Gun violence in K-12 schools in the United States: Moving towards a preventive (versus reactive) framework.

Intentional shootings in K-12 schools in the U.S. persist as a public health problem. The number of shootings in K-12 schools has increased precipitously since 2017. And with approximately 100,000 K-12 public schools nationally serving 51 million children, investing in a comprehensive gun violence prevention strategy is critical. Unfortunately, our current school gun violence prevention approach almost exclusively centers reactive strategies that are in place to respond to acts of gun violence in the moment, rather than preventive strategies that would prevent them from occurring at all. Reliance on these strategies alone, however, is not sufficient. In line with the core tenets of public health prevention and the Whole School, Whole Child, Whole Community model, we present a more expansive school gun violence prevention framework that broadens the spectrum of what constitutes "school gun violence prevention." Our work highlights how enhancing basic neighborhood and school structures-including investments in public libraries, affordable housing, and universal school-based violence prevention programs-are key to both preventing gun violence and promoting well-being. We also highlight the role of stricter gun laws, reasonable school security efforts, bystander interventions, building awareness within school communities, and meaningful investments in early interventions and mental health services. Children, who have been tragically exposed to any number of adverse experiences in the wake of the COVID-19 pandemic, deserve more reasoned choices and large-scale investments in understanding and cutting off the root causes of school gun violence; not just a reliance on strategies that focus on what to do in the moment of a violent act. As gun violence in K-12 schools persists, we must reframe the discourse about school gun violence around prevention, not reaction.

Automated Substance Use/Sexual Risk Reporting and HIV Test Acceptance Among Emergency Department Patients Aged 13-24 Years.

Despite federal guidelines, many adolescents and emerging adults are not offered HIV testing by their healthcare providers. As such, many-including those who may be at high-risk for contracting HIV given their sexual and/or substance use risk-are not routinely tested. The current study examines sexual risk and substance use among emergency department patients aged 13-24 years (n = 147), who completed an automated screening as part of a tablet-based intervention designed to increase HIV testing. Twenty seven percent (n = 39) of participants chose to test for HIV after completing the tablet-based intervention. Among this sample, sexual risk was a significant independent predictor of HIV testing (χ2 = 16.50, p < 0.001). Problem substance use (e.g. trying but failing to quit) also predicted testing (χ2 = 7.43, p < 0.01). When considering these behaviors together, analyses indicated that the effect of problem substance use (ß = 0.648, p = 0.154) on testing is explained by sexual risk behavior (ß = 1.425, p < 0.01). The study's findings underscore the value of using routine automated risk screenings to collect sensitive data from emergency department patients, followed by computer-based HIV test offers for adolescent youth. Our research indicates tablet-based interventions can facilitate more accurate reporting of sexual behavior and substance use, and can also potentially increase HIV test uptake among those at risk.

The importance of content and choice in a technology-based intervention to increase HIV testing.

Although the Centers for Disease Control and Prevention recommends routine HIV testing in emergency departments and other facilities, many patients are never offered testing, and those who are offered testing frequently decline. In response, our team developed and evaluated a series of differently configured technology-based interventions to explore how we can most effectively increase HIV testing among reluctant patients. The current study examines how different videos (onscreen physician vs. onscreen community member), and different intervention configurations (enabling some participants to select a video while others are assigned to watch a video or to view bullet-point text), could potentially increase self-efficacy to test for HIV among patients who had never tested. Analyses of data from 285 emergency department patients in New York City who declined HIV testing offered by hospital staff indicated that participants reported highly significant differences in self-efficacy depending on their history of previous testing, whether they were enabled to select a video or were assigned a video, and which video they watched. Participants who reported no previous testing reported significantly lower pre-test self-efficacy compared to those who had tested at least once before. Among those who had not previously tested, the greatest pre-post increases in self-efficacy were reported by participants who were randomly enabled to select an intervention video and chose to watch video depicting a physician. Our findings highlight the importance, not only of intervention content, but how that content is delivered to specific participants. These findings may inform more effective technology-based behavioral health interventions.

Youth exposure to violence involving a gun: evidence for adverse childhood experience classification.

Adverse childhood experiences (ACEs) have historically included child maltreatment, household dysfunction, and other critical issues known to impact children negatively. Although youth experiences with violence are broadly captured in some ACE measures, youth exposure to violence involving a gun has not been included specifically in the operationalizing, and therefore scientific study, of ACEs. There are numerous implications of this omission, including limiting access to ACE interventions that are currently available and resources for individuals who have been exposed to gun violence. Thus, and given the persistent prevalence of gun violence in the US, we conducted a systematic review of the literature over the past two decades on the assessment of and response to ACEs and gun violence. Eighty-one journal articles across four search engines met our inclusion criteria. Our findings provide evidence that youth gun violence exposure should be classified as an ACE. In addition to increasing access to resources for youth affected by gun violence, these findings may improve the likelihood of funding and research into gun violence, with direct implications for prevention and intervention efforts.

Stimulus-associated urinary urges in overactive bladder syndrome.

AIMS: Although anecdotal reports of urinary urgency at one's front door are common in overactive bladder syndrome (OAB), little research has been done on how one's front door and other stimuli are related to urinary symptoms. We hypothesized that individuals with OAB would have higher scores on the Urinary Cues Questionnaire, developed for this study to assess stimulus-associated urinary urges, than those without OAB. METHODS: Online surveys were administered to 328 women age 18-40 years recruited from a respondent panel maintained by CINT such that one-third of the sample reported a diagnosis of OAB. The survey assessed OAB symptoms and the frequency with which participants associated 42 stimuli with the urge to urinate. RESULTS: Psychometric analyses showed internal consistency estimates of the Urinary Cues Questionnaire of α = 0.97 and a test-retest correlation of 0.91. Women with OAB had significantly higher Urinary Cues Scores than those without OAB, with a t-test showing a large effect size of d = 1.49 (95%CI 1.24, 1.74), P < 0.001. DISCUSSION: Behavioral treatments aimed at reducing the response to cues may be useful in OAB, but more research is needed on both treatment implications and on the trajectory of symptom development.

Implementation of Online Opioid Prevention, Recognition and Response Trainings for Laypeople: Year 1 Survey Results.

BACKGROUND: This article reports on the first implementation of an online opioid-overdose prevention, recognition and response training for laypeople. The training was disseminated nationally in November 2014. Between 2000 and 2014, U.S. opioid deaths increased by 200%. The importance of complementary approaches to reduce opioid overdose deaths, such as online training, cannot be overstated. OBJECTIVES: A retrospective evaluation was conducted to assess perceived knowledge, skills to intervene in an overdose, confidence to intervene, and satisfaction with the training. MEASUREMENTS: Descriptive statistics were used to report sample characteristics, compare experiences with overdose and/or naloxone between subgroups, and describe participants' satisfaction with the trainings. Z-ratios were used to compare independent proportions, and paired t-tests were used to compare participant responses to items pre- and posttraining, including perceived confidence to intervene and perceived knowledge and skills to intervene successfully. RESULTS: Between January and October 2015, 2,450 laypeople took the online training; 1,464 (59.8%) agreed to be contacted. Of these, 311 (21.2% of those contacted) completed the survey. Over 80% reported high satisfaction with content, format and mode of delivery and high satisfaction with items related to confidence and overdose reversal preparedness. Notably, 89.0% of participants felt they had the knowledge and skills to intervene successfully posttraining compared to 20.3% pretraining (z = -17.2, p <.001). Similarly, posttraining, 87.8% of participants felt confident they could successfully intervene compared to 24.4% pretraining (z = -15.9, p <.001). CONCLUSIONS: This study demonstrates the effectiveness of the GetNaloxoneNow.org online training for laypeople.

Weight and skin colour as predictors of vitamin D status: results of an epidemiological investigation using nationally representative data.

OBJECTIVE: Current US dietary recommendations for vitamin D vary by age. Recent research suggests that body weight and skin colour are also major determinants of vitamin D status. The objective of the present epidemiological investigation was to clarify the role of age as a predictor of vitamin D status, while accounting for body weight and skin colour, among a nationally representative sample. DESIGN: We calculated the mean serum 25-hydroxyvitamin D levels for the US population by age and weight, as well as by weight and race/ethnicity group. Multiple regression analyses were utilized to evaluate age and weight as predictors of vitamin D status: serum 25-hydroxyvitamin D levels with age alone, age and body weight, and age, body weight and their two-way interaction were modelled for the entire sample and each age subgroup. Graphical data were developed using B-spline non-linear regression. SETTING: National Health and Nutrition Examination Survey (31 934 unweighted cases). SUBJECTS: Individuals aged 1 year and older. RESULTS: There were highly significant differences in mean vitamin D status among US residents by weight and skin colour, with those having darker skin colour or higher body weight having worse vitamin D status. Although a significant factor, the impact of age on vitamin D status was notably less than the impact of body weight. CONCLUSIONS: Vitamin D status varied predominantly by body weight and skin colour. Recommendations by nutritionists for diet and supplementation needs should take this into account if vitamin D-related health disparities are to be meaningfully reduced across the USA.

Feasibility of a Computer-Based Intervention Addressing Barriers to HIV Testing Among Young Patients Who Decline Tests at Triage.

Young people face greatly increased human immunodeficiency virus (HIV) risk and high rates of undiagnosed HIV, yet are unlikely to test. Many also have limited or inconsistent access to health care, including HIV testing and prevention education, and prior research has documented that youth lack knowledge necessary to understand the HIV test process and to interpret test results. Computer-based interventions have been used to increase HIV test rates and knowledge among emergency department (ED) patients, including those who decline tests offered at triage. However, patients aged 18-24 years have been less likely to test, even after completing an intervention, compared to older patients in the same ED setting. The current pilot study sought to examine the feasibility and acceptability of a new tablet-based video intervention designed to address established barriers to testing among ED patients aged 18-24 years. In particular, we examined whether young ED patients would: agree to receive the intervention; complete it quickly enough to avoid disrupting clinical workflows; accept HIV tests offered by the intervention; demonstrate increased postintervention knowledge; and report they found the intervention acceptable. Over 4 weeks, we recruited 100 patients aged 18-24 in a high-volume urban ED; all of them declined HIV tests offered at triage. Almost all (98%) completed the intervention (mean time <9 mins), 30% accepted HIV tests offered by the tablets. Knowledge was significantly higher after than before the intervention (t = -6.67, p < .001) and patients reported generally high acceptability. Additional research appears warranted to increase postintervention HIV testing.

Importance of body weight and skin color in determining appropriate vitamin D3 supplement doses for children and adolescents.

BACKGROUND: Deficiencies in vitamin D directly impact children's health and place minority and obese youth at risk for a range of health issues. The Institute of Medicine (IOM) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium has set both a recommended daily allowance (RDA) for vitamin D supplementation and a population-wide sufficiency target for the biomarker of vitamin D status, serum 25-hydroxyvitamin D (25(OH)D). However, new research suggests that the RDA is not sufficient to meet the target biomarker status for individuals who are heavy or who have dark skin. Our objective was to provide appropriate daily vitamin D supplementation levels for these individuals. METHODS: Using data derived from the National Health and Nutrition Examination Survey (NHANES) and a recently published dosing formula, we calculated the required supplemental dose of vitamin D to meet the IOM target in children and adolescents. RESULTS: To be sure that 95% of the target population meets the IOM's population-wide biomarker target, some individuals require a daily dose of up to 2,000 international units (IUs) of supplemental vitamin D. CONCLUSION: Health professionals should work with their patients to encourage lifelong vitamin D supplement use at a dosage sufficient to obtain adequate 25(OH)D levels.

Computer-based video to increase HIV testing among emergency department patients who decline.

The Centers for Disease Control and Prevention recommend routine HIV screening in clinical settings, including emergency departments (EDs), because earlier diagnosis enables treatment before symptoms develop and delivery of interventions to reduce continued transmission. However, patients frequently decline testing. This study delivered a 16-min video-based intervention to 160 patients who declined HIV tests in a high volume, urban ED. One third of participants (n = 53) accepted an HIV test post-intervention. Interviews with a subset of participants (n = 40) show that before the video, many were unaware HIV testing could be conducted without drawing blood, or that results could be delivered in 20 min.

Technology-related distracted walking behaviours in Manhattan's most dangerous intersections.

Use of mobile devices has been cited as a distraction while driving, and more recently, among pedestrians crossing urban streets. In 2010, over half of New York City traffic fatalities were pedestrians. The aim of this study was to estimate the prevalence of distracted walking due to pedestrians' use of headphones, mobile phones, or both. Data were gathered by direct observations at the 10 intersections in Manhattan with the highest frequency of pedestrian-motor vehicle collisions. More than 1 in 4 of the >3500 pedestrians observed were distracted by mobile electronic devices while crossing during the 'walk' (28.8%) and 'don't walk' (26.3%) signals. Poisson regression analyses established there was a significant difference in individuals talking on a mobile device during the 'walk' signal versus the 'don't walk' signal; however, no other significant differences in other distracted walking behaviours were observed. This study contributes to the emerging literature on distracted walking behaviour by pedestrians in busy urban areas and can help to inform pedestrian-focused safety efforts.

Helmet use among users of the Citi Bike bicycle-sharing program: a pilot study in New York City.

The use of bicycle helmets to prevent or reduce serious head injuries is well established. However, it is unclear how to effectively promote helmet use, particularly in the context of bicycle-sharing programs. The need to determine rates of helmet use specifically among users of bicycle-sharing programs and understand if certain characteristics, such as time of day, affect helmet use, is imperative if effective promotion and/or legislative efforts addressing helmet use are to be developed. We estimated the prevalence of helmet use among a sample of Citi Bike program users in New York City. A total of 1,054 cyclists were observed over 44 h and across the 22 busiest Citi Bike locations. Overall, 85.3% (95% CI 82.2, 88.4%) of the cyclists observed did not wear a helmet. Rates of helmet non-use were also consistent whether cyclists were entering or leaving the docking station, among cyclists using the Citi Bikes earlier versus later in the day, and among cyclists using the Citi Bikes on weekends versus weekdays. Improved understanding about factors that facilitate and hinder helmet use is needed to help reduce head injury risk among users of bicycle sharing programs.

Helmet use among cyclists in New York City.

Lack of helmet use while bicycling can have deleterious effects on health. Despite evidence that helmets can greatly reduce the risk of head injury, the prevalence of helmet use among riders, including those in urban bicycle-share programs, has been shown to be very low. Building upon the authors' previous work, this study's aim was to assess prevalence of helmet use among cyclists riding on widely used New York City (NYC) bike lanes. Across a 2-month period, cyclists were filmed in five NYC locations with bike lanes. Filming took place at two separate time periods (recreation and commute) at each location. Helmet use was coded for each cyclist. A total of 1,921 riders were observed across 10 h. Overall, half (50.0 %) of all riders were observed wearing a helmet. Rates of using a helmet were consistent across all five locations. In addition, only 21.7 % of Citi Bike users and 15.3 % of other bicycle rentals were observed wearing helmets while cycling. The prevalence of helmet use was significantly higher among males than females (z = 4.48, p < .001). Cyclists observed during the recreational time period were also less likely than those observed during the commuting time period to be wearing a helmet (z = 7.17, p < .001). The results of this study contribute to the growing literature about cyclist helmet use in urban areas.

Use of sunscreen and indoor tanning devices among a nationally representative sample of high school students, 2001-2011.

Adolescents are particularly vulnerable to engaging in poor skin-protection behaviors. The objective of this study was to examine use of sunscreen and indoor tanning devices among a nationally representative sample of high school students during a 10-year period (2001-2011) using data from the Youth Risk Behavior Surveillance System. The percentage of youth who reported using sunscreen declined from 67.7% in 2001 to 56.1% in 2011. The prevalence of using indoor tanning devices was highest among white females: 37.4% in 2009 and 29.3% in 2011. These findings indicate the need for prevention efforts aimed at adolescents to reduce risks for skin cancer.

Prevalence of sleep duration on an average school night among 4 nationally representative successive samples of American high school students, 2007-2013.

Consistency, quality, and duration of sleep are important determinants of health. We describe sleep patterns among demographically defined subgroups from the Youth Risk Behavior Surveillance System reported in 4 successive biennial representative samples of American high school students (2007 to 2013). Across the 4 waves of data collection, 6.2% to 7.7% of females and 8.0% to 9.4% of males reported obtaining 9 or more hours of sleep. Insufficient duration of sleep is pervasive among American high school students. Despite substantive public health implications, intervention research on this topic has received little attention.

Gun-free zones and active shootings in the United States: a matched case-control study.

Background: Most Americans believe that gun-free zones make locations more vulnerable to violent crimes, particularly active shootings. However, there is no empirical evidence regarding the impact of gun-free zones on protecting locations from violence. The objective of this study was to estimate the association between gun-free zones and active shootings. Methods: We used a pair-matched case-control study where cases were all US establishments where active shootings occurred between 2014 and 2020, and controls were randomly selected US establishments where active shootings could have but did not occur, pair-matched by establishment type, year, and county. Gun-free status of included establishments was determined via local laws, company policy, news reporting, Google Maps and posted signage, and calling establishments. Findings: Of 150 active shooting cases, 72 (48.0%) were determined to have occurred in a gun-free zone. Of 150 controls where no active shooting occurred, 92 (61.3%) were determined to be gun-free. After accounting for matched pairs, the conditional odds of an active shooting in gun-free establishments were 0.38 times those in non-gun-free establishments, with a 95% confidence interval of 0.19-0.73 (p-value = 0.0038). Several robustness analyses affirmed these findings. Interpretation: It is unlikely that gun-free zones attract active shooters; gun-free zones may be protective against active shootings. This study challenges the proposition of repealing gun-free zones based on safety concerns. Funding: This work was funded in part by the National Collaborative on Gun Violence Research and the Arnold Foundation.

Protocol for a nationwide case-control study of firearm violence prevention tactics and policies in K-12 schools.

BACKGROUND: Most U.S. K-12 schools have adopted safety tactics and policies like arming teachers and installing metal detectors, to address intentional school gun violence. However, there is minimal research on their effectiveness. Furthermore, sociodemographic factors may influence their implementation. Controlled studies are necessary to investigate their impact on gun violence and related disciplinary outcomes. OBJECTIVE: The paper outlines the protocol for a case-control study examining gun violence prevention policies in U.S. K-12 schools. The study aims to investigate if there is an association between the total number and type of specific safety tactics and policies and the occurrence of intentional shootings in K-12 public schools, student disciplinary outcomes, and if urbanicity, economic, and racial factors modify these associations. METHODS: We will create a nationally representative dataset for this study and ascertain a full census of case schools (schools that experienced intentional gunfire on the campus during school hours since 2015) through national school shooting databases. Matched control schools will be randomly selected from U.S. Department of Education's national database of all public schools. We will analyze 27 school safety strategies organized into seven key exposure groupings. RESULTS: Supported by the National Institutes for Child Health and Development (R01HD108027-01) and having received Institutional Review Board approval, our study is currently in the data collection phase. Our analytical plan will determine the association between the number and type of school safety tactics and policies with the occurrence of intentional shootings and suspensions and expulsions in a national sample of approximately 650 K-12 public schools. Additional analyses will investigate the effect modification of specific covariates. CONCLUSION: As the first national, controlled study, its results will provide novel and needed data on the effectiveness of school safety tactics and policies in preventing intentional shootings at K-12 public schools.

Advertising of toothpaste in parenting magazines.

We assessed advertisements for children's toothpaste in two widely read US parenting magazines. Data on the number and type of toothpaste advertisements in two parenting magazines were collected from 116 magazine issues between 2007 and 2011. The number of children's toothpaste advertisements per year and across magazines was computed. The amount of toothpaste presented in each advertisement was categorized. We noted whether the toothpaste advertisement stated that the toothpaste was fluoridated. We identified a total of 117 children's toothpaste advertisements in these magazines and confirmed that the majority of the magazine issues contained at least one toothpaste advertisement. Of the 31 advertisements that depicted a picture of a toothbrush with toothpaste, all but one (96.8 %) depicted a full swirl of toothpaste covering the entire toothbrush head, which is well over the recommended amount. The pictures on the advertisements show an excessive amount of toothpaste on the brush, which directly conflicts with the instructions on many toothpastes and dentist recommendations. Those advertisements with photographs that depict a toothbrush with a full brush head of toothpaste are showing over four times the recommended amount for children.