Community-Academic Partnership to Assess the Role of Physical Disinvestment on Firearm Violence in Toledo, OH.

Reversing physical disinvestment, e.g., by remediating abandoned buildings and vacant lots, is an evidence-based strategy to reduce urban firearm violence. However, adoption of this strategy has been inconsistent across US cities. Our community-academic partnership sought to support adoption in Toledo, OH, USA, by generating locally relevant analyses on physical disinvestment and firearm violence. We used a spatial case-control design with matching. Physical disinvestment measures were derived from a citywide parcel foot audit conducted by the Lucas County Land Bank in summer 2021. Firearm violence outcomes were incident-level shootings data from the Toledo Police Department from October 2021 through February 2023. Shooting locations were matched to controls 1:4 on poverty rate, roadway characteristics, and zoning type. Exposures were calculated by aggregating parcels within 5-min walking buffers of each case and control point. We tested multiple disinvestment measures, including a composite index. Models were logistic regressions that adjusted for the matching variables and for potential spatial autocorrelation. Our sample included N = 281 shooting locations and N = 1124 matched controls. A 1-unit increase in the disinvestment score, equal to approximately 1 additional disrepair condition for the average parcel within the walking buffer, was associated with 1.68 times (95% CI: 1.36, 2.07) higher odds of shooting incidence. Across all other measures, greater disinvestment was associated with higher odds of shooting incidence. Our finding of a strong association between physical disinvestment and firearm violence in Toledo can inform local action. Community-academic partnership could help increase adoption of violence prevention strategies focused on reversing physical disinvestment.

Validity of individual self-report oral health measures in assessing periodontitis for causal research applications.

BACKGROUND: Self-reported measures of periodontitis developed for use in population surveillance are increasingly used in causal research. Numerous studies evaluate the validity of these measures against clinical parameters of periodontitis, yet few include validation parameters outside of multivariable models. Individual item validity is necessary to adequately inform use of these measures in causal research. METHODS: We used data from the National Health and Nutrition Examination Survey 2011-2014 in which dentate participants completed full-mouth periodontal examinations (N = 6966). We evaluated six self-report questionnaire items related to periodontal disease status against periodontitis case definitions developed by the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC-AAP). We estimated the sensitivity and specificity of individual items using severe and moderate-to-severe periodontitis classifications. We additionally combined items to evaluate the validity of joint measures. RESULTS: Sensitivity was highest when measures were evaluated against severe periodontitis. Self-rated oral health of fair/poor demonstrated the highest sensitivity for severe (0.60) and moderate-to-severe periodontitis (0.48). Specificity was highest when evaluated against moderate-to-severe periodontitis, with self-reported history of tooth mobility as the most specific measure (0.87 for severe disease; 0.92 for moderate-to-severe) followed by a history of bone loss (0.88 for severe; 0.91 for moderate-to-severe). Combining questions generally improved specificity at the expense of sensitivity. CONCLUSIONS: Our findings related to item-specific validity and the associated clinical profiles facilitate needed considerations for the use of self-reported measures of periodontitis in causal research. Additionally, item-specific validity can be used to inform assessments of misclassification bias within such investigations.

Cross sectional analysis of Chicago vs suburban Cook County suicide deaths among 10-24-year-olds in the Illinois violent death reporting system.

BACKGROUND: In 2014, suicide was the second leading cause of death among 10- to 24-year-olds in the US. Studies note disparities in youth suicide based on sex, race/ethnicity, and urban vs rural settings. This study investigates demographics, mental health indicators, and other circumstances surrounding youth/young adult deaths by suicide, comparing Chicago and suburban Cook County from 2005 to 2010. METHODS: Using the Illinois Violent Death Reporting System (IVDRS), we employed a cross-sectional design to provide descriptive analysis of decedents in three age groups (10-14, 15-19, and 20-24 years) in two geographic areas: urban (city of Chicago) and suburban (suburban Cook County) between January 1, 2005 and December 31, 2010. We used chi-square testing to test for significant differences in each age group by demographics, mental health indicators, and suicide markers in each area. RESULTS: Between 2005 and 2010, the IVDRS reported 299 deaths by suicide among 10-24-year-olds, 52% in Chicago, and 48% in suburban Cook County. Of these deaths, 5.7%, 33.4% and 60.9% were ages 10-14, 15-19, and 20-24 years, respectively. Non-Hispanic (NH) whites comprised 50.7% of the totals, NH Blacks 26.5%, Hispanics 16.8%, and Asians 5.7%. In Chicago, males were 84% of suicides and 62.7% in suburban Cook County among 15-19-year-olds (p < 0.05). White race was significantly different in 10-14-year-olds: 0% in Chicago, 54% in suburban Cook County (p < 0.05). Racial and ethnic differences in suicides among 15-19-year-olds in Chicago vs suburban Cook County were: NH White 22.4% vs 74.5% (p < 0.001), NH Black 46.9% vs 13.7% (p < 0.05), Hispanic 24.5% vs 7.8% (p < 0.05). There were also differences for 20-24-year-olds with NH White 43% vs 65.4% and NH Black 32% vs 13.6% (p < 0.05 for both). For mechanism of death, in 15-19-year-olds, there were differences between city and suburban in firearm deaths (42.9% vs 20%, p < 0.05) and in poisoning (0 vs 14%, p < 0.05). CONCLUSIONS: Our analyses detected significant location-related differences in the characteristics of decedents within the Chicago region indicating that local data are needed to inform suicide prevention efforts so that those at most risk can be prioritized for services. IVDRS is a potent tool in identifying these variations.

Child deaths of undetermined intent: An analysis of circumstances using Illinois Violent Death Reporting System data.

BACKGROUND: There is little information available about the circumstances surrounding the deaths of children aged 0 to 14 years in which the manner of death is of undetermined intent. METHODS: We analyzed data collected in the Illinois Violent Death Reporting System to describe victim demographics, location of injury, seasonality, day of week, and circumstances surrounding the victims' deaths. RESULTS: From 2005 to 2010 in Cook County, Illinois, 192 cases were identified of children aged 0 to 14 years, in which the manner of death was of undetermined intent. The majority of cases were younger than 1 year (81%), male (62%), and non-Hispanic black (66%); occurred in the City of Chicago (65%); and also occurred most frequently during the months of May (15%) and July (13%) and on Sunday (19%). Circumstances of note were having information on the location of death available for the victim (90%); scene investigation was not performed/unknown/not documented (81%); and the victim not presenting with red petechiae (84%). By ethnicity, a lower proportion of Hispanic victims had parental drug information available compared with non-Hispanic victims (17% and 40%, respectively; p = 0.017); Hispanic victims were more likely than non-Hispanic victims to have a documented acute illness at the time of injury leading to death (57% and 33%, respectively; p = 0.015). The availability of scene information and the successful contact of one or both parents of the victim following the victim's death varied by location. CONCLUSIONS: No public health surveillance system exists for the collection of this type of death. There is not enough information provided to develop an effective intervention. The systematic, thorough collection of information surrounding these deaths is necessary to pinpoint possible contributing mechanisms of death for these children. LEVEL OF EVIDENCE: Epidemiologic, level IV.

Enlarged subarachnoid spaces and intracranial hemorrhage in children with accidental head trauma.

OBJECTIVE Benign external hydrocephalus (BEH) is an enlargement of the subarachnoid spaces (SASs) that can be seen in young children. It is controversial whether children with BEH are predisposed to developing subdural hemorrhage (SDH) with or without trauma. This issue is clinically relevant as a finding of unexplained SDH raises concerns about child abuse and often prompts child protection and law enforcement investigations. METHODS This retrospective study included children (1-24 months of age) who underwent head CT scanning after an accidental fall of less than 6 feet. Head CT scans were reviewed, cranial findings were documented, and the SAS was measured and qualitatively evaluated. Enlarged SAS was defined as an extraaxial space (EAS) greater than 4 mm on CT scans. Clinical measurements of head circumference (HC) were noted, and the head circumference percentile was calculated. The relationship between enlarged SAS and HC percentile, and enlarged SAS and intracranial hemorrhage (ICH), were investigated using bivariate analysis. RESULTS Of the 110 children included in this sample, 23 had EASs greater than 4 mm. The mean patient age was 6.8 months (median 6.0 months). Thirty-four patients (30.9%) had ICHs, including subarachnoid/subpial (6.2%), subdural (6.2%), epidural (5.0%), and unspecified extraaxial hemorrhage (16.5%). Enlarged SAS was positively associated with subarachnoid/subpial hemorrhage; there was no association between enlarged SASs and either SDH or epidural hemorrhage. A larger SAS was positively associated with larger HC percentile; however, HC percentile was not independently associated with ICH. CONCLUSIONS Enlarged SAS was not associated with SDH, but was associated with other ICHs. The authors' findings do not support the theory that BEH predisposes children to SDH with minor accidental trauma.

Suicide in Illinois, 2005-2010: A reflection of patterns and risks by age groups and opportunities for targeted prevention.

BACKGROUND: Suicide accounts for two thirds of all deaths from intentional or violence-related injury and is a leading cause of death in the United States. Patterns of suicide have been well described among high-risk groups, but few studies have compared the circumstances related to suicides across all age groups. We sought to understand the epidemiology of suicide cases in Illinois and to characterize the risks and patterns for suicide among different age groups. METHODS: We used suicide data collected from the Illinois Violent Death Reporting System to assess demographics, method of suicide, circumstances, and mental health status among different age groups. RESULTS: Between 2005 and 2010, 3,016 suicides were reported; 692 (23%) were female, and the median age (n = 3,013) was 45 years (range, 10-98 years). The most common method/weapon types were hanging/strangulation (33%), firearm (32%) and poisoning (21%). Hanging was more common (74%) among young people aged 10 to 19 years, while firearm use was more common among elderly persons age 65 years and older (55%). The percentage of victims within an age group experiencing a crisis within two weeks before committing suicide was highest among 10- to 14-year-olds, while the risk factor of having a family member or friend die in the past 5 years was highest among older victims. CONCLUSION: The final analysis demonstrated age-related trends in suicide in Illinois, suggesting prevention programs should tailor services by age. LEVEL OF EVIDENCE: Epidemiologic study, level IV.

Factors associated with suicide among adolescents and young adults not in mental health treatment at time of death.

BACKGROUND: Suicide is the third-leading cause of death among Illinois residents aged 15 to 24 years. The Illinois Violent Death Reporting System (IVDRS) was developed to help prevent these deaths by providing timely, complete data. Understanding the circumstances surrounding suicide for those aged 15 to 24 years who are not receiving mental health treatment can help others: (1) recognize signs of potential crisis and (2) connect them to mental health treatment. METHODS: The IVDRS data were collected from five Illinois counties-Cook, DuPage, Kane, McHenry, and Peoria-from 2005 to 2010. All cases with the manner suicide, aged 15 to 24 years, were extracted for analysis. Data were described using frequencies and percentages, and statistical differences between groups were determined using χ analysis. RESULTS: There were a total of 386 suicides in those aged 15 to 24 years in IVDRS from 2005 to 2010. Most 15- to 19-year-olds (67%) and 20- to 24-year-olds (78%) were not receiving mental health treatment at the time of death. Among those not receiving mental health treatment, 22% and 13% of those aged 15 to 19 and 20 to 24 years, respectively, had disclosed their intent to commit suicide to another. One third were identified as being depressed or in a depressed mood (not necessarily a clinical diagnosis) in both age groups. One quarter in both age groups experienced a crisis (current, acute precipitating, or forthcoming event) within 2 weeks of their suicides. CONCLUSIONS: The majority of adolescents and young adults were not in mental health treatment at the time death. Among those not in mental health treatment at the time of death, the 15- to 19-year-olds were more likely to share their suicidal intentions than the 20- to 24-year-olds. LEVEL OF EVIDENCE: Epidemiological study, level IV.