Prevention of Firearm Violence Through Specific Types of Community-based Programming: An Eastern Association for the Surgery of Trauma Evidence-based Review.

OBJECTIVE: The purpose of this review was to provide an evidence-based recommendation for community-based programs to mitigate gun violence, from the Eastern Association for the Surgery of Trauma (EAST). SUMMARY BACKGROUND DATA: Firearm Injury leads to >40,000 annual deaths and >115,000 injuries annually in the United States. Communities have adopted culturally relevant strategies to mitigate gun related injury and death. Two such strategies are gun buyback programs and community-based violence prevention programs. METHODS: The Injury Control and Violence Prevention Committee of EAST developed Population, Intervention, Comparator, Outcomes (PICO) questions and performed a comprehensive literature and gray web literature search. Using GRADE methodology, they reviewed and graded the literature and provided consensus recommendations informed by the literature. RESULTS: A total of 19 studies were included for analysis of gun buyback programs. Twenty-six studies were reviewed for analysis for community-based violence prevention programs. Gray literature was added to the discussion of PICO questions from selected websites. A conditional recommendation is made for the implementation of community-based gun buyback programs and a conditional recommendation for community-based violence prevention programs, with special emphasis on cultural appropriateness and community input. CONCLUSIONS: Gun violence may be mitigated by community-based efforts, such as gun buybacks or violence prevention programs. These programs come with caveats, notably community cultural relevance and proper support and funding from local leadership.Level of Evidence: Review, Decision, level III.

Firearms training: what is actually taught?

INTRODUCTION: Firearm safety instructors and public health professionals are natural allies in the quest to prevent firearm injuries. We audited basic firearm classes to provide information that can help familiarise public health professionals and others with the content covered. METHODS: With the advice of expert instructors, we created an audit form. Volunteers audited 20 basic firearm classes in seven north-eastern states. RESULTS: All trainers covered a wide variety of safety issues. Some specific basics were covered in 90+% of the classes, including how to safely load/unload a gun, keeping your finger off the trigger until ready to shoot, and being aware of your target and what is behind it. In 50%-75% of the classes, the trainer covered topics such as operating a safety, clearing jams and cartridge malfunctions, and recommended storing guns unloaded and locked when not in use. Few instructors covered firearm suicide prevention (10%) or domestic violence (10%). Most encouraged gun ownership, gun carrying, gun use in self-defence and membership in a gun rights group. DISCUSSION: From a public health standpoint, we would like to see more instructors covering topics such as firearm suicide and alternatives to gun use in self-defence, and to recommend safer storage of firearms.

An International Interprofessional Study of Mental Models and Factors Delaying Neuroimaging of Critically Head-Injured Children Presenting to Emergency Departments.

OBJECTIVES: Thousands of head-injured children are cared for by interprofessional teams in emergency departments every day. Teams must balance performing time-consuming interventions with safe transport for neuroimaging. This study aims to describe and compare providers' perspectives on the transfer of head-injured children to neuroimaging and factors contributing to delays. METHODS: Participants were interprofessional health care providers involved in the care of head-injured children at sites in the United Kingdom, the United States, and New Zealand. They first viewed a 3-minute video of a child with a severe head injury presenting to their resuscitation bay. Next, they were presented with 5 physiologically different simulated scenarios and asked to report whether interventions were required before transporting each patient to neuroimaging. Then, they reported team and system factors contributing to delays in neuroimaging. RESULTS: Two hundred forty of 296 providers completed the intervention. The percentage of providers reporting that they would directly transport to neuroimaging without intervention was 89% for "stable," 49% for "Cushing's triad," 26% for "hypoxic," 25% for "tachycardic," and 5% for "extremis." There were differences noted in responses by profession for the hypoxia and tachycardia cases. No differences were noted between trainees and attending physicians for any cases. The most frequent factors reported as delaying neuroimaging were team decision making and waiting for equipment, medications, and scanner availability. CONCLUSIONS: There is variability in providers' perspectives on the interventions required before transporting severely head-injured patients for imaging. Diverse team and system factors contribute to delays in imaging.

A Qualitative Study of Multidisciplinary Providers' Experiences With the Transfer Process for Injured Children and Ideas for Improvement.

OBJECTIVE: Most injured children initially present to a community hospital, and many will require transfer to a regional pediatric trauma center. The purpose of this study was 1) to explore multidisciplinary providers' experiences with the process of transferring injured children and 2) to describe proposed ideas for process improvement. METHODS: This qualitative study involved 26 semistructured interviews. Subjects were recruited from 6 community hospital emergency departments and the trauma and transport teams of a level I pediatric trauma center in New Haven, Conn. Participants (n = 34) included interprofessional providers from sending facilities, transport teams, and receiving facilities. Using the constant comparative method, a multidisciplinary team coded transcripts and collectively refined codes to generate recurrent themes across interviews until theoretical saturation was achieved. RESULTS: Participants reported that the transfer process for injured children is complex, stressful, and necessitates collaboration. The transfer process was perceived to involve numerous interrelated components, including professions, disciplines, and institutions. The 5 themes identified as areas to improve this transfer process included 1) Creation of a unified standard operating procedure that crosses institutions/teams, 2) Enhancing 'shared sense making' of all providers, 3) Improving provider confidence, expertise, and skills in caring for pediatric trauma transfer cases, 4) Addressing organization and environmental factors that may impede/delay transfer, and 5) Fostering institutional and personal relationships. CONCLUSIONS: Efforts to improve the transfer process for injured children should be guided by the experiences of and input from multidisciplinary frontline emergency providers.

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

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.

Preparing for Disaster: a Cross-Sectional Study of Social Connection and Gun Violence.

Living in communities with persistent gun violence is associated with negative social, behavioral, and health outcomes, analogous to those of a natural disaster. Taking a disaster-preparedness approach may identify targets for community-based action to respond to on-going gun violence. We assessed the relevance of adapting a disaster-preparedness approach to gun violence and, specifically, the relationship between perceived collective efficacy, its subscales of social cohesion and informal social control, and exposure to gun violence. In 2014, we conducted a cross-sectional study using a community-based participatory research approach in two neighborhoods in New Haven, CT, with high violent crime rates. Participants were ≥18 years of age and English speaking. We measured exposure to gun violence by adapting the Project on Human Development in Chicago Neighborhoods Exposure to Violence Scale. We examined the association between perceived collective efficacy, measured by the Sampson Collective Efficacy Scale, and exposure to gun violence using multivariate modeling. We obtained 153 surveys (51% response rate, 14% refusal rate, and 35% non-response rate). Ninety-five percent reported hearing gunfire, 58% had friend or family member killed by gun violence, and 33% were physically present during a shooting. In the fully adjusted model, one standard deviation higher perceived collective efficacy was associated with lower reported exposure to gun violence (ß = -0.91, p < 0.001). We demonstrated that it is possible to activate community members and local officials to engage in gun violence research. A novel, community-based approach adapted from disaster-preparedness literature may be an effective framework for mitigating exposure to gun violence in communities with persistent gun violence.

Approach to a Standardized Injury Prevention Coordinator Training Curriculum.

The effectiveness of trauma center-based injury prevention programs is constrained by a number of variables. These include the wide range of injury types, the variety of possible interventions, institutional support and funding, and the knowledge and experience of the persons responsible for these programs. As the field of injury prevention has increased in complexity, so must the role and professional development of these injury prevention professionals responsible for these programs. Trauma center-based injury prevention coordinators are a diverse group with variable education and professional background especially related to public health, advocacy, epidemiology, biostatistics, and research. Furthermore, inconsistencies exist with their job titles, responsibilities, accountability, and authority, as well as the associated professional resources available to them. The American Trauma Society, with facilitation by the member organizations of the Trauma Prevention Coalition, has addressed the need to standardize the educational foundation for injury prevention coordinators by providing the basis of core competencies that are necessary to successfully oversee an American College of Surgeon's Committee on Trauma-verified trauma center's injury prevention program. This inaugural Injury Prevention Coordinators Course was launched in conjunction with the Society of Trauma Nurses 2015 annual conference in Jacksonville, FL, with 7 additional courses having been held through March 2016, comprising 150 participants. The goal of this 2-day, formal trauma center-based, course is to address and standardize key educational segments, including impact of trauma, program development, program evaluation, public health models, injury and data analysis, epidemiology, advocacy, building partnerships and coalitions, and the use of media promotion to ensure consistency throughout the industry.

Understanding the makeup of a growing field: A committee on trauma survey of the national network of hospital-based violence intervention programs.

BACKGROUND: Among Hospital Based Violence Intervention programs (HVIPs), little is known about variation in services provided, funding sources, or populations served. STUDY DESIGN: Twenty-eight member programs of Health Alliance for Violence Intervention participated in a survey administered by the American College of Surgeons Committee on Trauma. Questions were quantitative and qualitative. For qualitative analysis, questions pertaining to the domains were assessed for common themes and assessed across all subject domains. RESULTS: All programs enroll patients injured by community violence, some by intimate partner violence (IPV), trafficking, and rarely by child or elder abuse. Programs with more funding (≥$300,000 per year) were more likely federally, state, or city funded. Lower funded programs (≤$300,000 per year) were funded by foundations or philanthropy. In both qualitative and quantitative analysis, barriers to starting or sustaining HVIPs included funding, and lack of risk reduction and mental health resources. Successful programs had stable funding, adequate staffing, and buy in from hospitals and staff. CONCLUSION: HVIPs serve diverse populations in variable models. There is opportunity to expand the reach of HVIPs, and the experience if existing programs is an invaluable resource.

Creating a room of our own.

In today's busy healthcare arena, nurses may not have the time or energy to take advantage of advancement on the clinical ladder. The decision was made to create a "room of our own," where nurses who aspire for this recognition could develop and refine their portfolio and be supported in the skills necessary to prepare their folders for advancement. In this article, the authors described the curriculum, challenges, and lessons learned in creating a portfolio development program for nurses' advancement.

Impact of statewide safe sleep legislation on hospital practices and rates of sudden unexpected infant deaths.

BACKGROUND: Sudden Unexpected Infant Death (SUID) is the leading cause of death in the post-neonatal period in the United States. In 2015, Connecticut (CT) passed legislation to reduce the number of SUIDs from hazardous sleep environments requiring birthing hospitals/centers provide anticipatory guidance on safe sleep to newborn caregivers before discharge. The objective of our study was to understand the barriers and facilitators for compliance with the safe sleep legislation by birthing hospitals and to determine the effect of this legislation on SUIDs associated with unsafe sleep environments. METHODS: We surveyed the directors and/or educators of the 27 birthing hospitals & one birthing center in CT, about the following: 1) methods of anticipatory guidance given to parents at newborn hospital discharge; 2) knowledge about the legislation; and 3) barriers and facilitators to complying with the law. We used a voluntary online, anonymous survey. In addition, we evaluated the proportion of SUID cases presented at the CT Child Fatality Review Panel as a result of unsafe sleep environments before (2011-2015) and after implementation of the legislation (2016-2018). Chi-Square and Fisher's exact tests were used to evaluate the proportion of deaths due to Positional Asphyxia/Accident occurring before and after legislation implementation. RESULTS: All 27 birthing hospitals and the one birthing center in CT responded to the request for the method of anticipatory guidance provided to caregivers. All hospitals reported providing anticipatory guidance; the birthing center did not provide any anticipatory guidance. The materials provided by 26/27 (96%) of hospitals was consistent with the American Academy of Pediatrics (AAP) Guidelines. There was no significant change in rates of SUID in CT before (58.86/100,000) and after (55.92/100,000) the passage of the legislation (p = 0.78). However, more infants died from positional asphyxia after (20, 27.0%) than before the enactment of the law (p < 0.01). CONCLUSIONS: Despite most CT hospitals providing caregivers with anticipatory guidance on safe sleep at newborn hospital discharge, SUIDs rates associated with positional asphyxia increased in CT after the passage of the legislation. The role of legislation for reducing the number of SUIDs from hazardous sleep environments should be reconsidered.

Survivors of gun violence and the experience of recovery.

BACKGROUND: Survivors of gun violence may develop significant mental health sequelae and are at higher risk for reinjury through repeat violence. Despite this, survivors of gun violence often return to the community where they were injured with suboptimal support for their mental health, emotional recovery, and well-being. The goal of this study was to characterize the posthospitalization recovery experience of survivors of gun violence. METHODS: We conducted a qualitative research study with a community-based participatory research approach. In partnership with a community-based organization, we conducted in-depth one-on-one interviews and used snowball sampling to recruit survivors of gun violence. We applied the constant comparison method of qualitative analysis to catalogue interview transcript data by assigning conceptual codes and organizing them into a consensus list of themes. We presented the themes back to the participants and community members for confirmation. RESULTS: We conducted 20 interviews with survivors of gun violence; all were black men, aged 20 years to 51 years. Five recurring themes emerged: (1) Isolation, physical and social restriction due to fear of surroundings; (2) Protection, feeling unsafe leading to the desire to carry a gun; (3) Aggression, willingness to use a firearm in an altercation; (4) Normalization, lack of reaction driven by the ubiquity of gun violence in the community; and (5) Distrust of health care providers, a barrier to mental health treatment. CONCLUSION: Survivors of gun violence describe a disrupted sense of safety following their injury. As a result, they experience isolation, an increased need to carry a firearm, a normalization of gun violence, and barriers to mental health treatment. These maladaptive reactions suggest a mechanism for the violent recidivism seen among survivors of gun violence and offer potential targets to help this undertreated, high-risk population. LEVEL OF EVIDENCE: Care management/Therapeutic V.

Building community resilience to prevent and mitigate community impact of gun violence: conceptual framework and intervention design.

INTRODUCTION: The USA has the highest rate of community gun violence of any developed democracy. There is an urgent need to develop feasible, scalable and community-led interventions that mitigate incident gun violence and its associated health impacts. Our community-academic research team received National Institutes of Health funding to design a community-led intervention that mitigates the health impacts of living in communities with high rates of gun violence. METHODS AND ANALYSIS: We adapted 'Building Resilience to Disasters', a conceptual framework for natural disaster preparedness, to guide actions of multiple sectors and the broader community to respond to the man-made disaster of gun violence. Using this framework, we will identify existing community assets to be building blocks of future community-led interventions. To identify existing community assets, we will conduct social network and spatial analyses of the gun violence episodes in our community and use these analyses to identify people and neighbourhood blocks that have been successful in avoiding gun violence. We will conduct qualitative interviews among a sample of individuals in the network that have avoided violence (n=45) and those living or working on blocks that have not been a location of victimisation (n=45) to identify existing assets. Lastly, we will use community-based system dynamics modelling processes to create a computer simulation of the community-level contributors and mitigators of the effects of gun violence that incorporates local population-based based data for calibration. We will engage a multistakeholder group and use themes from the qualitative interviews and the computer simulation to identify feasible community-led interventions. ETHICS AND DISSEMINATION: The Human Investigation Committee at Yale University School of Medicine (#2000022360) granted study approval. We will disseminate study findings through peer-reviewed publications and academic and community presentations. The qualitative interview guides, system dynamics model and group model building scripts will be shared broadly.

Establishing an injury prevention program to address pediatric pedestrian collisions.

The implementation of a pedestrian safety education program in public schools can change the knowledge and beliefs about safe pedestrian behaviors among students and their parents or caregivers with the goal of reducing morbidity and mortality of children. WalkSafe is a well-established, multiphase pedestrian safety intervention program. This program has been shown to improve pedestrian safety knowledge of school-aged children in kindergarten through grade 5 after receiving a 3-day educational curriculum. A reduction in pediatric pedestrian struck injuries is anticipated following program implementation in an urban area with significantly increased incidence of such injuries.

Establishing the first Hartford consensus-compliant medical school in the United States.

BACKGROUND: Following the Hartford Consensus meetings, the Stop the Bleed Campaign was created to reduce the prevalence of death from exsanguination in the case of traumatic hemorrhage. The campaign revolves around providing hemorrhage control training to members of the public and increasing public access to hemorrhage control equipment. To our knowledge, no medical school has established a self-sustaining Stop the Bleed program to train their students and faculty as well as made hemorrhage control equipment available for use in an emergency. METHODS: Bleeding control classes were offered at the Frank H. Netter MD School of Medicine beginning in January 2018. A proposal was made to the medical school's Council on Curriculum Oversight in May 2018 to incorporate the training as part of the required curriculum for first-year students. A second proposal was made to Quinnipiac University's Emergency Management Team in June 2018 to purchase hemorrhage control equipment. RESULTS: Twelve bleeding control courses were held between January and August 2018. Two hundred ten medical students, 19 faculty members, and 36 public safety officers completed initial training. Thirty-four medical students, two faculty members, and two public safety officers became certified instructors. Training was incorporated into the first-year curriculum to be taught by certified second-year students under the direction of the school's Department of Surgery. The school purchased approved training equipment. A student-coordinator position was created in the Surgery Interest Group. Hemorrhage control equipment was purchased for each public safety officer, patrol vehicles, and for the Central Dispatch headquarters. Public-access equipment has been purchased for each Automated External Defibrillator cabinet at the medical school. CONCLUSION: The School of Medicine community has been empowered with the ability to save lives. Students and faculty have been trained in life-saving skills, a self-sustaining training process has been created, and equipment has been purchased for hemorrhage control efforts.

A tabletop school bus rollover: Connecticut-wide drills to build pediatric disaster preparedness and promote a novel hospital disaster readiness checklist.

OBJECTIVE: To assess emergency medical services (EMS) and hospital disaster plans and communication and promote an integrated pediatric disaster response in the state of Connecticut, using tabletop exercises to promote education, collaboration, and planning among healthcare entities. DESIGN: Using hospital-specific and national guidelines, a disaster preparedness plan consisting of pediatric guidelines and a hospital checklist was created by The Connecticut Coalition for Pediatric Disaster Preparedness. SETTING: Five school bus rollover tabletop exercises were conducted, one in each of Connecticut's five EMS regions. Action figures and playsets were used to depict patients, healthcare workers, vehicles, the school, and the hospital. PARTICIPANTS: EMS personnel, nurses, physicians and hospital administrators. INTERVENTION: Participants had a facilitated debriefing of the EMS and prehospital response to disasters, communication among prehospital organizations, public health officials, hospitals, and schools, and surge capacity, capability, and alternate care sites. A checklist was completed for each exercise and was used with the facilitated debriefing to generate an afteraction report. Additionally, each participant completed a postexercise survey. MAIN OUTCOME MEASURES: Each after-action report and postexercise survey was compared to established guidelines to address gaps in hospital specific pediatric readiness. RESULTS: Exercises occurred at five hospitals, with inpatient capacity ranging 77-1,592 beds, and between 0 and 221 pediatric beds. There were 27 participants in the tabletop exercises, and 20 complete survey responses for analysis (74 percent). After the exercises, pediatric disaster preparedness aligned with coalition guidelines. However, methods of expanding surge capacity and methods of generating surge capacity and capability varied (p < 0.031). CONCLUSION: Statewide tabletop exercises promoted coalition building and revealed gaps between actual and ideal practice. Generation of surge capacity and capability should be addressed in future disaster education.

Feasibility of providing child restraint devices after a motor vehicle crash in a pediatric emergency department.

OBJECTIVE: Motor vehicle crashes (MVCs) cause disproportionate childhood morbidity and mortality. Ensuring that children are placed in appropriate child restraint devices (CRDs) would significantly reduce injuries and deaths as well as medical costs. The goal of the study is to evaluate the feasibility of providing child restraint devices after an MVC in a pediatric emergency department (PED). METHODS: A guideline was developed to assess the need for CRDs for patients discharged from a PED after an MVC. Providers were educated on the use of the guideline. Caregivers were provided a brief educational intervention on legislation, proper installation, and best practices prior to distribution of a CRD. Quality assurance was conducted weekly to monitor for any missed opportunities. RESULTS: From August 31, 2015, to August 31, 2016, 291 patients <7 years were evaluated in the PED of a level 1 trauma center following an MVC. Two hundred forty-seven children were correctly identified according to the guidelines (84.9%). Of these, 187 (75.7%) were identified as not requiring a replacement seat and 60 (24.3%) required a CRD replacement based on crash mechanisms and restraint use status and received a CRD replacement. Of the remaining 44 children, 38 (86.4%) whose crash mechanisms were severe enough or who were inappropriately restrained were not provided a CRD and thus missed; 6 (13.6%) received a replacement seat even though criteria were not met. Thus, PED providers correctly identified 61.2% (60/98) of children who required CRD replacement after an MVC. CONCLUSION: Caring for children who present for evaluation after an MVC offers an opportunity for ED personnel to provide education to caregivers about the appropriate use of CRDs and state legislation. Establishing guidelines for the provision of a CRD for children who present to an ED following an MVC may help to improve the safety of children being transported in motor vehicles. Having a systematic process and adequate supply of CRDs readily available contributes to the success of children being discharged with the appropriate age- and weight-based CRD after being treated in an ED following an MVC.

Prevention of firearm injuries with gun safety devices and safe storage: An Eastern Association for the Surgery of Trauma Systematic Review.

BACKGROUND: Over 50,000 homicides and suicides occur each year. An estimated half of all US 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.). METHODS: A comprehensive review of the literature was performed. We used Grading of Recommendations Assessment, Development, and Evaluation methodology to assess the breadth and quality of the data specific to our Population, Intervention, Comparator, Outcomes (PICO) questions. RESULTS: A total of 176 studies were initially identified, then, 120 more added after a subsequent literature review, with 97 removed as duplicates. One hundred 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. CONCLUSION: 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. LEVEL OF EVIDENCE: Systematic review, level III.

Primary prevention of contact sports-related concussions in amateur athletes: a systematic review from the Eastern Association for the Surgery of Trauma.

BACKGROUND: Awareness of the magnitude of contact sports-related concussions has risen exponentially in recent years. Our objective is to conduct a prospectively registered systematic review of the scientific evidence regarding interventions to prevent contact sports-related concussions. METHODS: Using the Grading of Recommendations Assessment, Development, and Evaluation methodology, we performed a systematic review of the literature to answer seven population, intervention, comparator, and outcomes (PICO) questions regarding concussion education, head protective equipment, rules prohibiting high-risk activity and neck strengthening exercise for prevention of contact sports-related concussion in pediatric and adult amateur athletes. A query of MEDLINE, PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature, and Embase was performed. Letters to the editor, case reports, book chapters, and review articles were excluded, and all articles reviewed were written in English. RESULTS: Thirty-one studies met the inclusion criteria and were applicable to our PICO questions. Conditional recommendations are made supporting preventive interventions concussion education and rules prohibiting high-risk activity for both pediatric and adult amateur athletes and neck strengthening exercise in adult amateur athletes. Strong recommendations are supported for head protective equipment in both pediatric and adult amateur athletes. Strong recommendations regarding newer football helmet technology in adult amateur athletes and rules governing the implementation of body-checking in youth ice hockey are supported. CONCLUSION: Despite increasing scientific attention to sports-related concussion, studies evaluating preventive interventions remain relatively sparse. This systematic review serves as a call to focus research on primary prevention strategies for sports-related concussion. LEVEL OF EVIDENCE: IV. PROSPERO REGISTRATION NUMBER: #42016043019.

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. LEVEL OF EVIDENCE: Epidemiological, level III.

Evaluating distracted driving behaviors in parents of children in suburban and rural areas of Alabama.

BACKGROUND: Distracting driving is considered a dangerous epidemic in teenage drivers and adult drivers nationwide. Cell phone use, such as talking and texting is one of the most common driving distractions among adult and teenage drivers. Using the model of a previously published study from New Haven, Connecticut, we sought to investigate the driving behaviors of parents while transporting their children in Alabama. METHODS: A comparison study was conducted of 150 participants from suburban (n = 86) and rural (n = 64) clinics in Alabama. Participants were recruited to complete a survey regarding their cell phone usage while driving with children. The inclusion criteria were having children younger than 18 years, a valid driver's license, and cell phone and English speaking. The survey consisted of 10 questions focusing on parental driving behaviors. Following the survey, an educational intervention was provided. A Z test proportions was used to compare the responses. RESULTS: Ninety percent of the suburban parents reported cell phone use while driving their children as compared with 86% of the rural parents. A significant difference was found between suburban parents and rural parents for cell phone use in speaker mode (Z = 3.35; p < 0.001; 95% confidence interval, 13-45), reading and sending texts while driving (Z = 4.1; p < 0.001; 95% CI, 19-51), and surfing the Internet (Z = 4.9; p < 0.001; 95% CI, 25-57). There was no statistical significance noted for the following: use of Bluetooth device, talking on the cell phone when parked/at red light, and texting while parked/at red light. CONCLUSIONS: Cell phone use among parents while transporting children is common in the state of Alabama. Parents living in suburban areas use cell phones in the speaker mode, read and send text messages, and surf the Web more often when compared with parents in rural areas. Further research on how to best implement injury prevention interventions should be done to target high-risk areas with distracted driving behaviors. LEVEL OF EVIDENCE: Epidemiologic study, level III.