Does lower use of academic affiliation by university faculty in top U.S. newspapers contribute to misinformation about abortion?

BACKGROUND: University faculty are considered trusted sources of information to disseminate accurate information to the public that abortion is a common, safe and necessary medical health care service. However, misinformation persists about abortion's alleged dangers, commonality, and medical necessity. METHODS: Systematic review of popular media articles related to abortion, gun control (an equally controversial topic), and cigarette use (a more neutral topic) published in top U.S. newspapers between January 2015 and July 2020 using bivariate analysis and logistic regression to compare disclosure of university affiliation among experts in each topic area. RESULTS: We included 41 abortion, 102 gun control, and 130 smoking articles, which consisted of 304 distinct media mentions of university-affiliated faculty. Articles with smoking and gun control faculty experts had statistically more affiliations mentioned (90%, n = 195 and 88%, n = 159, respectively) than abortion faculty experts (77%, n = 54) (p = 0.02). The probability of faculty disclosing university affiliation was similar between smoking and gun control (p = 0.73), but between smoking and abortion was significantly less (Ave Marginal Effects - 0.13, p = 0.02). CONCLUSIONS: Fewer faculty members disclose their university affiliation in top U.S. newspapers when discussing abortion. Lack of academic disclosure may paradoxically make these faculty appear less 'legitimate.' This leads to misinformation, branding abortion as a 'choice,' suggesting it is an unessential medical service. With the recent U.S. Supreme Court landmark decision, Dobbs v. Jackson Women's Health Organization, and subsequent banning of abortion in many U.S. states, faculty will probably be even less likely to disclose their university affiliation in the media than in the past.

Empowering the affected: Informing community-based solutions through interviews with survivors of interpersonal firearm violence-Perspectives of survivors of firearm injuries.

BACKGROUND: Firearm violence remains epidemic in the United States, with interpersonal gun violence leading to significant morbidity and mortality. Interpersonal violence has strong associations with social determinants of health, and community-specific solutions are needed to address root causes. We hypothesized that open-ended interviews with survivors of interpersonal firearm violence would identify themes in individual and community-level factors that contribute to ongoing violence. METHODS: Between July 2017 and November 2019, we performed a mixed-methods study in which qualitative and quantitative data were obtained from survivors of interpersonal firearm violence admitted to our urban level I trauma center. Qualitative data were obtained through semistructured, open-ended interviews with survivors. Quantitative data were obtained via survey responses provided to these same individuals. Qualitative and quantitative data were then used to triangulate and strengthen results. RESULTS: During the study period, 51 survivors were enrolled in the study. The most common cause of firearm violence reported by survivors was increased gang and drug activity (n = 40, 78%). The most common solution expressed was to reduce drug and gang lifestyle by offering jobs and educational opportunities to afflicted communities to improve opportunities (n = 35, 69%). Nearly half of the survivors (n = 23, 45%) believe that firearm violence should be dealt with by the affected community itself, and another group of survivors believe that it should be through partnership between the community and trauma centers (n = 19, 37%). CONCLUSION: Interviews with survivors of firearm violence at our urban level I trauma center suggest that drug and gang lifestyle perpetuate ongoing violence and that this would best be overcome by improving access to quality education and job opportunities. To address endemic firearm violence in their communities, trauma centers should identify opportunities to partner in developing programs that provide improved education, job access, and conflict mediation. LEVEL OF EVIDENCE: Prognostic and epidemiological, level I.

Firearm homicide mortality is influenced by structural racism in US metropolitan areas.

INTRODUCTION: Metropolitan cities in the United States suffer from higher rates of gun violence. However, the specific structural factors associated with increased gun violence are poorly defined. We hypothesized that firearm homicide in metropolitan cities would be impacted by Black-White segregation index. METHODS: This cross-sectional analysis evaluated 51 US metropolitan statistical areas (MSAs) using data from 2013 to 2017. Several measures of structural racism were examined, including the Brooking Institute's Black-White segregation index. Demographic data were derived from the US Census Bureau, US Department of Education, and US Department of Labor. Crime data and firearm homicide mortality rates were obtained from the Federal Bureau of Investigation and the Centers for Disease Control. Spearman ρ and linear regression were performed. RESULTS: Firearm mortality was associated with multiple measures of structural racism and racial disparity, including White-Black segregation index, unemployment rate, poverty rate, single parent household, percent Black population, and crime rates. In regression analysis, percentage Black population exhibited the strongest association with firearm homicide mortality (ß = 0.42, p < 0.001). Black-White segregation index (ß = 0.41, p = 0.001) and percent children living in single-parent households (ß = 0.41, p = 0.002) were also associated with higher firearm homicide mortality. Firearm legislation scores were associated with lower firearm homicide mortality (ß = -0.20 p = 0.02). High school and college graduation rates were not associated with firearm homicide mortality and were not included in the final model. CONCLUSION: Firearm homicide disproportionately impacts communities of color and is associated with measures of structural racism, such as White-Black segregation index. Public health interventions targeting gun violence must address these systemic inequities. Furthermore, given the association between firearm mortality and single-parent households, intervention programs for at-risk youth may be particularly effective. LEVEL OF EVIDENCE: Epidemiological level II.

Patterns and Trends of Gun Violence Against Women in the United States.

OBJECTIVE: To examine patterns and trends of firearm injuries in a nationally representative sample of US women. SUMMARY OF BACKGROUND DATA: Gun violence in the United States exceeds rates seen in most other industrialized countries. Due to the paucity of data little is known regarding demographics and temporal variations in firearm injuries among women. METHODS: Data were extracted from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System (2001-2017) for women 18 years and older. Number of nonfatal firearm assaults and homicide per year were extracted and crude population-based injury rates were calculated. Sub-stratification by age-group and time period were performed. RESULTS: Between 2001 and 2017, there were 88,823 nonfatal firearm assaults involving women and 29,106 firearm homicides. There were 4116 victims of nonfatal firearm assault in 2001 (3.8 per 105) and 12,959 by 2017 (10.0 per 105). Homicide rates were 1.5 per 105 in 2001 and 1.7 per 105 in 2017. Sub-stratification by age-group and time period showed that there were no significant changes in nonfatal firearm assault rates between 2001 and 2010 (P-trend = 0.132 in 18-44 yo; 0.298 in 45-64 yo). However between 2011 and 2017, nonfatal assault rates increased from 7.10 per 105 to 19.24 per 105 in 18-44 yo (P-trend = 0.013) and from 1.48 per 105 to 3.93 per 105 in 45-64 yo (P-trend = 0.003). Similar trends were seen with firearm homicide among 18-44 yo (1.91 per 105 to 2.47 per 105 in 2011-2017, P-trend = 0.022). However, the trends among 45-64 yo were not significant in both time periods. CONCLUSIONS: Female victims of gun violence are increasing and more recent years have been marked with higher rates of firearm injuries, particularly among younger women. These data suggest that improved public health strategies and policies may be beneficial in reducing gun violence against US women.

Geodemographic analysis of pediatric firearm injuries in Miami, FL.

PURPOSE: Firearm injuries (GSW) are a growing public health concern and leading cause of morbidity and mortality among children, yet predictors of injury remain understudied. This study examines the correlates of pediatric GSW within our county. METHODS: We retrospectively queried an urban Level 1 trauma center registry for pediatric (0-18 years) GSW from September 2013 to January 2019, examining demographic, clinical, and injury information. We used a geographic information system to map GSW rates and perform spatial and spatiotemporal cluster analysis to identify zip code "hot spots." RESULTS: 393 cases were identified. The cohort was 877% male, 87% African American, 10% Hispanic, and 22% Caucasian/Other. Injuries were 92% violence-related and 4% accidental, with 63% occurring outside school hours. Mortality was 12%, with 53% of deaths occurring in the resuscitation unit. Zip-level GSW rates ranged from 0 to 9 (per 1000 < 18 years) by incident address and 0-6 by home address. Statistically significant hot spots were in predominantly underserved African American and Hispanic neighborhoods. CONCLUSIONS: Geodemographic analysis of pediatric GSW injuries can be utilized to identify at-risk neighborhoods. This methodology is applicable to other metropolitan areas where targeted interventions can reduce the burden of gun violence among children. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: Level III.

Self-Inflicted Gun Violence Injuries Epidemic in the United States: A Closer Look at the Nation's Well-Being.

Gun-related injuries are a hotly debated sociopolitical topic in the United States. Annually, more than 33 million Americans seek heathcare services for mental health issues. These conditions are the leading cause of combined disability and death among women and the second highest among men. Our study's main objective was to identify cases of self-inflicted penetrating firearm injuries with reported pre-existing psychiatric conditions as defined in the 2013-2016 National Trauma Data Standard. The 2013-2016 Research Data Sets (RDSs) were reviewed. Cases were identified using the ICD-9 external cause codes 955-955.4, and ICD 10th Edition Clinical Modification external cause codes X72-X74. Odds ratios were calculated, and categorical data were analyzed by using the chi-squared test, with significance defined as P < 0.05. The 2013-2016 Research Data Set consists of 3,577,168 reported cases, with 15,535 observations of self-inflicted penetrating firearms injuries. Of those patients, 18.4 per cent had major psychiatric illnesses, 7.5 per cent had alcohol use disorder, 6.4 per cent had drug use disorder, and 0.6 per cent had dementia. An upward trend in the proportion of patients with major psychiatric illnesses was observed, from 15.5 per cent in 2013 to 18.6 per cent in 2016, peaking in 2015 at 20.9 per cent. Nearly one in three self-inflicted penetrating firearm injuries in the United States is associated with pre-existing behavioral health conditions. Advances in understanding the behavioral and social determinants leading to these conditions, and strategies to improve the diagnosis of mental illness and access to mental health care are required.

Firearm laws and illegal firearm flow between US states.

BACKGROUND: Considerable variation in firearm legislation exists. Prior studies show an association between stronger state laws and fewer firearm deaths. We hypothesized that firearms would flow from states with weaker laws to states with stronger laws based on proximity and population. METHODS: Crime gun trace data from 2015 to 2017 was accessed from the Bureau of Alcohol, Tobacco, Firearms and Explosives and compared with the count and composition of firearm legislation in 2015 among the contiguous 48 states. Additional independent variables included population, median household income, distance, and presence or absence of a shared border. We used Exponential Random Graph Models to identify predictors of traced firearm transfers between origin and destination states. RESULTS: After controlling for network structure, firearm laws in origin states were associated with fewer traced firearm transfers (incidence rate ratio [IRR], 0.88; 95% confidence interval [CI], 0.83-0.93; p < 0.001). Conversely, more firearm laws in destination states were associated with more traced firearm transfers (IRR, 1.10; 95% CI, 1.06-1.15; p < 0.001). Larger population at the origin was associated with increased transfers (IRR, 1.38; 95%CI, 1.27-1.50; p < 0.001), as was larger population at the destination state (IRR, 1.45; 95% CI, 1.35-1.56; p < 0.001). Greater distance was associated with fewer transfers (for each 1,000 km; IRR, 0.35; 95% CI, 0.27-0.46; p < 0.001), and transfers were greater between adjacent states (IRR, 2.49; 95% CI, 1.90-3.27; p < 0.001). CONCLUSION: State firearm legislation has a significant impact on gun trafficking even after controlling for network structure. States with stricter firearm legislation are negatively impacted by states with weaker regulations, as crime guns flow from out-of-state. LEVEL OF EVIDENCE: Epidemiologic, level III.

Adolescências feridas: retrato das violências com arma de fogo notificadas no Brasil / Wounded adolescences: a portrait of firearm violence reported in Brazil

RESUMO: Objetivos: Descrever as notificações de violências interpessoais e autoprovocadas com arma de fogo em adolescentes e identificar os fatores associados à notificação desses eventos. Metodologia: Estudo transversal com dados do Sistema de Informação de Agravos de Notificação (SINAN) de 2011 a 2017, em adolescentes de 10 a 19 anos feridos por arma de fogo. Utilizou-se o teste χ2 para verificar a diferença de proporção entre os sexos. Realizaram-se análise de correlação e regressão linear múltipla entre o logaritmo da taxa de notificação por arma de fogo e cada variável independente, em amostra de municípios de grande porte. Aplicaram-se teste de normalidade e homocedasticidade ao modelo final. Resultados: Registraram-se 30.103 notificações de violências com armas de fogo em adolescentes, sendo 74,7% no sexo masculino de 15 a 19 anos (83,8%). Entre as meninas, a violência é mais comum na residência, com agressor conhecido e violência física e sexual combinadas. A taxa de óbito por arma de fogo foi maior em Fortaleza, Maceió, João Pessoa, Salvador e Natal, variando de 105,88 a 71,73 por 100 mil. A maior taxa de notificação de violência por arma de fogo teve associação com maiores taxas de óbito por esse tipo de arma e maior cobertura das unidades de saúde. Conclusão: A violência perpetrada por arma de fogo é um importante problema de saúde pública em adolescentes. Os ataques ao estatuto do desarmamento e a flexibilização do porte e da posse de armas afrontam diretamente o presente e o futuro das crianças e adolescentes.

ABSTRACT: Objective: To describe the notifications of interpersonal and self-inflicted firearm violence in adolescents and to identify the factors associated with the notification of this event. Methodology: Cross-sectional study analyzing data from Sinan from 2011 to 2017, in adolescents aged 10-19 years, injured by firearms. The χ2 test was used to verify the gender ratio difference. Correlation analysis and multiple linear regression were performed between the logarithm of the firearm notification rate and each independent variable, in a sample of large municipalities. Results: There were 30,103 reports of firearm violence in adolescents, of which (74.7%) were males aged 15-19 years (83.8%). Among girls, violence is more common at home, with a known perpetrator, and with physical and sexual violence combined. The death rate by firearms was higher in Fortaleza, Maceió, João Pessoa, Salvador and Natal, ranging from 105.88 to 71.73 per 100 thousand. Higher notification rates of firearm violence were associated with higher firearm death rates and greater coverage of health facilities. Conclusion: Firearm violence is a major public health problem in adolescents. Attacks on the disarmament statute and the loosening of gun possession and ownership directly confront the present and future of children and adolescents.

Analysis of the medical response to November 2015 Paris terrorist attacks: resource utilization according to the cause of injury.

PURPOSE: The majority of terrorist acts are carried out by explosion or shooting. The objective of this study was first, to describe the management implemented to treat a large number of casualties and their flow together with the injuries observed, and second, to compare these resources according to the mechanism of trauma. METHODS: This retrospective cohort study collected medical data from all casualties of the attacks on November 13th 2015 in Paris, France, with physical injuries, who arrived alive at any hospital within the first 24 h after the events. Casualties were divided into two groups: explosion injuries and gunshot wounds. RESULTS: 337 casualties were admitted to hospital, 286 (85%) from gunshot wounds and 51 (15%) from explosions. Gunshot casualties had more severe injuries and required more in-hospital resources than explosion casualties. Emergency surgery was required in 181 (54%) casualties and was more frequent for gunshot wounds than explosion injuries (57% vs. 35%, p < 0·01). The types of main surgery needed and their delay following hospital admission were as follows: orthopedic [n = 107 (57%); median 744 min]; general [n = 27 (15%); 90 min]; vascular [n = 19 (10%); median 53 min]; thoracic [n = 19 (10%); 646 min]; and neurosurgery [n = 4 (2%); 198 min]. CONCLUSION: The resources required to deal with a terrorist attack vary according to the mechanism of trauma. Our study provides a template to estimate the proportion of various types of surgical resources needed overall, as well as their time frame in a terrorist multisite and multitype attack. FUNDING: Assistance Publique-Hôpitaux de Paris.

Community distress predicts youth gun violence.

BACKGROUND: The purpose of this study was to investigate our institution's experience with pediatric firearm events. We sought to determine the relationship between a community's level of socioeconomic distress and the incidence of youth gun violence. METHODS: We performed a retrospective review of children <18 years involved in firearm events. Using visual cluster analysis, we portrayed all firearm events and violent firearm events (assaults + homicides). Distressed community indices (DCIs) were obtained from an interface that uses US Census Bureau data. Incident rate ratios (IRRs) were calculated for firearm circumstances (i.e. assault, homicide, suicide) using a DCI. Significant IRRs were analyzed to discern which DCI metrics contributed most to gun violence. RESULTS: There were 114 children involved in firearm events; 66 were county residents. The DCI of injury location significantly predicted total firearm events (IRR 1.02, 95% CI 1.01-1.03), assaults (IRR 1.02, 95% CI 1.01-1.05), and violent firearm events (IRR 1.03, 95% CI 1.01-1.05). The proportion of adults without a high school diploma, poverty rate, median income ratio, and housing vacancy rate were highly predictive of gun violence (VIP >1). CONCLUSION: Community distress significantly predicts pediatric firearm violence. Local interventions should target neighborhoods with high levels of distress to prevent further youth gun violence. LEVEL OF EVIDENCE: Retrospective study, IV.

Twenty years of pediatric gunshot wounds in our community: Have we made a difference?

BACKGROUND/PURPOSE: Pediatric gunshot wounds (GSWs) carry significant incidence, mortality, and cost. We evaluated 20 years of GSW demographics at this level 1 trauma center and constructed a risk map triangulating areas of high incidence with risk factors. METHODS: Children 0-18 years suffering a GSW between 1996 and 2016 were identified via our trauma registry. Hospital charges, demographic, socioeconomic, and institutional variables were retrospectively reviewed. Multivariable logistic regression identified predictors of mortality. Geographic information system (GIS) mapping of incident location and residence identified areas of higher incidence. RESULTS: The cohort (n = 898) was 86.4% male. Mean age was 15.6 ±â€¯3.4 years. Median Injury Severity Score (ISS) was 9 (1-75). Procedural and/or operative intervention occurred in 52.9%. Intent included assault (81.5%) and unintentional injury (12.8%). Hospital charges showed significant annual increase. Annual incidence varied without trend (p = 0.89). Mapping revealed significant clustering of GSWs in known lower socioeconomic areas. Yearly and total GSWs were highest in one particular zip code. ISS was a significant predictor of mortality (n = 18) (OR 1.19, 95% CI 1.15-1.22, p < 0.001). CONCLUSIONS: Our impoverished neighborhoods have higher pediatric GSW incidence, unchanged over 20 years. Alternative community-based prevention efforts should involve neighborhood capacity building and economic strengthening. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: Level IV.

Mass shootings: Are children safer in the streets than in the home?

PURPOSE: Though the total fatality and injury count in mass shootings is known, the burden on the pediatric population remains undefined. We sought to define the impact of domestic vs. public mass shootings in the pediatric population. METHODS: Open-source databases, Everytown for Gun Violence, and Mother Jones were cross-referenced and used to review domestic and public mass shootings from 2009 to 2016. Mass shootings were defined as four or more fatalities and any injuries. Domestic mass shootings were defined as ones that occurred in the home where the assailant was either a family member or a past or present intimate partner of a family member. Public mass shootings occurred in a public space where the shooter was unknown to the victim. The number of incidents in each group, fatalities and injuries, and effect on children <18 years were analyzed along with perpetrator characteristics. Categorical data were analyzed using Fisher's Exact test. RESULTS: There were 71 Domestic and 31 Public mass shootings accounting for 331 vs. 281 fatalities and 28 vs. 217 injuries (p < 0.0001). Children <18 years accounted for 44% of Domestic and 10% of Public fatalities (p < 0.0001) and 46% vs. 2% of all injuries (p < 0.0001). The assailant was prohibited from owning or possessing a firearm in 32% of Domestic and 39% of Public mass shootings accounting for 54 vs. 25 fatalities. CONCLUSION: The pediatric fatality rate in mass shootings is alarming, especially among Domestic shooting events. This is a public health issue and requires vigilance to protect at-risk youth. TYPE OF STUDY: Epidemiology study, retrospective review. LEVEL OF EVIDENCE: Level IV.