Harms and Benefits Inventory (HBI): initial validation of a novel assessment of perceived harms and benefits of firearm policies and practices.

INTRODUCTION: Understanding gun owners' perceptions of potential firearm policies' harms and benefits is critical to successful policy development and implementation. We used national survey data to develop and validate a novel instrument, the Harms and Benefits Inventory (HBI), for policy-makers and advocates to better consider the citizen perspective. METHOD: We conducted a nationally representative survey of American gun owners and non-owners (N=2007) using the Social Science Research Solutions probability panel. The survey included 31 candidate HBI items and questions about gun ownership and exposure, storage and carry behaviours, policy positions, and sociodemographic characteristics. Exploratory factor analyses (EFAs) were conducted on HBI items from a randomly selected subsample (N=1003) and then tested with a confirmatory factor analysis (CFA) on data from the second half of the sample (N=1004). RESULTS: The best-fitting EFA model was upheld in the CFA and included 21 items with 5 underlying factors. Underlying factors included: (1) firearm regulation, cost and accessibility, (2) special restrictions, (3) permit and education, (4) relaxed restrictions and (5) and hobby and sport. Internal consistency was good to excellent within each of the five scales. Validity was supported by correlations between HBI scales and survey questions. DISCUSSION: Findings support the validity of the HBI in assessing perceptions of potential harms and benefits of firearm policies and practices. Understanding perceptions of potential harms and benefits of gun policies at the time of development or implementation can improve uptake and reduce unintended consequences of these policies.

Best for Whom? Heterogeneous Treatment Effects of Breastfeeding on Child Development.

The slogan "Breast is Best" has been popularized by medical organizations and parenting networks to extoll the benefits of breastfeeding, yet the causal effects are widely debated. Our study contributes to the debate by examining whether breastfeeding has differential effects based on the propensity to breastfeed, which is also known as causal effect heterogeneity. Prior studies attempt to isolate the causal effect of breastfeeding by netting out confounding characteristics, but we argue that the effects of breastmilk are unlikely to operate in a vacuum. The social forces that promote or constrain breastfeeding among different populations in American society can also shape its effects. Using rich intergenerational panel data from the NLSY79 Child and Young Adult cohort (n = 7902), we evaluate heterogeneous treatment effects in the relationship between breastfeeding and child development from ages 4 to 14 using stratification-multilevel propensity score models. We find that breastfeeding is associated with small benefits for behavioral development, math scores, and academic ability among those with the highest propensities to breastfeed. By contrast, its small benefits for reading comprehension and vocabulary are concentrated among children with the lowest propensities to breastfeed. Our findings suggest that the social process of selection into breastfeeding cannot be fully disentangled from its estimated effects. The social context not only shapes who breastfeeds in American society, but also who benefits most.

Conversation starters: Understanding the facilitators and barriers to physician-initiated secure firearm storage conversations.

OBJECTIVE: This paper aims to understand what general practice physicians (GPs) perceive as facilitators and barriers to initiating anticipatory guidance around firearm safety. METHODS: We employ qualitative interviewing to have in-depth conversations with 18 GPs. Participants were randomly selected from a national panel of physicians and screened for specialty (general practice or internist), practice setting (not hospital-based), and time spent on direct patient care (80% +). The sample was stratified at the state level by the presence of safe storage or child access protection laws, with half of the participants selected from each stratum. RESULTS: We identify five physician-perceived barriers to providing secure firearm storage counseling, including inadequate screening mechanisms to trigger conversations, physician perceptions of who is at risk for firearm injury, time pressures, concerns about patient receptivity, and a need for training. CONCLUSION: Prior to focusing on how to have conversations about firearm safety, interventions designed to increase the incidence of physician-initiated guidance need to address the structural issues of why those conversations typically do not occur. PRACTICE IMPLICATIONS: Findings indicate the need for revised screening tools and improved physician education as to who is at risk for gun injury and how to best approach firearm safety conversations.

Missouri Citizen Perceptions: Giving Second Amendment Preservation Legislation a Second Look.

In June 2021, Missouri passed the "Second Amendment Preservation Act" (SAPA). Though SAPA passed easily and had gubernatorial support, many Missouri law enforcement agencies, including the Missouri Sheriff's Association, oppose it. Missing from this policy conversation, and deserving of analysis, is the voice of Missouri citizens. Using qualitative interview data and survey data, we explored what if anything Missouri gun owners knew about SAPA and what they perceived its effects would be on gun-related murders, suicides, gun thefts, and mass shootings. Most Missouri gun owners had not heard about SAPA and were ambivalent about its potential effect on gun safety outcomes. Our findings also indicate that respondents' attitudes toward SAPA and the impact of such policy on safety is driven by gun ownership (i.e., primary versus living in a household with firearms), partisan identification, and attitudes toward government firearm regulation.

Home, but Left Alone: Time at Home and Child Abuse and Neglect During COVID-19.

We use high-frequency mobile phone movement data and quick-release administrative data from Georgia to examine how time at home during the COVID-19 pandemic is related to child maltreatment referrals. Findings show that referrals plummeted by 58% relative to previous years, driven by fewer referrals from education personnel. After this initial decline, however, each 15 minutes at home was associated with an increase in referrals of material neglect by 3.5% and supervisory neglect by 1%. Our results describe how children have fared during the initial wave of the pandemic, and the results have long-term implications for child development and well-being.

Paid Family Leave: An Upstream Intervention to Prevent Family Violence.

Purpose: Family violence imposes tremendous costs on victims and society. Rarely are policies focused on the primary prevention of family violence. Given the prevalence of family violence-including child maltreatment and intimate partner violence (IPV)-during the perinatal period, policies targeting this vulnerable time period may be successful in primary prevention. Paid family leave (PFL) programs provide income-replacement during particularly stressful family events, such as the birth of a child. Method: In this commentary, we describe the conceptual links between PFL, child maltreatment, and IPV, suggesting that PFL may be a promising strategy for the primary prevention of child maltreatment and IPV. Results: There is emerging evidence that policies targeting the early years of life may reduce child maltreatment and IPV. Conclusion: Addressing the concrete and economic challenges faced by caregivers is one promising strategy for the prevention of family violence.

The power of the future: Intergenerational income mobility and child maltreatment in the United States.

BACKGROUND: Recent research has shown that the likelihood of children experiencing intergenerational, upward income mobility depends on the community in which they are raised. Whether parents consider their children's economic chances in their parenting decisions, however, is not well understood. OBJECTIVE: To examine the relationship between county-level income mobility-distinct from income inequality and poverty-and child maltreatment. PARTICIPANTS AND SETTING: Administrative data from the National Child Abuse and Neglect Data System: Child File for 2406 counties were merged with measures of intergenerational income mobility from Chetty et al. (2014a), including the probability that a child born in the bottom quintile of the national income distribution reaches the top quintile by age thirty. METHODS: Weighted least squares analyses were used to empirically estimate the relationship between intergenerational income mobility and child maltreatment report rates. Maltreatment reports were also divided into subgroups by age and metropolitan status. RESULTS: Counties where children have a greater chance of moving up the income ladder have lower child maltreatment report rates, independent from income inequality and poverty rates. This relationship is consistent across all child ages (0-17). The relationship between upward income mobility and substantiated child maltreatment is also negatively correlated among non-metropolitan counties. CONCLUSIONS: Children experience a lower risk for maltreatment if they are more likely to move up the income ladder in adulthood. Macroeconomic factors and policies that reduce income inequality and enhance economic mobility are likely to prevent child maltreatment.

The neglected ones: Time at home during COVID-19 and child maltreatment.

The early months of the COVID-19 pandemic led to extreme social isolation, precarious employment and job loss, working from home while tending to children, and limited access to public services. The confluence of these factors likely affects child health and well-being. We combine early release child maltreatment reports in Indiana with unique and newly available mobile phone movement data to better understand the relationship between staying at home intensively during the COVID-19 pandemic and child maltreatment. Our findings indicate that the prolonged stays at home promoted by the early public health response to COVID-19 resulted in reductions in child maltreatment reports overall and substantiated reports of maltreatment. However, relative to areas that stayed home less, children in areas that stayed home more were more likely to be both reported for and a confirmed victim of maltreatment, particularly neglect. These areas have historically been socioeconomically advantaged and experienced lower rates of maltreatment. We only observe increases in confirmed child maltreatment in metropolitan counties, suggesting that the effects of staying home on child maltreatment may reflect both the differential risk of leaving home and access to services in metropolitan-rather than non-metropolitan-counties. Staying at home has been challenging for many families. Families likely need assistance as the pandemic persists, evolves, and when it ends.

Impact of ShotSpotter Technology on Firearm Homicides and Arrests Among Large Metropolitan Counties: a Longitudinal Analysis, 1999-2016.

Over the past decade, large urban counties have implemented ShotSpotter, a gun fire detection technology, across the USA. It uses acoustic listening devices to identify discharged firearms' locations. We examined the effect of ShotSpotter with a pooled, cross-sectional time-series analysis within the 68 large metropolitan counties in the USA from 1999 to 2016. We identified ShotSpotter implementation years through publicly available media. We used a Poisson distribution to model the impact of ShotSpotter on firearm homicides, murder arrests, and weapons arrests. ShotSpotter did not display protective effects for all outcomes. Counties in states with permit-to-purchase firearm laws saw a 15% reduction in firearm homicide incidence rates; counties in states with right-to-carry laws saw a 21% increase in firearm homicide incidence rates. Results suggest that implementing ShotSpotter technology has no significant impact on firearm-related homicides or arrest outcomes. Policy solutions may represent a more cost-effective measure to reduce urban firearm violence.

The best of intentions: Prenatal breastfeeding intentions and infant health.

Health organizations recommend that mothers exclusively breastfeed infants for the first six months of life. The current study contributes to a growing body of research that examines whether the purported benefits of breastfeeding are causal. We systematically evaluated the role of an expectant mother's prenatal breastfeeding intentions, which reflect not only demographic characteristics, but also knowledge, attitudes, and social norms about infant feeding, and therefore serve as a proxy for positive maternal selection into breastfeeding. We used the Infant Feeding Practices Study (IFPS) II (n = 1008) to examine a heretofore overlooked group of mothers-those who intended to breastfeed but did not actually breastfeed. Results suggest that mothers who intended to breastfeed had infants with fewer ear infections and respiratory syncytial viruses, and used fewer antibiotics in the first year of life compared to infants whose mothers did not intend to breastfeed, irrespective of whether they actually breastfed. Because breastfeeding intention is a confounding characteristic that proxies for positive maternal selection and does not represent a causal mechanism for infant health, we further examined how mothers who intended to breastfeed differed from mothers who did not intend to breastfeed. Results suggest that mothers who intended to breastfeed had more knowledge about potential food contaminants and consulted more sources of information about nutrition and diet than mothers who did not intend to breastfeed. Taken together, our results underscore the need for new policy interventions aimed at improving infant health.

Health Insurance and Human Capital: Evidence from the Affordable Care Act's Dependent Coverage Mandate.

Prior to 2010, young adults between the ages of 18 and 34 had the highest rates of uninsurance in America. The "Dependent Care Provision" of the Affordable Care Act sought to increase insurance rates among young adults by allowing them to stay on their parents' policy until age 26. We examine the human capital decisions young adults make once they have an option for health insurance outside of employer-sponsored health insurance. Using the American Community Survey from 2001 to 2016 and a difference-in-differences research design, we found that the implementation of the mandate was associated with a 3-5 percent increase in college enrollment among women 23-25 years of age. This result is robust to a variety of specifications. We did not find a consistent effect among men. Our results suggest that increased flexibility in health insurance markets has implications for human capital investment.

Does unemployment affect child abuse rates? Evidence from New York State.

This article used child maltreatment reports from New York State from 2000 to 2010 to investigate the relationship between county level unemployment and county level child maltreatment rates. Models showed that a 1 percentage point increase in unemployment rates reduced the child report rate by approximately 4.25%. Report rates for young children (children under the age of 6) and older children (children ages 6 and over) responded similarly to changes in local unemployment, but the relationship between unemployment rates and child maltreatment reports did vary by a county's metropolitan designation. The negative relationship between unemployment and child maltreatment reports was largely contained to metropolitan counties. The relationship between unemployment and child maltreatment reports in non-metropolitan counties was often positive but not statistically significant. These findings were robust to a number of specifications. In alternate models, the county's mandated reporter employment rate was added as a control; the inclusion of this variable did not alter the results.

Parental disability, parent care, and offspring mental health outcomes.

Decades of research supports a widely held view that providing parent care is stressful, and that these stresses are associated with adverse mental health outcomes. However, some recent studies suggest an additional possibility, namely that "noncaregiver stress"-a consequence of having a parent with major care needs, but not being an active caregiver-may be a serious problem as well. This finding emerges in data which permit separate controls for parental needs for care and offspring provision of parent care. We extend these results using Generations and Gender Programme data from five countries-Bulgaria, France, Georgia, Romania, and Russia-for which the necessary variables can be comparably measured. Our outcome variable is a depression score based on a 7-item scale. In country-specific regressions, we find two instances of statistically significant associations of depression with the regular provision of personal care to a parent with care needs, i.e., the usual "caregiver stress" result. However, we also find two instances of statistically significant differences in respondents' depressive symptoms that are associated with having a parent with care needs, i.e., instances of "noncaregiver stress." We find limited evidence of gender-specific responses to both forms of stress. Our evidence supports both the typical caregiver stress response and the less-studied noncaregiver stress response, which suggests the need for additional research.

Child maltreatment reporting patterns and predictors of substantiation: comparing adolescents and younger children.

Adolescents, and especially male adolescents, make up a disproportionately smaller portion of maltreatment reports compared to younger children. This study used the National Child Abuse and Neglect Data System to better understand the characteristics of adolescents reported to Child Protective Services (CPS), to examine whether these characteristics changed over time, and to determine whether certain child or CPS report characteristics predicted CPS involvement. Although adolescents were the focal group, younger children were also analyzed for comparison. Between 2005 and 2010, reports of neglect and the proportion of children of Hispanic and unknown racial/ethnic origins increased. Concurrently, the proportion of cases resulting in CPS involvement declined. Although race/ethnicity predicted CPS involvement, this pattern was not consistent across all age groups or races/ethnicities. The type of alleged maltreatment did not typically predict CPS involvement; however, allegations of sexual abuse among school-aged children and adolescents, particularly among girls, were more likely to result in CPS involvement. These findings can assist child welfare professionals in determining appropriate services tailored to families and developing prevention programs targeting adolescents.