, suicide rates were consistently highest for men and non-Hispanic American Indian/Alaska Natives compared with rates for women and other racial/ethnic groups; however, rates were highest for non-Hispanic whites in more metropolitan counties. Trends indicate that suicide rates for non-Hispanic blacks were lowest in nonmetropolitan/rural counties and highest in more urban counties. Increases in suicide rates occurred for all age groups across urbanization levels, with the highest rates for persons aged 35-64 years. For mechanism of death, greater increases in rates of suicide by firearms and hanging/suffocation occurred across all urbanization levels; rates of suicide by firearms in nonmetropolitan/rural counties were almost two times that of rates in larger metropolitan counties. Suicide rates in nonmetropolitan/rural counties are consistently higher than suicide rates in metropolitan counties. These trends also are observed by sex, race/ethnicity, age group, and mechanism of death. Interventions to prevent suicides should be ongoing, particularly in rural areas. Comprehensive suicide prevention efforts might include leveraging protective factors and providing innovative prevention strategies that increase access to health care and mental health care in rural communities. In addition, distribution of socioeconomic factors varies in different communities and needs to be better understood in the context of suicide prevention.

Implementing parallel spreadsheet models for health policy decisions: The impact of unintentional errors on model projections

PubMed Central

Bailey, Stephanie L.; Bono, Rose S.; Nash, Denis; Kimmel, April D.

2018-01-01

Background Spreadsheet software is increasingly used to implement systems science models informing health policy decisions, both in academia and in practice where technical capacity may be limited. However, spreadsheet models are prone to unintentional errors that may not always be identified using standard error-checking techniques. Our objective was to illustrate, through a methodologic case study analysis, the impact of unintentional errors on model projections by implementing parallel model versions. Methods We leveraged a real-world need to revise an existing spreadsheet model designed to inform HIV policy. We developed three parallel versions of a previously validated spreadsheet-based model; versions differed by the spreadsheet cell-referencing approach (named single cells; column/row references; named matrices). For each version, we implemented three model revisions (re-entry into care; guideline-concordant treatment initiation; immediate treatment initiation). After standard error-checking, we identified unintentional errors by comparing model output across the three versions. Concordant model output across all versions was considered error-free. We calculated the impact of unintentional errors as the percentage difference in model projections between model versions with and without unintentional errors, using +/-5% difference to define a material error. Results We identified 58 original and 4,331 propagated unintentional errors across all model versions and revisions. Over 40% (24/58) of original unintentional errors occurred in the column/row reference model version; most (23/24) were due to incorrect cell references. Overall, >20% of model spreadsheet cells had material unintentional errors. When examining error impact along the HIV care continuum, the percentage difference between versions with and without unintentional errors ranged from +3% to +16% (named single cells), +26% to +76% (column/row reference), and 0% (named matrices). Conclusions Standard error-checking techniques may not identify all errors in spreadsheet-based models. Comparing parallel model versions can aid in identifying unintentional errors and promoting reliable model projections, particularly when resources are limited. PMID:29570737

Implementing parallel spreadsheet models for health policy decisions: The impact of unintentional errors on model projections.

PubMed

Bailey, Stephanie L; Bono, Rose S; Nash, Denis; Kimmel, April D

2018-01-01

Spreadsheet software is increasingly used to implement systems science models informing health policy decisions, both in academia and in practice where technical capacity may be limited. However, spreadsheet models are prone to unintentional errors that may not always be identified using standard error-checking techniques. Our objective was to illustrate, through a methodologic case study analysis, the impact of unintentional errors on model projections by implementing parallel model versions. We leveraged a real-world need to revise an existing spreadsheet model designed to inform HIV policy. We developed three parallel versions of a previously validated spreadsheet-based model; versions differed by the spreadsheet cell-referencing approach (named single cells; column/row references; named matrices). For each version, we implemented three model revisions (re-entry into care; guideline-concordant treatment initiation; immediate treatment initiation). After standard error-checking, we identified unintentional errors by comparing model output across the three versions. Concordant model output across all versions was considered error-free. We calculated the impact of unintentional errors as the percentage difference in model projections between model versions with and without unintentional errors, using +/-5% difference to define a material error. We identified 58 original and 4,331 propagated unintentional errors across all model versions and revisions. Over 40% (24/58) of original unintentional errors occurred in the column/row reference model version; most (23/24) were due to incorrect cell references. Overall, >20% of model spreadsheet cells had material unintentional errors. When examining error impact along the HIV care continuum, the percentage difference between versions with and without unintentional errors ranged from +3% to +16% (named single cells), +26% to +76% (column/row reference), and 0% (named matrices). Standard error-checking techniques may not identify all errors in spreadsheet-based models. Comparing parallel model versions can aid in identifying unintentional errors and promoting reliable model projections, particularly when resources are limited.

Relationships between depressive symptoms and self-reported unintentional injuries: the cross-sectional population–based FIN-D2D survey

PubMed Central

2012-01-01

Background There is a lack of knowledge on the influence of different levels of physical activity (PA) on unintentional injuries among those with depressive symptoms (DS). The aim of this study was to evaluate the relationship between PA categories and unintentional injuries among participants with and without DS based on a cross-sectional population–based FIN-D2D survey conducted in 2007. Methods Out of 4500, 2682 participants (60%) aged 45–74 years attended in this study. The unintentional injuries over the past year were captured in a questionnaire. DS were determined with the Beck Depression Inventory (≥ 10 points) and PA with the International Physical Activity Questionnaire. The statistical significance between DS and unintentional injury categories was evaluated by using t-test, chi-square test, or permutation test, analysis of covariance, or regression models. The factors related to unintentional injuries were estimated by univariate and multivariate logistic regression models. Results The proportion of subjects with unintentional injuries was higher among those with DS (17%) compared to those without DS (10%) (age- and gender-adjusted p = 0.023). The median (range) number of activity-loss days after injury was 22 (0–365) in participants with DS and 7 (0–120) in participants without DS ( p = 0.009). The percentage of subjects with unintentional injuries was not significantly different between PA categories in participants with DS and without DS. A stepwise multivariate logistic regression analysis showed that DS, functional ability, and musculoskeletal diseases were related to unintentional injuries. Conclusions PA level was not related to unintentional injuries, whereas those with DS had a higher prevalence of unintentional injuries and prolonged activity-loss after injury. These results underline the importance of injury prevention, especially among those who have DS and additional risk factors. PMID:22781103

State Firearm Laws, Firearm Ownership, and Safety Practices Among Families of Preschool-Aged Children

PubMed Central

Martin-Storey, Alexa; Crosnoe, Robert

2014-01-01

Objectives. We investigated how state-level firearms legislation is associated with firearm ownership and storage among families with preschool-aged children. Methods. Using 2005 nationally representative data from the Early Childhood Longitudinal Study-Birth Cohort (n = 8100), we conducted multinomial regression models to examine the associations between state-level firearms legislation generally, child access prevention (CAP) firearms legislation specifically, and parental firearm ownership and storage safety practices. Results. Overall, 8% of families with children aged 4 years living in states with stronger firearm laws and CAP laws owned firearms compared with 24% of families in states with weaker firearm laws and no CAP laws. Storage behaviors of firearm owners differed minimally across legislative contexts. When we controlled for family- and state-level characteristics, we found that firearm legislation and CAP laws interacted to predict ownership and storage behaviors, with unsafe storage least likely among families in states with both CAP laws and stronger firearm legislation. Conclusions. Broader firearm legislation is linked with the efficacy of child-specific legislation in promoting responsible firearm ownership. PMID:24825210

27 CFR 478.38 - Transportation of firearms.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Transportation of firearms... Administrative and Miscellaneous Provisions § 478.38 Transportation of firearms. Notwithstanding any other... such firearm if, during such transportation the firearm is unloaded, and neither the firearm nor any...

27 CFR 478.38 - Transportation of firearms.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Transportation of firearms... Administrative and Miscellaneous Provisions § 478.38 Transportation of firearms. Notwithstanding any other... such firearm if, during such transportation the firearm is unloaded, and neither the firearm nor any...

27 CFR 478.38 - Transportation of firearms.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Transportation of firearms... Administrative and Miscellaneous Provisions § 478.38 Transportation of firearms. Notwithstanding any other... such firearm if, during such transportation the firearm is unloaded, and neither the firearm nor any...

27 CFR 478.38 - Transportation of firearms.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Transportation of firearms... Administrative and Miscellaneous Provisions § 478.38 Transportation of firearms. Notwithstanding any other... such firearm if, during such transportation the firearm is unloaded, and neither the firearm nor any...

Guns and gender-based violence in South Africa.

PubMed

Abrahams, Naeemah; Jewkes, Rachel; Mathews, Shanaaz

2010-09-07

The criminal use of firearms in South Africa is widespread and a major factor in the country having the third-highest homicide rate in the world. Violence is a common feature of South African society. A firearm in the home is a risk factor in intimate partner violence, but this has not been readily demonstrated in South Africa because of a lack of data. We drew on several South African studies including national homicide studies, intimate partner studies, studies with male participants and studies from the justice sector, to discuss the role of gun ownership on gender-based violence. Guns play a significant role in violence against women in South Africa, most notably in the killing of intimate partners. Although the overall homicide data suggest that death by shooting is decreasing, data for intimate partner violence are not readily available. We have no idea if the overall decrease in gunshot homicides applies to women in relationships, and therefore gun control should remain high on the legislative agenda.

Homicide-suicide in Konya, Turkey between 2000 and 2007.

PubMed

Dogan, Kamil Hakan; Demirci, Serafettin; Gunaydin, Gursel; Buken, Bora

2010-01-01

Homicide followed by the suicide of the murderer is a relatively rare lethal incident in which an individual kills another person and subsequently dies by suicide. Cases involving a homicide and a suicide in which death examinations and autopsies were performed at The Konya Branch of the Forensic Medicine Council between 2000 and 2007 were retrospectively investigated. During the studied time period, there were 10 homicide-suicide cases identified with 10 perpetrators killing 12 victims. Nine of the perpetrators were men and eight of the victims were women. The precipitating motive was an impending divorce in four of the cases. Two perpetrators were described as severely depressed, one had a diagnosis of antisocial personality disorder, and one was a pedophile who had reactive depression. Firearms were used in eight of the homicide cases and seven of the suicides. Constricting the use of firearms may reduce/prevent future homicide-suicide cases, as it is the most commonly used method to carry out homicide-suicides.

Characteristics of drowning deaths in North Carolina.

PubMed

Patetta, M J; Biddinger, P W

1988-01-01

A retrospective study of 1,052 unintentional drowning deaths in North Carolina during the period from 1980 through 1984 was carried out, with emphasis on the victims' activity and alcohol consumption, and the settings of the accidents. The data suggest that many drownings are preventable, and reinforce the etiologic importance of ethanol consumption in such deaths. The overall drowning rate for North Carolina residents during the period covered by the study was 3.2 per 100,000 persons. Nonwhite males had the highest rate, 8.8 per 100,000 population. The next highest rate was for white males, 4.7 per 100,000. Swimming and wading, involved in 41 percent of the drowning deaths, was the most frequently associated activity. Fishing was involved in 15 percent of the deaths, and motor vehicle accidents with 8 percent. Most occurred in freshwater settings, notably lakes and ponds, 39 percent, and rivers and creeks, 29 percent. Of the 752 victims 15 years and older tested for blood ethanol, 53 percent had positive tests and 38 percent had blood alcohol concentrations of 100 milligrams per deciliter or greater. Significant percentages of victims 15 years and older with blood alcohol concentrations greater than 100 milligrams per deciliter were found in all settings and activity groups.

United States life tables eliminating certain causes of death, 1999-2001.

PubMed

Arias, Elizabeth; Heron, Melonie; Tejada-Vera, Betzaida

2013-05-31

This report presents abridged cause-elimination life tables and multiple-decrement life table functions for 33 selected causes of death, by race (white and black) and sex, for the total United States. It is the fourth in a set of reports that present life table data for the United States and each state for the period 1999-2001. The life table functions presented in this report represent the mortality experience of a hypothetical cohort assuming that a particular cause of death is eliminated. The report includes a description of the methodology used to estimate the life table functions shown in four sets of tables. Each set contains seven tables, one each for the total population, total males, total females, white males, white females, black males, and black females. From birth, a person has a 31% chance of dying of Diseases of heart (heart disease) and a 22% chance of dying of Malignant neoplasms (cancer). In contrast, the probabilities of dying from Accidents (unintentional injuries), Diabetes mellitus (diabetes), and Septicemia--3 of the 10 leading causes of death in 1991-2001--are much smaller. Likewise, elimination of heart disease would increase life expectancy at birth by almost 4 years, and elimination of cancer by more than 3 years. Other leading causes of death have a much smaller impact.

27 CFR 478.33a - Theft of firearms.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Theft of firearms. 478.33a Section 478.33a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative...

27 CFR 478.33a - Theft of firearms.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Theft of firearms. 478.33a Section 478.33a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative...

27 CFR 478.29a - Acquisition of firearms by nonresidents.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Acquisition of firearms by nonresidents. 478.29a Section 478.29a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION...

27 CFR 478.29a - Acquisition of firearms by nonresidents.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Acquisition of firearms by nonresidents. 478.29a Section 478.29a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION...

27 CFR 478.29a - Acquisition of firearms by nonresidents.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Acquisition of firearms by nonresidents. 478.29a Section 478.29a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION...

27 CFR 478.29a - Acquisition of firearms by nonresidents.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Acquisition of firearms by nonresidents. 478.29a Section 478.29a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION...

27 CFR 478.33a - Theft of firearms.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Theft of firearms. 478.33a Section 478.33a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative...

27 CFR 478.33a - Theft of firearms.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Theft of firearms. 478.33a Section 478.33a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative...

27 CFR 478.29a - Acquisition of firearms by nonresidents.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Acquisition of firearms by nonresidents. 478.29a Section 478.29a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION...

Psychosocial factors associated with lifetime experience of serious unintentional injury in South Korea.

PubMed

Ham, Ok Kyung

2008-01-01

The purpose of this study was to determine the prevalence of lifetime unintentional-injury experience and evaluate the quality of life of unintentional-injury victims, to provide useful data for the development of interventions aimed at decreasing the incidence of unintentional injuries. DESIGN, SAMPLE, AND METHODS: This study utilized data obtained from cross-sectional surveys of 24,327 Korean individuals aged 19-65 years, performed using face-to-face interviews. Demographic characteristics, unintentional-injury experience, attributes of health behavior, and health-related quality of life (HRQoL) questions were included in the study instruments. About 11.8% of the subjects had experienced an unintentional injury that required hospitalization at least once in their lifetime. Being older, being male, having less education and lower income, working in a blue-collar job, and being enrolled in medical aid programs were associated with increased likelihood of having an unintentional injury. Among the HRQoL and risk-taking behavior variables, limitations in daily activities, suicide ideation, and binge drinking were significantly associated with injury experience. Public health efforts to prevent unintentional injuries should target high-risk populations such as males, those with low incomes and education levels, and binge drinkers. Efforts should also be made to enhance the HRQoL of injury victims.

Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study.

PubMed

Park, Tae Woo; Saitz, Richard; Ganoczy, Dara; Ilgen, Mark A; Bohnert, Amy S B

2015-06-10

To study the association between benzodiazepine prescribing patterns including dose, type, and dosing schedule and the risk of death from drug overdose among US veterans receiving opioid analgesics. Case-cohort study. Veterans Health Administration (VHA), 2004-09. US veterans, primarily male, who received opioid analgesics in 2004-09. All veterans who died from a drug overdose (n=2400) while receiving opioid analgesics and a random sample of veterans (n=420,386) who received VHA medical services and opioid analgesics. Death from drug overdose, defined as any intentional, unintentional, or indeterminate death from poisoning caused by any drug, determined by information on cause of death from the National Death Index. During the study period 27% (n=112,069) of veterans who received opioid analgesics also received benzodiazepines. About half of the deaths from drug overdose (n=1185) occurred when veterans were concurrently prescribed benzodiazepines and opioids. Risk of death from drug overdose increased with history of benzodiazepine prescription: adjusted hazard ratios were 2.33 (95% confidence interval 2.05 to 2.64) for former prescriptions versus no prescription and 3.86 (3.49 to 4.26) for current prescriptions versus no prescription. Risk of death from drug overdose increased as daily benzodiazepine dose increased. Compared with clonazepam, temazepam was associated with a decreased risk of death from drug overdose (0.63, 0.48 to 0.82). Benzodiazepine dosing schedule was not associated with risk of death from drug overdose. Among veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of death from drug overdose in a dose-response fashion. © Park et al 2015.

Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study

PubMed Central

Saitz, Richard; Ganoczy, Dara; Ilgen, Mark A; Bohnert, Amy S B

2015-01-01

Objective To study the association between benzodiazepine prescribing patterns including dose, type, and dosing schedule and the risk of death from drug overdose among US veterans receiving opioid analgesics. Design Case-cohort study. Setting Veterans Health Administration (VHA), 2004-09. Participants US veterans, primarily male, who received opioid analgesics in 2004-09. All veterans who died from a drug overdose (n=2400) while receiving opioid analgesics and a random sample of veterans (n=420 386) who received VHA medical services and opioid analgesics. Main outcome measure Death from drug overdose, defined as any intentional, unintentional, or indeterminate death from poisoning caused by any drug, determined by information on cause of death from the National Death Index. Results During the study period 27% (n=112 069) of veterans who received opioid analgesics also received benzodiazepines. About half of the deaths from drug overdose (n=1185) occurred when veterans were concurrently prescribed benzodiazepines and opioids. Risk of death from drug overdose increased with history of benzodiazepine prescription: adjusted hazard ratios were 2.33 (95% confidence interval 2.05 to 2.64) for former prescriptions versus no prescription and 3.86 (3.49 to 4.26) for current prescriptions versus no prescription. Risk of death from drug overdose increased as daily benzodiazepine dose increased. Compared with clonazepam, temazepam was associated with a decreased risk of death from drug overdose (0.63, 0.48 to 0.82). Benzodiazepine dosing schedule was not associated with risk of death from drug overdose. Conclusions Among veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of death from drug overdose in a dose-response fashion. PMID:26063215

Motor vehicle driver death and high state maximum speed limits: 1991-1993.

PubMed

Yamane, Grover K; Bradshaw, Benjamin S

2008-09-01

To measure the association between motor vehicle crash (MVC) driver death and high state maximum speed limits. This study used a case-control design and assessed driver deaths from three major types of MVCs: non-collision; collision with motor vehicles in transit; and collision with stationary objects. The study period was 1991-1993. For each type of crash, case subject populations of fatally injured drivers were obtained from the U.S. Department of Transportation Fatality Analysis Reporting System. Four control subject populations, each associated with a different cause of death, were obtained from a U.S. national death certificate database (the causes of death were unintentional poisoning, non-Hodgkin lymphoma, drowning, and diabetes mellitus). Subjects were considered exposed if the state in which they crashed (for cases) or died (for controls) had a maximum speed limit greater than 55 mph. Each of the three case subject populations was compared against each of the four control subject populations. Odds ratios (ORs) were adjusted for age and gender. For non-collision driver death, ORs ranged from 3.06 to 6.56, depending on the year and control group; all the ORs were significant. For collision with motor vehicles in transit driver death, ORs ranged from 1.12 to 2.22; all the ORs were significant. For collision with stationary objects driver death, ORs ranged from 0.87 to 1.83. There was a moderately strong and significant association between non-collision driver death and high state maximum speed limits. For collision with motor vehicles in transit driver death, the association was somewhat milder but still consistent. For collision with stationary objects driver death, the presence of an association was unclear. During 1991-1993, the effects of high state maximum speed limits may have been different for different types of MVCs.

Firearm Ownership and Violent Crime in the U.S.: An Ecologic Study.

PubMed

Monuteaux, Michael C; Lee, Lois K; Hemenway, David; Mannix, Rebekah; Fleegler, Eric W

2015-08-01

Although some view the ownership of firearms as a deterrent to crime, the relationship between population-level firearm ownership rates and violent criminal perpetration is unclear. The purpose of this study is to test the association between state-level firearm ownership and violent crime. State-level rates of household firearm ownership and annual rates of criminal acts from 2001, 2002, and 2004 were analyzed in 2014. Firearm ownership rates were taken from a national survey and crime data were taken from the Federal Bureau of Investigation Uniform Crime Reports. Rates of criminal behavior were estimated as a function of household gun ownership using negative binomial regression models, controlling for several demographic factors. Higher levels of firearm ownership were associated with higher levels of firearm assault and firearm robbery. There was also a significant association between firearm ownership and firearm homicide, as well as overall homicide. The findings do not support the hypothesis that higher population firearm ownership rates reduce firearm-associated criminal perpetration. On the contrary, evidence shows that states with higher levels of firearm ownership have an increased risk for violent crimes perpetrated with a firearm. Public health stakeholders should consider the outcomes associated with private firearm ownership. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

27 CFR 478.120 - Firearms or ammunition imported by or for a nonimmigrant alien.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Firearms or ammunition... BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Importation § 478.120 Firearms or ammunition imported by or for a...

27 CFR 478.120 - Firearms or ammunition imported by or for a nonimmigrant alien.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Firearms or ammunition... BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Importation § 478.120 Firearms or ammunition imported by or for a...

27 CFR 478.120 - Firearms or ammunition imported by or for a nonimmigrant alien.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Firearms or ammunition... BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Importation § 478.120 Firearms or ammunition imported by or for a...

27 CFR 478.39a - Reporting theft or loss of firearms.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Reporting theft or loss of firearms. 478.39a Section 478.39a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION...

27 CFR 478.120 - Firearms or ammunition imported by or for a nonimmigrant alien.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Firearms or ammunition... BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Importation § 478.120 Firearms or ammunition imported by or for a...

27 CFR 478.39a - Reporting theft or loss of firearms.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Reporting theft or loss of firearms. 478.39a Section 478.39a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION...

27 CFR 478.39a - Reporting theft or loss of firearms.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Reporting theft or loss of firearms. 478.39a Section 478.39a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION...

27 CFR 478.39a - Reporting theft or loss of firearms.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Reporting theft or loss of firearms. 478.39a Section 478.39a Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION...

The epidemiology of firearm suicide in the United States.

PubMed

Romero, Michael P; Wintemute, Garen J

2002-03-01

Little attention has been given to the role of firearms in suicide. In 1998, firearms were the leading method of committing suicide for both men and women, responsible for three times the number of suicides compared to the next leading method. Understanding the epidemiology of firearm suicide will increase awareness of firearm suicide as a major public health problem. Rates of firearm suicide have changed little over the past two decades and have consistently exceeded rates of firearm homicide. The firearm suicide rate among men is approximately six times that of women. While firearm suicide rates are highest among the elderly, the majority (66%) of firearm suicides are among persons under 55 years of age. Firearm suicide rates among women of all ages have dropped modestly, while rates among elderly men have risen considerably. Whites have roughly twice the rate of firearm suicide as do blacks and other race/ethnicity groups. Individual-level empirical studies have consistently indicated that keeping firearms in the home is associated with an increased risk of suicide. For suicide prevention to be effective, the availability and use of firearms in suicides must be addressed.

Wounds due to a modified shot gun (home-made): a case report.

PubMed

Palimar, Vikram; Nayak, Vinod C; Arun, M; Kumar, Pradeep G; Bhagavath, Prashantha

2010-05-01

In a case of firearm fatality, the autopsy surgeon is required to opine as to the range of fire in addition to the cause of death which will help in reconstruction of the events. Problems may arise in estimating the range of fire based on wound ballistics when there is an alteration or modification in the internal ballistics. We encountered such a case in the department of Forensic Medicine, Kasturba Medical College, Manipal, which is discussed. Copyright (c) 2010. Published by Elsevier Ltd.

Long-term trends of suicide by choice of method in Norway: a joinpoint regression analysis of data from 1969 to 2012.

PubMed

Puzo, Quirino; Qin, Ping; Mehlum, Lars

2016-03-11

Suicide mortality and the rates by specific methods in a population may change over time in response to concurrent changes in relevant factors in society. This study aimed to identify significant changing points in method-specific suicide mortality from 1969 to 2012 in Norway. Data on suicide mortality by specific methods and by sex and age were retrieved from the Norwegian Cause-of-Death Register. Long-term trends in age-standardized rates of suicide mortality were analyzed by using joinpoint regression analysis. The most frequently used suicide method in the total population was hanging, followed by poisoning and firearms. Men chose suicide by firearms more often than women, whereas poisoning and drowning were more frequently used by women. The joinpoint analysis revealed that the overall trend of suicide mortality significantly changed twice along the period of 1969 to 2012 for both sexes. The male age-standardized suicide rate increased by 3.1% per year until 1989, and decreased by 1.2% per year between 1994 and 2012. Among females the long-term suicide rate increased by 4.0% per year until 1988, decreased by 5.5% through 1995, and then stabilized. Both sexes experienced an upward trend for suicide by hanging during the 44-year observation period, with a particularly significant increase in 15-24 year old males. The most distinct change among men was seen for firearms after 1988 with a significant decrease through 2012 of around 5% per year. For women, significant reductions since 1985-88 were observed for suicide by drowning and poisoning. The present study demonstrates different time trends for different suicide methods with significant reductions in suicide by firearms, drowning and poisoning after the peak in the suicide rate in the late 1980s. Suicide by means of hanging continuously increased, but did not fully compensate for the reduced use of other methods. This lends some support for the effectiveness of method-specific suicide preventive measures, such as restrictions to the access to firearms, which had been implemented in Norway during the relevant time period.

Working hours associated with unintentional sleep at work among airline pilots

PubMed Central

Marqueze, Elaine Cristina; Nicola, Ana Carolina B; Diniz, Dag Hammarskjoeld M D; Fischer, Frida Marina

2017-01-01

ABSTRACT OBJECTIVE Tto identify factors associated with unintentional sleep at work of airline pilots. METHODS This is a cross-sectional epidemiological study conducted with 1,235 Brazilian airline pilots, who work national or international flights. Data collection has been performed online. We carried out a bivariate and multiple logistic regression analysis, having as dependent variable unintentional sleep at work. The independent variables were related to biodemographic data, characteristics of the work, lifestyle, and aspects of sleep. RESULTS The prevalence of unintentional sleep while flying the airplane was 57.8%. The factors associated with unintentional sleep at work were: flying for more than 65 hours a month, frequent technical delays, greater need for recovery after work, work ability below optimal, insufficient sleep, and excessive sleepiness. CONCLUSIONS The occurrence of unintentional sleep at work of airline pilots is associated with factors related to the organization of the work and health. PMID:28678902

Road traffic and other unintentional injuries among travelers to developing countries

PubMed Central

Stewart, Barclay; Yankson, Isaac Kofi; Afukaar, Francis; Medina, Martha Hijar; Cuong, Pham Viet; Mock, Charles

2015-01-01

Synopsis Injuries result in nearly 6 million deaths and incur 52 million disability-adjusted life years annually, comprising 15% of the global disease burden. More than 90% of this burden occurs in low- and middle-income countries (LMICs). Given this burden, it’s not unexpected that injuries are the leading cause of death among travelers to LMICs, namely from road traffic crashes and drowning. Opportunely, the majority of injuries are preventable. Therefore, pre-travel advice regarding foreseeable dangers and how to avoid them may significantly mitigate injury risk, such as: wearing seatbelts, helmets and personal flotation devices when appropriate; responsibly consuming alcohol; and closely supervising children. Upon return, travelers to LMICs are in a unique position; having shared injury risks while abroad, travelers can advocate for injury control initiatives that might make the world safer for travelers and local populations alike. PMID:26900117

What We Know About ADHD and Driving Risk: A Literature Review, Meta-Analysis and Critique

PubMed Central

Jerome, Laurence; Segal, Alvin; Habinski, Liat

2006-01-01

Introduction This article examines the literature on ADHD and unintentional driving injury. This literature has emerged over the last decade as part of the burgeoning epidemic of road traffic death and injury which is the number one cause of death in young adults in North America. Methods The available literature on observational outcome studies and experimental pharmacological interventions is critically reviewed. A meta-analysis of behavioral outcomes and a review of effect size of pharmacological studies are presented. Results Current data support the utility of stimulant medication in improving driving performance in younger ADHD drivers. A conceptual model of risk factors in young ADHD drivers is offered. Conclusion The current state of screening instruments for identifying high risk subjects within this clinical group is summarized along with a final section on emerging trends and future prospects for intervention. PMID:18392181

Head Trauma with or without Mild Brain Injury Increases the Risk of Future Traumatic Death: A Controlled Prospective 15-Year Follow-Up Study.

PubMed

Vaaramo, Kalle; Puljula, Jussi; Tetri, Sami; Juvela, Seppo; Hillbom, Matti

2015-10-15

Patients who have recovered from traumatic brain injury (TBI) show an increased risk of premature death. To investigate long-term mortality rates in a population admitted to the hospital for head injury (HI), we conducted a population-based prospective case-control, record-linkage study, All subjects who were living in Northern Ostrobothnia, and who were admitted to Oulu University Hospital in 1999 because of HI (n=737), and 2196 controls matched by age, gender, and residence randomly drawn from the population of Northern Ostrobothnia were included. Death rate and causes of death in HI subjects during 15 years of follow-up was compared with the general population controls. The crude mortality rates were 56.9, 18.6, and 23.8% for subjects having moderate-to-severe traumatic brain injury (TBI), mild TBI, and head injury without TBI, respectively. The corresponding approximate annual mortality rates were 6.7%, 1.4%, and 1.9%. All types of index HI predicted a significant risk of traumatic death in the future. Subjects who had HI without TBI had an increased risk of both death from all causes (hazard ratio 2.00; 95% confidence interval 1.57-2.55) and intentional or unintentional traumatic death (4.01, 2.20-7.30), compared with controls. The main founding was that even HI without TBI carries an increased risk of future traumatic death. The reason for this remains unknown and further studies are needed. To prevent such premature deaths, post-traumatic therapy should include an interview focusing on lifestyle factors.

Deaths from Falls Among Persons Aged ≥65 Years - United States, 2007-2016.

PubMed

Burns, Elizabeth; Kakara, Ramakrishna

2018-05-11

Deaths from unintentional injuries are the seventh leading cause of death among older adults (1), and falls account for the largest percentage of those deaths. Approximately one in four U.S. residents aged ≥65 years (older adults) report falling each year (2), and fall-related emergency department visits are estimated at approximately 3 million per year.* In 2016, a total of 29,668 U.S. residents aged ≥65 years died as the result of a fall (age-adjusted rate †  = 61.6 per 100,000), compared with 18,334 deaths (47.0) in 2007. To evaluate this increase, CDC produced age-adjusted rates and trends for deaths from falls among persons aged ≥65 years, by selected characteristics (sex, age group, race/ethnicity, and urban/rural status) and state from 2007 to 2016. The rate of deaths from falls increased in the United States by an average of 3.0% per year during 2007-2016, and the rate increased in 30 states and the District of Columbia (DC) during that period. In eight states, the rate of deaths from falls increased for a portion of the study period. The rate increased in almost every demographic category included in the analysis, with the largest increase per year among persons aged ≥85 years. Health care providers should be aware that deaths from falls are increasing nationally among older adults but that falls are preventable. Falls and fall prevention should be discussed during annual wellness visits, when health care providers can assess fall risk, educate patients about falls, and select appropriate interventions.

Unintentional non-traffic injury and fatal events: Threats to children in and around vehicles.

PubMed

Zonfrillo, Mark R; Ramsay, Mackenzie L; Fennell, Janette E; Andreasen, Amber

2018-02-17

There have been substantial reductions in motor vehicle crash-related child fatalities due to advances in legislation, public safety campaigns, and engineering. Less is known about non-traffic injuries and fatalities to children in and around motor vehicles. The objective of this study was to describe the frequency of various non-traffic incidents, injuries, and fatalities to children using a unique surveillance system and database. Instances of non-traffic injuries and fatalities in the United States to children 0-14 years were tracked from January 1990 to December 2014 using a compilation of sources including media reports, individual accounts from families of affected children, medical examiner reports, police reports, child death review teams, coroner reports, medical professionals, legal professionals, and other various modes of publication. Over the 25-year period, there were at least 11,759 events resulting in 3,396 deaths. The median age of the affected child was 3.7 years. The incident types included 3,115 children unattended in hot vehicles resulting in 729 deaths, 2,251 backovers resulting in 1,232 deaths, 1,439 frontovers resulting in 692 deaths, 777 vehicles knocked into motion resulting in 227 deaths, 415 underage drivers resulting in 203 deaths, 172 power window incidents resulting in 61 deaths, 134 falls resulting in 54 deaths, 79 fires resulting in 41 deaths, and 3,377 other incidents resulting in 157 deaths. Non-traffic injuries and fatalities present an important threat to the safety and lives of very young children. Future efforts should consider complementary surveillance mechanisms to systematically and comprehensively capture all non-traffic incidents. Continued education, engineering modifications, advocacy, and legislation can help continue to prevent these incidents and must be incorporated in overall child vehicle safety initiatives.

27 CFR 479.91 - Unserviceable firearms.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Unserviceable firearms. 479.91 Section 479.91 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND...

27 CFR 479.91 - Unserviceable firearms.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Unserviceable firearms. 479.91 Section 479.91 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND CERTAIN...

27 CFR 479.91 - Unserviceable firearms.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Unserviceable firearms. 479.91 Section 479.91 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND CERTAIN...

27 CFR 479.91 - Unserviceable firearms.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Unserviceable firearms. 479.91 Section 479.91 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND...

27 CFR 479.91 - Unserviceable firearms.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Unserviceable firearms. 479.91 Section 479.91 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND...

Prevention of Firearm Suicide in the United States: What Works and What Is Possible.

PubMed

Mann, J John; Michel, Christina A

2016-10-01

About 21,000 suicides in the United States in 2014 involved a firearm. The authors reviewed evidence from around the world regarding the relationship between firearm ownership rates and firearm suicide rates and the potential effectiveness of policy-based strategies for preventing firearm suicides in the United States. Relevant publications were identified by searches of PubMed, PsycINFO, MEDLINE, and Google Scholar from 1980 to September 2015, using the search terms suicide AND firearms OR guns. Excluding duplicates, 1,687 results were found, 60 of which were selected for inclusion; these sources yielded an additional 10 studies, for a total of 70 studies. Case-control and ecological studies investigating geographic and temporal variations in firearm ownership and firearm suicide rates indicate that greater firearm availability is associated with higher firearm suicide rates. Time-series analyses, mostly from other countries, show that legislation reducing firearm ownership lowers firearm suicide rates. Because the Second Amendment curtails legislation broadly restricting firearm access in the United States, the emphasis is shifted to restricting access for those at risk of harming themselves or others. Most suicides involve guns purchased years earlier. Targeted initiatives like gun violence restraining orders, smart gun technology, and gun safety education campaigns potentially reduce access to already purchased firearms by suicidal individuals. Such measures are too new to have evidence of effectiveness. Broadly reducing availability and access to firearms has lowered firearm suicide rates in other countries but does not appear feasible in the United States. Approaches restricting access of at-risk individuals to already purchased firearms by engaging the public and major stakeholders require urgent implementation and outcome evaluation for firearm suicide prevention.

Austrian firearm legislation and its effects on suicide and homicide mortality: A natural quasi-experiment amidst the global economic crisis.

PubMed

König, Daniel; Swoboda, Patrick; Cramer, Robert J; Krall, Christoph; Postuvan, Vita; Kapusta, Nestor D

2018-08-01

Restriction of access to suicide methods has been shown to effectively reduce suicide mortality rates. To examine how the global economic crisis of 2008 and the firearm legislation reform of 1997 affected suicide and homicide mortality rate within Austria. Official data for the years 1985-2016 for firearm certificates, suicide, homicide, unemployment rates and alcohol consumption were examined using auto regressive error and Poisson regression models. Firearm certificates, total suicide mortality rate, suicide and homicides by firearms, and the fraction of firearm suicides/homicides among all suicides/homicides decreased after the firearm legislation reform in 1997. However, significant trend changes can be observed after 2008. The availability of firearm certificates significantly increased and was accompanied by significant changes in trends of firearm suicide and homicide rates. Concurrently, the total suicide mortality rate in 2008, for the first time since 1985, stopped its decreasing trend. While the total homicide rate further decreased, the fraction of firearm homicides among all homicides significantly increased. The initially preventative effect of the firearm legislation reform in Austria in 1997 seems to have been counteracted by the global economic downturn of 2008. Increased firearm availability was associated with corresponding increases in both firearm suicide and firearm homicide mortality. Restrictive firearm legislation should be an imperative part of a country's suicide prevention programme. Although firearm legislation reform may have long-lasting effects, societal changes may facilitate compensatory firearm acquisitions and thus counteract preventive efforts, calling in turn again for adapted counter-measures. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

27 CFR 478.33 - Stolen firearms and ammunition.

Code of Federal Regulations, 2011 CFR

2011-04-01

... ammunition. 478.33 Section 478.33 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative and Miscellaneous Provisions § 478.33 Stolen firearms and ammunition. No person shall transport or...

27 CFR 478.33 - Stolen firearms and ammunition.

Code of Federal Regulations, 2014 CFR

2014-04-01

... ammunition. 478.33 Section 478.33 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative and Miscellaneous Provisions § 478.33 Stolen firearms and ammunition. No person shall transport or...

27 CFR 478.33 - Stolen firearms and ammunition.

Code of Federal Regulations, 2012 CFR

2012-04-01

... ammunition. 478.33 Section 478.33 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative and Miscellaneous Provisions § 478.33 Stolen firearms and ammunition. No person shall transport or...

27 CFR 478.33 - Stolen firearms and ammunition.

Code of Federal Regulations, 2010 CFR

2010-04-01

... ammunition. 478.33 Section 478.33 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative and Miscellaneous Provisions § 478.33 Stolen firearms and ammunition. No person shall transport or...

27 CFR 478.33 - Stolen firearms and ammunition.

Code of Federal Regulations, 2013 CFR

2013-04-01

... ammunition. 478.33 Section 478.33 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative and Miscellaneous Provisions § 478.33 Stolen firearms and ammunition. No person shall transport or...

27 CFR 479.112 - Registration of imported firearms.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Registration of imported firearms. 479.112 Section 479.112 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

27 CFR 479.112 - Registration of imported firearms.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Registration of imported firearms. 479.112 Section 479.112 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

27 CFR 479.161 - National Firearms Act stamps.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true National Firearms Act stamps. 479.161 Section 479.161 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

27 CFR 479.112 - Registration of imported firearms.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Registration of imported firearms. 479.112 Section 479.112 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

27 CFR 479.112 - Registration of imported firearms.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Registration of imported firearms. 479.112 Section 479.112 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

27 CFR 479.161 - National Firearms Act stamps.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false National Firearms Act stamps. 479.161 Section 479.161 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

27 CFR 479.103 - Registration of firearms manufactured.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Registration of firearms manufactured. 479.103 Section 479.103 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

27 CFR 479.161 - National Firearms Act stamps.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false National Firearms Act stamps. 479.161 Section 479.161 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

27 CFR 479.66 - Subsequent transfer of firearms.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Subsequent transfer of firearms. 479.66 Section 479.66 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...

27 CFR 479.161 - National Firearms Act stamps.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false National Firearms Act stamps. 479.161 Section 479.161 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES...