Occupational stress among farm and ranch operators in the midwestern United States.

BACKGROUND: This study used surveillance data from 2018 and 2020 to test the stability of work-related strain symptoms (high stress, sleep deprivation, exhaustion) with demographic factors, work characteristics, and musculoskeletal symptoms among farm and ranch operators in seven midwestern states of the United States. METHODS: Cross-sectional surveys were conducted among farm and ranch operators in 2018 (n = 4423) and 2020 (n = 3492). Operators were asked whether, in the past 12 months, they experienced extended work periods that resulted in high stress levels, sleep deprivation, exhaustion/fatigue, or other work-related strain symptoms. Covariates included personal and demographic factors, work characteristics, number of injuries, work-related health conditions, and exposures on the operation. Summary statistics were tabulated for explanatory and outcome variables. The classification (decision) tree approach was used to assess what variables would best separate operators with and without reported strain symptoms, based on a set of explanatory variables. Regularized regression was used to generate effect estimates between the work strain variables and explanatory variables. RESULTS: High stress level, sleep deprivation, and exhaustion were reported more frequently in 2018 than 2020. The classification tree reproduced the 2018 model using 2020 data with approximately 80% accuracy. The mean number of reported MSD symptoms increased slightly from 1.23 in 2018 to 1.41 in 2020. Older age, more time spent in farm work, higher gross farm income (GFI), and MSD symptoms in six body regions (ankles/feet, knees, lower back, neck, shoulders, wrists/hands) were associated with all three work strain symptoms. CONCLUSIONS: Musculoskeletal pain and discomfort was a strong predictor for stress, sleep deprivation, and exhaustion among farmers and ranchers. This finding indicates that reducing MSD pain and discomfort is beneficial for both physical and mental health.

Gun Violence Exposure and Posttraumatic Symptoms Among Children and Youth.

Although statistics on youth homicide and injury from gun violence are available, little research has focused on how gun violence overlaps with other victimizations or on the psychological impact of gun violence on children. Pilot survey data were collected on the experiences of 630 U.S. children (age range: 2-17 years) from Boston, Philadelphia, and rural areas of eastern Tennessee. Youth aged 10-17 years completed a self-report survey on a wide range of gun violence exposures, and parents of younger children (aged 2-9 years) completed the survey as a proxy for that child. Direct gun violence exposure, witnessing gun violence, and hearing gunshots were all significantly associated with other forms of victimization, rs = .10-.38, p < .001. The findings suggest that youth who experience direct gun violence are often exposed to multiple violent contexts. For older youth (ages 10-17 years) polyvictimization was most strongly associated with posttraumatic symptoms, ß = .35, p < .001, although witnessing gun violence still uniquely predicted a higher level of symptoms, ß = .18, p < .01. For younger children (ages 2-9 years), hearing and witnessing gun violence were both related to posttraumatic symptoms, ß = .15, p < .01 for both, even after controlling for polyvictimization. Mental health professionals and trauma-informed services should be mindful that the traumatic impact of gun violence for children may not necessarily be attached to direct victimization experiences but may also result from simply seeing or hearing it in their neighborhoods.

Comparisons of Cocaine-Only, Opioid-Only, and Users of Both Substances in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

BACKGROUND: Cocaine and opioid co-use is a notable public health concern, but little is known about correlates of this behavior. Most prior findings come from treatment samples and concern cocaine and heroin. Findings from a nationally representative sample involving primarily prescription opioid misuse would expand knowledge. METHODS: Past-12-month cocaine and/or opioid users in Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) formed the sample (N = 839). Cocaine-only, opioid-only, and cocaine/opioid co-users were compared regarding sociodemographics, other substance involvement, psychiatric, and medical conditions/events. RESULTS: Opioid-only users were the largest group (n = 622), followed by cocaine-only (n = 144) and co-users (n = 73). The vast majority of opioid misuse was of prescription opioids (1.4% with past-12-month use of heroin). Notably, co-users did not differ from single drug users in frequency of use of either drug. Co-users did not have significantly greater incidence of any psychiatric conditions, medial conditions, or events. In preliminary analyses, co-users were more likely than either single use group to report several classes of other drug use. However, for most comparisons, opioid use did not add substantial risk beyond cocaine use. Differences on multiple sociodemographic variables suggested opioid-only users were at lowest risk of negative outcomes. These results may relate to a finding that opioid-only users were less likely to have sought treatment. CONCLUSIONS/IMPORTANCE: This sample of past-12-month cocaine and/or opioid users had greater involvement with other substances, more psychiatric and medical conditions compared to the general population. Co-users had greater involvement with other substances than opioid-only users in particular.

Characterization of air manganese exposure estimates for residents in two Ohio towns.

This study was conducted to derive receptor-specific outdoor exposure concentrations of total suspended particulate (TSP) and respirable (dae ≤ 10 µm) air manganese (air-Mn) for East Liverpool and Marietta (Ohio) in the absence of facility emissions data, but where long-term air measurements were available. Our "site-surface area emissions method" used U.S. Environmental Protection Agency's (EPA) AERMOD (AMS/EPA Regulatory Model) dispersion model and air measurement data to estimate concentrations for residential receptor sites in the two communities. Modeled concentrations were used to create ratios between receptor points and calibrated using measured data from local air monitoring stations. Estimated outdoor air-Mn concentrations were derived for individual study subjects in both towns. The mean estimated long-term air-Mn exposure levels for total suspended particulate were 0.35 µg/m³ (geometric mean [GM]) and 0.88 µg/m³ (arithmetic mean [AM]) in East Liverpool (range: 0.014-6.32 µg/m³) and 0.17 µg/m³ (GM) and 0.21 µg/m³ (AM) in Marietta (range: 0.03-1.61 µg/m³). Modeled results compared well with averaged ambient air measurements from local air monitoring stations. Exposure to respirable Mn particulate matter (PM10; PM <10 µm) was higher in Marietta residents.

Unbalanced estrogen metabolism in ovarian cancer.

Greater exposure to estrogens is a risk factor for ovarian cancer. To investigate the role of estrogens in ovarian cancer, a spot urine sample and a saliva sample were obtained from 33 women with ovarian cancer and 34 age-matched controls. Thirty-eight estrogen metabolites, conjugates and DNA adducts were analyzed in the urine samples using ultraperformance liquid chromatography/tandem mass spectrometry, and the ratio of adducts to metabolites and conjugates was calculated for each sample. The ratio of depurinating estrogen-DNA adducts to estrogen metabolites and conjugates was significantly higher in cases compared to controls (p < 0.0001), demonstrating high specificity and sensitivity. DNA was purified from the saliva samples and analyzed for genetic polymorphisms in the genes for two estrogen-metabolizing enzymes. Women with two low-activity alleles of catechol-O-methyltransferase plus one or two high-activity alleles of cytochrome P450 1B1 had higher levels of estrogen-DNA adducts and were more likely to have ovarian cancer. These findings indicate that estrogen metabolism is unbalanced in ovarian cancer and suggest that formation of estrogen-DNA adducts plays a critical role in the initiation of ovarian cancer.

A brief, critical review of research on impaired control over alcohol use and suggestions for future studies.

Impaired control, defined as "a breakdown of an intention to limit consumption" (Heather et al. J Stud Alcohol 1993; 54, 701), has historically been considered an important aspect of addiction. Despite recognition of its importance to addiction and potential value as an early indicator of problem drinking risk, we argue that impaired control over alcohol use has not received sufficient research attention. In an effort to spark further research, the present critical review offers brief discussion of the current state of knowledge regarding impaired control and avenues for future research. Three main research areas are addressed: (i) epidemiology; (ii) measurement issues; and (iii) potential mechanisms underlying relationships between impaired control and subsequent problem drinking. Measurement issues include complexities involved in self-report assessment of impaired control, development and validation of human and animal laboratory models, and impaired control's relationship to other constructs (i.e., impulsivity and other difficulties with self-control; symptoms of dependence such as craving). We discuss briefly 2 potential mechanisms that may help to explain why some drinkers experience impaired control while others do not: neurobiological dysfunction and family history/genetics. Suggestions for future research are focused on ways in which the impaired control construct may enhance prediction of who might be at particular risk of subsequent problem drinking and to facilitate intervention to reduce problem alcohol use.

Unbalanced estrogen metabolism in thyroid cancer.

Well-differentiated thyroid cancer most frequently occurs in premenopausal women. Greater exposure to estrogens may be a risk factor for thyroid cancer. To investigate the role of estrogens in thyroid cancer, a spot urine sample was obtained from 40 women with thyroid cancer and 40 age-matched controls. Thirty-eight estrogen metabolites, conjugates and DNA adducts were analyzed by using ultraperformance liquid chromatography/tandem mass spectrometry and the ratio of adducts to metabolites and conjugates was calculated for each sample. The ratio of depurinating estrogen-DNA adducts to estrogen metabolites and conjugates significantly differed between cases and controls (p < 0.0001), demonstrating high specificity and sensitivity. These findings indicate that estrogen metabolism is unbalanced in thyroid cancer and suggest that formation of estrogen-DNA adducts might play a role in the initiation of thyroid cancer.

Is school community readiness related to physical activity before and after the Ready for Recess intervention?

The purpose of this study was to determine: (i) the effect of schools' baseline community readiness (CR) on youth physical activity (PA) at recess prior to the Ready for Recess intervention; (ii) if changes in PA due to the intervention were explained by baseline CR and (iii) if specific components of the intervention altered an association between baseline CR and changes in youth PA. Methods that were employed included: six informants from each of 17 schools participated in CR interviews at baseline (N = 101). CR scores were calculated based on the CR model's nine stages. Direct observation was used to measure PA. Poisson models evaluated the association between baseline CR and PA. Results were that seven schools were in denial, eight in vague awareness and two in pre-planning stages. CR marginally predicted pre-intervention PA. When compared with youth at schools in denial, youth at schools in vague awareness and pre-planning demonstrated significant increases in moderate/vigorous PA. Ready for Recess strengthened this association. This is the first study to demonstrate that school CR may explain changes in PA at recess after a school-based PA intervention. Low CR levels may contraindicate interventions. Efforts to increase school CR a priori may be critical to increasing PA among youth.

Changes in community readiness among key school stakeholders after Ready for Recess.

School community readiness (CR) for health promotion efforts may be critical to the effectiveness of school-based interventions aimed at promoting youth physical activity and reducing childhood obesity. The purpose of this study was to: (i) identify key informants who scored highest on school CR at baseline and (ii) determine the effects of Ready for Recess on changes in CR among school key informants from baseline to post-intervention. Key informants (N = 98) across 17 schools participated in CR interviews. Interview questions focused on school CR for physical activity and childhood obesity efforts across six dimensions. At baseline, principals scored higher than teachers in overall readiness and knowledge of the issue and higher than recess staff and nurses in leadership. Leadership readiness decreased across key informants at post-intervention and principals demonstrated greater decreases when compared with recess staff. Baseline disparities between principals and other key informants suggest principals may have overestimated the readiness of staff implementing the intervention. Declines among principals indicate that they may not have been prepared to deliver adequate support to successfully implement the intervention. These results illuminate the importance of assessing/improving school readiness prior to interventions. The CR model may provide an opportunity to improve school-based physical activity interventions.

Injury, Musculoskeletal Symptoms, and Stress as a Function of Aging in Agricultural Operators in the Central United States.

BACKGROUND: Studies show conflicting evidence on the association of age and occupational injury in agriculture, and few studies have addressed the effect of age on work-related chronic conditions or preventive practices among farmers. METHODS: We examined the probability of injury, work-related stress, musculoskeletal symptoms (MSS), and preventive practices for MSS as a function of aging using surveillance data of 7,711 farm and ranch operators in the central United States. FINDINGS: Segmented regression analyses of men (85% of sample) indicated that the probability of all four outcomes increased up to a certain age and then decreased; the changepoints in years of age being 59.6 for injury, 55.4 for work-related stress, 59.6 for MSS, and 67.9 for MSS preventive practices. Female operators had an increasing trend for stress up to age 29.7, while they showed no changepoints across their age spectrum in the proportion of injury, MSS, and prevention techniques. CONCLUSION/APPLICATION TO PRACTICE: These findings emphasize the need for preventive efforts particularly among younger and middle-aged farmers and ranchers, and the need to modify work duties to match work abilities at older ages.

Agricultural Injuries: Risk Factors and Severity by Affected Body Part among US (Midwest) Farmers.

OBJECTIVES: Statistics from the United States Bureau of Labor Statistics indicate that agriculture consistently ranks as the most hazardous industry in the US. To identify specific targets for prevention, we investigated injury risk factor profiles separately for each injured body site. We also characterized the severity of agricultural injuries by injured body site using the type of medical care and lost work time due to injury. METHODS: We used the Central States Center for Agricultural Safety and Health (CS-CASH) surveillance data for 2018 to perform descriptive statistics and regression modeling. RESULTS: We found that 12% (513/4351) of the participants experienced one or more injuries in the previous 12 months. Compared to female operators, male operators had 3.53 (95% CI: 1.17-10.68) times higher odds of back injury. Operators in livestock production had 2.77 times (95% CI:1.12-6.82), 2.28 times (95% CI:1.25-4.14), and 1.69 times (95% CI:1.10-2.59) higher odds of injury to the chest/trunk, finger, and leg/knee/hip, respectively, compared to operators in crop or mixed production. After adjusting for age and gender, operators who worked full time (vs. part-time) on the farm/ranch had 2.11 times (95% CI:1.03-4.34) higher odds of back injury. Arm/shoulder and leg/knee/hip injuries were more frequent in older age groups. CONCLUSIONS: Prevention measures should be tailored considering specifically livestock producers with emphasis on trainings on proper livestock handling, such as being gentle, establishing routine, keeping distance, and avoiding sudden and loud noise when handling animals. Applying these techniques avoid startling the animals and reduce the risk of injuries.

County-level analysis on occupation and ecological determinants of child abuse and neglect rates employing elastic net regression.

BACKGROUND: Occupation is a known determinant of worker physical and behavioral health risk, yet most previous studies have focused on unemployment, underemployment, and job satisfaction to understand child maltreatment risk. OBJECTIVE: This county-level study (n = 278) investigated the association between occupation and child maltreatment rates and community well-being in California, Colorado, Minnesota, Oregon, and New Mexico. PARTICIPANTS AND SETTING: States were selected due to having comparable, publicly available county-level data on substantiated child abuse and neglect rates within a five-year span between 2015 and 2020. METHODS: Using US Census Bureau American Community Survey data, we collected percentages of the employed population among 13 occupations. Five additional community health indicators came from the County Health Rankings and Roadmaps. Elastic net linear regression was used for variable selection and because of explanatory variables' interrelationships. Linear regression was used to model individual industries positively associated with child abuse rates. RESULTS: The elastic net model selected ten important variables in explaining child maltreatment rates. Important occupational sectors were agriculture, forestry, fishing (AFF), manufacturing, wholesale, retail, finance, and education. Important community indicators included housing, injury deaths, and poor mental health days. Only AFF and retail showed greater child abuse rates with increasing percentages of the workforce in these occupations in unadjusted models (AFF: ß = 0.03 SE = 0.01, p = 0.02; Retail: ß = 0.09 SE = 0.04, p = 0.02). CONCLUSIONS: Our findings suggest group-level effects of counties with a larger AFF and retail presence experiencing higher child maltreatment rates. Given that numerous prior studies of county economies note the strong associations of certain employment types with cultural attitudes, educational opportunities, regional biases, and other unmeasured variables, future studies should incorporate individual level data in a multilevel framework.

Estrogen-DNA Adducts and Breast Cancer Risk in Premenopausal Asian Women.

The incidence of breast cancer among premenopausal women has been increasing rapidly in recent decades in East Asia. This case-control study investigated whether estrogen-DNA adducts were associated with breast cancer risk in Taiwan. The control group (n = 146) comprised healthy female volunteers and women with non-proliferative breast disease. The case group (n = 221) comprised women either with proliferative benign breast disease or breast cancer. The ratios of estrogen-DNA adducts to their respective metabolites and conjugates in plasma were analyzed using ultraperformance LC/MS-MS. The SNPs of CYP1A1, CYP1B1, and COMT were genotyped. Logistic regression model was used to compare the estrogen-DNA adduct ratios between the two groups. The estrogen-DNA adduct ratio in the case group was significantly higher than that in the control group (median ratio: 58.52 vs. 29.36, P = 0.004). A multiple logistic regression model demonstrated that a unit increase in the natural log of the estrogen-DNA adduct ratio in premenopausal women was a significant predictor of breast cancer risk, with an estimated hazard ratio of 1.718 (1.444-2.046, P < 0.001). However, the CYP1A1, CYP1B1, and COMT SNPs were not associated with the estrogen-DNA adduct ratios. In conclusion, plasma estrogen-DNA adduct ratio was associated with the presence of breast cancer or proliferating benign breast disease in premenopausal women in Taiwan. PREVENTION RELEVANCE: This study provides evidence that endogenous estrogen-induced genotoxicity may contribute to the carcinogenesis of breast cancer in premenopausal Asian women. This work could have important preventive implication for the emerging disease in East Asia.

A latent class analysis of DSM-IV alcohol use disorder criteria and binge drinking in undergraduates.

BACKGROUND: Adolescent and adult samples have shown that the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) abuse and dependence criteria lie on a continuum of alcohol problem severity, but information on criteria functioning in college students is lacking. Prior factor analyses in a college sample (Beseler et al., 2010) indicated that a 2-factor solution fit the data better than a single-factor solution after a binge drinking criterion was included. The second dimension may indicate a clustering of criteria related to excessive alcohol use in this college sample. METHODS: The present study was an analysis of data from an anonymous, online survey of undergraduates (N = 361) that included items pertaining to the DSM-IV alcohol use disorder (AUD) diagnostic criteria and binge drinking. Latent class analysis (LCA) was used to determine whether the criteria best fit a categorical model, with and without a binge drinking criterion. RESULTS: In an LCA including the AUD criteria only, a 3-class solution was the best fit. Binge drinking worsened the fit of the models. The largest class (class 1, n = 217) primarily endorsed tolerance (18.4%); none were alcohol dependent. The middle class (class 2, n = 114) endorsed primarily tolerance (81.6%) and drinking more than intended (74.6%); 34.2% met criteria for dependence. The smallest class (class 3, n = 30) endorsed all criteria with high probabilities (30 to 100%); all met criteria for dependence. Alcohol consumption patterns did not differ significantly between classes 2 and 3. Class 3 was characterized by higher levels on several variables thought to predict risk of alcohol-related problems (e.g., enhancement motives for drinking, impulsivity, and aggression). CONCLUSIONS: Two classes of heavy-drinking college students were identified, one of which appeared to be at higher risk than the other. The highest risk group may be less likely to "mature out" of high-risk drinking after college.

The NIOSH Agricultural Centers' YouTube Channel: Time Series Modeling of Viewership of Agricultural Health and Safety Videos.

We sought to understand the mechanism underlying the growth trajectory in the United States Agricultural Safety and Health Centers YouTube channel. We also explored the benefits and limitations of using YouTube analytics to evaluate the impacts of public health interventions involving YouTube. Time series analysis of total views, total watch hours, average duration of watch time, and number of subscribers were assessed to determine the monthly patterns of non-seasonal and seasonal components in the data from 2013 to 2020. Health, safety, and animal handling video views were summarized descriptively across time and season. Lastly, time series regressions were used to determine the type of video that best predicted growth in the channel viewership metrics. The time series were not random but could be explained by autoregressive and moving average correlation structures. Health videos were the strongest predictors of future growth but were not the most watched type of video. Strong seasonality components indicated that videos were most watched during periods of high agricultural activity, but less so during the winter months. Generally, growth in YouTube viewership metrics was explained by past month viewership predicting future viewership. Outreach and media content may produce spikes of increased interest, but in order to sustainably grow the channel over time, Ag Centers and other agricultural stakeholders should continue to focus on the value of particular content to potential viewers, how and when content is released, and strategic promotion of the channel and its videos.

The enduring influence of drinking motives on alcohol consumption after fateful trauma.

OBJECTIVE: Drinking motives predict later levels of alcohol consumption and development of alcohol dependence, but their effects on stress-related drinking are less clear. Proximity to the terrorist attack on the World Trade Center (WTC) on 9/11/01 was significantly associated with alcohol consumption 1 and 16 weeks after 9/11/01. We investigated the relationship between drinking motives measured a decade earlier, proximity to the WTC, and drinking after 9/11/01. This event constitutes a natural experiment for studying the effects of previously measured drinking motives on alcohol consumption after fateful trauma. METHODS: Adult drinkers (N = 644) residing in a New Jersey county were evaluated for four drinking motives: coping with negative affect, for enjoyment, for social facilitation and social pressure. After 9/11/01, their exposure to the WTC attack and subsequent drinking were assessed. Poisson regression was used to assess the relationships between proximity to the WTC, drinking motives and post-9/11/01 drinking; models were adjusted for alcohol dependence, age, gender and race. RESULTS: Drinking to cope with negative affect predicted alcohol consumption 1 week after 9/11/01 (p = 0.04) and drinking for enjoyment predicted drinking 1 and 16 weeks after 9/11/01 (p = 0.001 and 0.01, respectively). The associations were independent of proximity to the WTC. No interactions were observed between drinking motives, proximity to the WTC or lifetime alcohol dependence. CONCLUSION: Drinking motives a decade earlier predicted higher alcohol consumption after fateful trauma independently from proximity to the WTC on 9/11/01. Results suggest that drinking motives constitute a robust, enduring influence on drinking behavior, including after traumatic experiences.

Imbalanced estrogen metabolism in the brain: possible relevance to the etiology of Parkinson's disease.

Damage to DNA by dopamine quinone and/or catechol estrogen quinones may play a significant role in the initiation of Parkinson's disease (PD). Depurinating estrogen-DNA adducts are shed from cells and excreted in urine. The aim of this study was to discover whether higher levels of estrogen-DNA adducts are associated with PD. Forty estrogen metabolites, conjugates, and DNA adducts were analyzed in urine samples from 20 PD cases and 40 matched controls by using ultra performance liquid chromatography/tandem mass spectrometry. The levels of adducts in cases versus controls (P < 0.005) suggest that unbalanced estrogen metabolism could play a causal role in the initiation of PD.

Assessing Nonresponse Bias in Farm Injury Surveillance Data.

HIGHLIGHTS: Despite a response rate of about 18%, there was scant evidence of nonresponse bias. Farm and ranch characteristics of operations responding to a mailed survey were similar to those not responding. Responders were significantly more likely to be married but only slightly older and more educated than nonresponders. Earlier survey responders reported more injuries and greater severity when injured compared to later responders. ABSTRACT: Nonresponse bias in a survey can result in misleading estimates of agricultural injuries and can misdirect prevention efforts aimed at reducing the burden of injuries on farmers. Responders (n = 2,977) and nonresponders (n = 13,849) were compared based on demographics and agricultural production characteristics to identify underrepresented subgroups. Injury characteristics were compared between early (n = 1,667) and late (n = 1,309) responders. Methods accounted for correlated data, sample size inflation of p-values, and assessment of meaningful differences. Few differences were identified between responders and nonresponders. Responders differed from nonresponders by state of residence, and responders were more likely to be married. Other characteristics (age, gender, education, farm size, crops grown, animals raised) were similar across groups. Early responders reported more injuries and more often sought medical care for an injury than late responders. The differences identified between responders and nonresponders were minimal and not likely to create bias. Differential reporting of injury and injury severity between early and late responders is worthy of further investigation.

Assessing Connections in an Agricultural Community Using Social Network Analysis.

Agricultural workers experience higher rates of injury and illness than other occupational groups. NIOSH-supported agricultural centers in the U.S. are funded to reduce injury and illness but require effective partnerships with other agricultural organizations to achieve this goal. Our purpose was to understand the structure of agricultural organization connections within six states in the western U.S., including how different types of organizations connect to one another, and specifically where the High Plains Intermountain Center for Agricultural Health and Safety (HICAHS) is positioned in the agricultural organization network. An electronic survey was distributed to contacts within organizations that had a previous history with HICAHS leadership and advisory board members. The survey asked respondents about their position in the organization, years with the organization and frequency of contact in the past year. A social network analysis was undertaken to assess the connections between agricultural organizations using measures of centrality (density, closeness, betweenness), cliques, clusters, and brokers. A two-tier structure was identified with a core group of 21 organizations and a peripheral group of 30 organizations. Influence was centered in the core group as evidenced by high centrality scores with minimal bridging between organizations. HICAHS was on the periphery, but on the cusp of being in the core. Agricultural producers, agricultural extension and insurance companies were central in the network. Centers are in a unique position to promote collaboration with stakeholders. The social network analysis identified missing connections that need further development in order to address agricultural safety and health.

Understanding the Impact of Seeing Gun Violence and Hearing Gunshots in Public Places: Findings From the Youth Firearm Risk and Safety Study.

There is a current public health emphasis on finding strategies for reducing the risks associated with children's gun violence exposure. This article examines the impact of seeing and hearing gun violence on youth of different ages and living in urban and nonurban areas. Participants were 630 youth, aged 2 to 17. Youth, ages 10 to 17, completed a self-report survey, and caregivers of young children, ages 2 to 9, completed the survey as a proxy for that child. Participants resided in Boston, MA; Philadelphia, PA; and rural areas of eastern TN. Participants were recruited through a variety of techniques including pediatric clinics, housing authorities, youth-serving agencies, festivals, word of mouth, and local e-mail lists for classified advertisements. Data were collected between October 2017 and April 2018 and analyzed in 2019. In total, 41% of youth in this study reported ever seeing or hearing gun violence; 32% had such an experience in the past year. Among exposed youth, 50% took protective action to keep themselves safe, and 58% reported being very or extremely afraid, sad, or upset as a result of the indirect gun violence. More youth living in urban compared with nonurban areas took some protective action. Females and younger children had increased odds of experiencing high fear as a result of the violence. Current gun violence prevention has typically targeted adolescents; however, current findings suggest the need to focus on younger children as well, including the distress resulting from indirect exposure to gun violence.