Exploring Firearm Access, Carriage, and Possession among Justice-Involved Youth.

Firearm carriage and possession predicts youth firearm violence victimization and perpetration. This study describes self-reported factors associated with firearm access, carriage, and possession among justice-involved youth. We conducted an exploratory, mixed-methods study. Participants were recruited from May 2022 to February 2023 from the Juvenile Justice Collaborative, a diversion program for justice-involved youth. We used online anonymous surveys to investigate exposures related to firearm access, carriage, and possession. We performed semi-structured interviews using the phenomenology framework. We used descriptive statistics to examine firearm exposures by participant demographics. We performed qualitative analyses using an iterative approach with constant comparison to identify key themes. We completed 28 surveys and 5 interviews. Most survey participants identified as male (57%) and Black (61%) with a median age of 18 years. Interview participants described the socialization and cultural normalization of firearms, most prominently among peers. Survey participants reported whether they had ever carried (25%) or possessed (21%) a firearm. Survey and interview participants endorsed protection in the context of increasing violence exposure over time as the primary motivation for firearm possession. Interview participants describe accessing firearms primarily through social networks while survey participants also reported access from strangers (25%) and licensed sellers/gun dealers (18%). In conclusion, justice-involved youth believe firearm carriage and possession may be needed for protection due to increasing violence exposure. Further investigation is necessary to determine interventions that may decrease firearm access, carriage, and possession among justice-involved youth.

The Relationship Between Postoperative Complications and Children's Quality of Life: A Mediation Analysis to Explore the Role of Family Factors.

OBJECTIVES: To explore whether postoperative morbidities after pediatric cardiac surgery affected children's health-related quality of life (HRQOL) at 6 months, through potentially modifiable parental psychological factors. DESIGN: We undertook a mediation analysis, to explore the causal pathway, based on data from a prospective, case-matched cohort study. PATIENTS: Six hundred sixty-six children undergoing cardiac surgery. SETTING: Five centers in the United Kingdom. INTERVENTIONS: No intervention. MEASUREMENTS AND MAIN RESULTS: Cases of morbidity were identified early after pediatric cardiac surgery, and matched controls with no morbidities were identified at discharge. Four mediators were assessed at 6 weeks after surgery, using the PedsQL Family Impact Module (Parent HRQOL and Family Function) and the PHQ-4 (Anxiety and Depression). The study outcome of child HRQOL was assessed at 6 months with the PedsQL. Of 666 children, 408 (65% of those surviving) contributed to the primary outcome. Children who had extracorporeal life support (ECLS) ( n = 11) ( p < 0.05) and multiple morbidities ( n = 62) ( p < 0.01) had worse 6-month HRQOL than those with a single morbidity ( n = 125) or no morbidity ( n = 209). After adjustment for case mix complexity and sociodemographic variables, there were significant indirect effects of parent HRQOL at 6 weeks, on the PedsQL Total Score (ECLS, -5.1 [-8.4 to -1.8]; p = 0.003; multiple morbidities, -2.1 [-3.7 to -0.5]; p = 0.01), PedsQL Physical Score (ECLS, -5.1 [-8.7 to -1.4]; p = 0.007; multiple morbidities, -2.1 [-3.8 to -0.4]; p = 0.016), and PedsQL Psychosocial Score (ECLS: -5.3 [-8.7 to -1.8); p = 0.003; multiple morbidities, -2.2 [-3.9 to -0.5]; p = 0.01). The proportion of the total effect of ECLS and multiple morbidity on the study outcomes mediated through parent HRQOL ranges between 18% and 61%. There was no evidence that the other three mediators had indirect effects on the study outcome. CONCLUSIONS: Parental HRQOL at 6 weeks after surgery contributes to child HRQOL at 6 months, among those with the severest types of morbidity, and as such should be a target for future interventions.

Trends in Hospital Care for Intentional Assault Gunshot Wounds Among Residents of Cook County, Illinois, 2018-2020.

Objectives. To examine gun violence with respect to hospital visits for treatment of intentional assault gunshot wounds (IGWs). Methods. IGW-coded visits among residents of Cook County, Illinois, were matched to census zip code tabulation areas (ZCTAs) to map changes in IGW visit frequencies between 2018 and 2020. Patient characteristics were compared across years, and Poisson regression models for the likelihood of an inpatient admission or in-hospital death were estimated. Results. Over the study period, Cook County residents made 7122 IGW-coded hospital visits to 89 Illinois hospitals, resulting in $342 million in charges and 24 894 hospital days. The number of visits almost doubled between 2018 and 2020, from 1553 to 3031; 6 ZCTAs had increases of more than 60 visits. Approximately one third of patients with a visit were admitted, and 6.5% died. Conclusions. Hospital statistics do not include the full toll of nonfatal gun injuries or the costs of related community-level trauma. The health care system remains crucial in implementing epidemiological approaches to violence prevention. Addressing the national spike in shootings will require large investments in community economic development and a professional public safety workforce. (Am J Public Health. 2022;112(5):795-802. https://doi.org/10.2105/AJPH.2022.306747).

A Community-Based Youth Diversion Program as an Alternative to Incarceration, Illinois, 2017-2019.

The US justice system unfairly targets youths of color; systemic reform plus interventions to keep youths out of the justice system are needed. The Juvenile Justice Collaborative provided care coordination and wraparound services to adolescents in a diversion program from 2017 to 2019 in Cook County, Illinois. Youths showed increased strengths and decreased needs by program's end. Youths who successfully completed the program showed reduced recidivism compared with nonprogram youths. Community-based alternatives to incarceration may decrease life disruption, promote positive health and social outcomes, and reduce further justice involvement. (Am J Public Health. 2022;112(9):1265-1268. https://doi.org/10.2105/AJPH.2022.306946).

County-level associations between food retailer availability and violent crime rate.

BACKGROUND: Violent crime (i.e., homicide, armed robbery, aggravated assault, and rape) continues to be a major public health concern in America. Several studies have linked the availability and density of specific features of the retail food environment, such as convenience stores and liquor stores, to violent crime rates due to the criminal activity that often occurs in and near these retailers. Nevertheless, there continues to be limited understanding of how other features (e.g., grocery stores, supercenters, restaurants, etc.) are associated with violent crime occurrence. This study aimed to fill this gap in knowledge by examining U.S. county-level associations between food retailer availability and violent crime rate. METHODS: We analyzed 2014 data on 3108 counties from the U.S. Department of Agriculture's Food Environment Atlas and Department of Justice's Unified Crime Reporting Program. Per capita food retailer measures represented the number of stores per 10,000 county residents. Violent crime rate represented the number of police reported violent crimes per 10,000 county residents. We used spatial lag regression models to assess associations between per capita retailer availability and violent crime rate after adjusting for potential confounders (e.g., % under 18, % Black, % Hispanic, % poverty, population density, etc.). In addition, we examined stratified OLS regression models to evaluate associations by metropolitan county status. RESULTS: Adjusted spatial regression models revealed that greater supercenter availability [ß: 2.42; 95% CI: 0.91-3.93; p-value: 0.001] and greater fast food restaurant availability [ß: 0.30; 95% CI: 0.18-0.42; p-value: < 0.001] were associated with higher violent crime rate. Greater availability of farmers' markets [ß: -0.42; 95% CI: -0.77 - - 0.07); p-value: 0.02] was associated with lower violent crime rate. Associations varied between metropolitan and non-metropolitan counties. Stratified OLS models revealed that greater grocery store availability was associated with lower violent crime rate among metropolitan counties only. Greater fast food restaurant availability was associated with lower violent crime rate among non-metropolitan counties only. CONCLUSIONS: Certain features of the retail food environment appear to be associated with county-level violent crime rates in America. These findings highlight the need for additional research on the influence of food retail and food landscape on violent crime occurrence at the community level.

Long-term effects of a community-based positive youth development program for Black youth: health, education, and financial well-being in adulthood.

BACKGROUND: Childhood poverty is known to be associated with poor health. For youth living in extreme poverty, community-based programs focused on youth development are one strategy to improve health and well-being outcomes. However, very few evaluations of the long-term effectiveness of youth development programs have been conducted. The aim of this study was to assess the long-term effectiveness of a positive youth development program (PYD), serving a segregated housing project with a history of community violence, to improve the health, education, and financial well-being of its alumni. METHODS: A quasi-experimental causal comparative study design was used to study the effectiveness of the Cabrini-Green Youth Program (CGYP). CGYP alumni (mean: 16.8 +/- 7.4 years after program participation) were surveyed. For comparison, participants from the same housing project who were eligible to participate in the CGYP but did not, were identified. RESULTS: In total, 246/417 (59%) eligible alumni were located. 221 alumni were available to be interviewed; 191/221 (86%) completed the interview survey along with 143 in the comparison group. Both groups self-identified as being Black, African American, and of Other race. Alumni were younger (34.6 vs. 38.1 years, p < .001), less likely to be female (62% vs. 74%, p =.03), and more likely to have been abused as a child (26% vs. 11%, p = .001). The majority in both groups reported to be in good to excellent health (83% of alumni vs. 74% of comparison group). After adjusting for comparison group differences, alumni were more likely to have completed college, 24% vs. 12% (adjusted odds ratio (aOR) 2.47, 95% CI, 1.25-4.86), and to end up with some money at the end of the month, 35% vs. 19% (aOR 2.16, 95% CI, 1.17, 3.97). CONCLUSIONS: Participation in a PYD program starting at a young age may be associated with reduced poverty in adulthood, possibly aided by higher educational attainment and resultant increased income. PYD may be an effective strategy to supplement evidenced-based poverty reducing policies. This study of a voluntary, community-based PYD program is unique in its up to 33-year follow-up and an outcome assessment that measures more than knowledge change.

Screening Students and Staff for Asymptomatic Coronavirus Disease 2019 in Chicago Schools.

OBJECTIVES: To assess rates of asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positivity in K-8 schools with risk mitigation procedures in place, and to evaluate SARS-CoV-2 transmission in school and household contacts of these positive individuals. STUDY DESIGN: In this prospective observational study, screening testing for SARS-CoV-2 was performed by oropharyngeal swabbing and polymerase chain reaction (PCR) analysis in students and staff at K-8 private schools in high-risk Chicago ZIP codes. New coronavirus disease 2019 (COVID-19) diagnoses or symptoms among participants, household contacts, and nonparticipants in each school were queried. RESULTS: Among 11 K-8 private schools across 8 Chicago ZIP codes, 468 participants (346 students, 122 staff members) underwent screening testing. At the first school, 17 participants (36%) tested positive, but epidemiologic investigation suggested against in-school transmission. Only 5 participants in the subsequent 10 schools tested positive for an overall 4.7% positivity rate (1.2% excluding school 1). All but 1 positive test among in-person students had high PCR cycle threshold values, suggesting very low SARS-CoV-2 viral loads. In all schools, no additional students, staff, or household contacts reported new diagnoses or symptoms of COVID-19 during the 2 weeks following screening testing. CONCLUSIONS: We identified infrequent asymptomatic COVID-19 in schools in high-risk Chicago communities and did not identify transmission among school staff, students, or their household contacts. These data suggest that COVID-19 mitigation procedures, including masking and physical distancing, are effective in preventing transmission of COVID-19 in schools. These results may inform future strategies for screening testing in K-8 schools.

A cross-sectional study of opioid involvement in non-poisoning suicide - risks and prevention opportunities.

OBJECTIVE: To examine prevalence, demographic, and incident factors associated with opioid-positivity in Illinois suicide decedents who died by causes other than poisoning. METHOD: Cross-sectional study of Illinois' suicide decedents occurring between January 2015 and December 2017. Data come from the National Violent Death Reporting System. We used Chi-square tests to compare decedent and incident circumstance characteristics by opioid toxicology screen status. Incident narratives were analyzed to obtain physical and mental health histories and circumstances related to fatal injury events. RESULTS: Of 1007 non-poisoning suicide decedents screened for opioids, 16.4% were opioid-positive. White race, age 75 and over, and widowed or unknown marital status were associated with opioid-positivity. Among opioid-positive decedents, 25% had a history of substance use disorder (SUD), 61% depression, and 19% anxiety. The majority (52%) of opioid-positive decedents died by firearm, a higher percentage than opioid-negative decedents. CONCLUSION: The opioid overdose crisis largely has not overlapped with non-poisoning suicide in this study. Overall, our analyses have not identified additional risk factors for suicide among opioid-positive suicide decedents. However, the overlap between opioid-positivity, SUD, and physical and mental health problems found among decedents in our data suggest several suicide prevention opportunities. These include medication assisted treatment for SUD which has been shown to reduce suicide, screening for opioid/benzodiazepine overlap, and limiting access to lethal means during opioid use. Improved death scene investigations for substances and use of the Prescription Drug Monitoring Program to document prescriptions are needed to further understanding of the role of substances in non-poisoning suicide.

Eviction and Pediatric Health Outcomes in Chicago.

According to Eviction Lab there were 6877 evictions in Chicago in 2016. The rate was "1.1%" and came out to 18.79 evictions per day in Chicago in 2016. The presence of children in a household (HH) poses a greater risk for eviction than race or gender. Census tract-level data from the Chicago Department of Public Health, the Eviction Lab and American Community Survey was used to assess the relationship between eviction and pediatric health outcomes for 653 census tracts in Chicago. Correlation matrices and linear regression models were used to evaluate the relationship between eviction and health outcomes. Regression models were adjusted for the following: (1) female-led family HH with less than a high school degree and below poverty and (2) race/ethnicity. Compared to White Non-Hispanic HH, predominantly Black and Hispanic HH had higher rates of very low birth weight (VLBW), infant mortality (IM), eviction filings, and evictions. All covariates were found to be significantly correlated (p < 0.01). Eviction filing rates and eviction rates were significant predictors for both VLBW and IM in both unadjusted and adjusted models (p < 0.05). Though we cannot conclude causality, these results suggest that census tracts which experience high rates of eviction also experience high rates of VLBW and IM and this relationship should be further investigated.

Promoting Safe Firearm Storage in an Urban Neighborhood: The Views of Parents Concerning the Role of Health Care Providers.

Pediatric clinics are uniquely positioned to assess and advocate for the health and safety of Chicago's children in relation to accidental firearm-related injury and death. The best means of counseling families should be tailored to the individual community and patient population. We aimed to determine rates of firearm ownership and attitudes towards counseling about firearms in a community on the west side of Chicago with high rates of gun violence. An anonymous survey about gun ownership was administered at a federally qualified health center. The survey was completed by 206 adults with children less than 18 living in the home. A minority of participants (8.3%; n = 17) indicated that a gun was kept in or around the home. The majority of firearm owners reported using safe storage practices. However, just over half of the gun owners and non-gun owners had a favorable opinion of counseling about firearm safety in healthcare settings. Other strategies in addition to physician counseling will be required to promote safe firearm storage in this neighborhood with high rates of community violence.

Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review.

BACKGROUND: To provide optimal care, medical students should understand that the social determinants of health (SDH) impact their patients' well-being. Those charged with teaching SDH to future physicians, however, face a paucity of curricular guidance. OBJECTIVE: This review's objective is to map key characteristics from publications about teaching SDH to students in undergraduate medical education (UME). METHODS: In 2016, the authors searched PubMed, Embase, Web of Science, the Cochrane and ERIC databases, bibliographies, and MedEdPORTAL for articles published between January 2010 and November 2016. Four reviewers screened articles for eligibility then extracted and analyzed data descriptively. Scoping review methodology was used to map key concepts and curricular logistics as well as educator and student characteristics. RESULTS: The authors screened 3571 unique articles of which 22 were included in the final review. Many articles focused on community engagement (15). Experiential learning was a common instructional strategy (17) and typically took the form of community or clinic-based learning. Nearly half (10) of the manuscripts described school-wide curricula, of which only three spanned a full year. The majority of assessment was self-reported (20) and often related to affective change. Few studies objectively assessed learner outcomes (2). CONCLUSIONS: The abundance of initial articles screened highlights the growing interest in SDH in medical education. The small number of selected articles with sufficient detail for abstraction demonstrates limited SDH curricular dissemination. A lack of accepted tools or practices that limit development of robust learner or program evaluation was noted. Future research should focus on identifying and evaluating effective instructional and assessment methodologies to address this gap, exploring additional innovative teaching frameworks, and examining the specific contexts and characteristics of marginalized and underserved populations and their coverage in medical education.

Mapping Child Safety Seat Use in Cases of Fatal or Incapacitating Child Motor Vehicle Injury in Cook County, Illinois from 2011 to 2015.

Child safety seat use reduces the risk of fatal injury by 71% for infants and 54% for toddlers, yet more than one-third of child passengers killed in traffic crashes in the US are unrestrained. Nearly half (47%) of crash injuries occur within 5 miles of the injured person's home. Mapping the location of motor vehicle crashes resulting in serious or fatal injury to unrestrained child passengers may pinpoint high-risk neighborhoods. Illinois Department of Transportation data were used to map crashes that resulted in a fatal or incapacitating injury to a child passenger (age 0 to 8) in Cook County, IL from 2011 to 2015. Maptitude® Geographic Information System (GIS) software was used to identify hot spots of unrestrained child passenger injury on the South Side and West Side of Chicago. Of 174 zip codes in Cook County, 3 zip codes on the South Side of Chicago (60620, 60621; 60628) accounted for 11% of the total unrestrained fatalities and incapacitating injuries among children. Results of this study reveal the feasibility of detecting geographic disparities in child passenger safety at the zip code and neighborhood level and indicate the potential for more targeted allocation of resources.

Classifying Injuries in Young Children as Abusive or Accidental: Reliability and Accuracy of an Expert Panel Approach.

OBJECTIVE: To assess interrater reliability and accuracy of an expert panel in classifying injuries of patients as abusive or accidental based on comprehensive case information. STUDY DESIGN: Data came from a prospective, observational, multicenter study investigating bruising characteristics of children younger than 4 years. We enrolled 2166 patients with broad ranges of illnesses and injuries presenting to one of 5 pediatric emergency departments in whom bruises were identified during examination. We collected comprehensive data regarding current and past injuries and illnesses, and provided deidentified, standardized case information to a 9-member multidisciplinary panel of experts with extensive experience in pediatric injury. Each panelist classified cases using a 5-level ordinal scale ranging from definite abuse to definite accident. Panelists also assessed whether report to child protective services (CPS) was warranted. We calculated reliability coefficients for likelihood of abuse and decision to report to CPS. RESULTS: The interrater reliability of the panelists was high. The Kendall coefficient (95% CI) for the likelihood of abuse was 0.89 (0.87, 0.91) and the kappa coefficient for the decision to report to CPS was 0.91 (0.87, 0.94). Reliability of pairs and subgroups of panelists were similarly high. A panel composite classification was nearly perfectly accurate in a subset of cases having definitive, corroborated injury status. CONCLUSIONS: A panel of experts with different backgrounds but common expertise in pediatric injury is a reliable and accurate criterion standard for classifying pediatric injuries as abusive or accidental in a sample of children presenting to a pediatric emergency department.

Investigating the Support Networks for Mothers of a High-density Public Housing Community and the Effects of Housing Closures on These Support Systems.

Over the past few decades, public housing initiatives have focused on the decentralization of poverty by replacing high-density public housing (HDPH) models with lower-density, mixed-income models. This action has resulted in the displacement of families who had lived in these developments for generations. In past studies, public housing residents have been shown to have stronger social ties than those living in other types of assisted housing. Research on the dismemberment of US public housing has demonstrated a "root shock" or disruption in the support infrastructure in these resource-limited communities. The purpose of this study was to use intergenerational analysis to analyze support systems of mothers in a low-income community and to investigate how the dismemberment of a Chicago HDPH community, Cabrini Green, affected parenting experiences and support infrastructure. Two generations of the former HDPH community were interviewed: (Gen1) mothers who raised their children in Cabrini Green and (Gen2) their daughter(s) who were raised in Cabrini Green but who now raise their children elsewhere. Interviews were analyzed for common themes in relation to mental health, social support networks, and parenting experiences. Four main components of parenting support were identified: familial support, father of child support, community support, and institutional support. Interviews suggest that the closing of Cabrini-Green high-rise buildings impacted relative contributions from specific components of mothers' support infrastructure, particularly community and institutional support. Mothers with support void in one component of support had better outcomes if they had the reserve to compensate by increasing one or more other areas of support. Programs that foster other sources of parenting support during and after public housing closures may help to improve outcomes for mothers and their families. By analyzing the experiences of mothers of both generations, we also gain insight into how experiences of motherhood and support systems compared before and after Cabrini Green's dissolution as well as insight into the participants' views on the impact of the housing closing on the parenting experience.

Predictors of Emergency Department Utilization Among Children in Vulnerable Families.

Preventable visits to the emergency department (ED) are estimated to represent as much as 56% of overall annual ED utilization and contribute to the high cost of health care in the United States. There are more than 25 million annual pediatric ED visits. OBJECTIVE: The aim of this study was to identify factors associated with high ED utilization among children in vulnerable families. METHODS: The Fragile Families and Child Wellbeing Study is a longitudinal cohort of approximately 5000 vulnerable children. Data from the 9-year follow-up survey were used in this analysis. Bivariate and multivariate logistic regression analyses were performed to identify correlates with high ED utilization (≥4 visits per year). RESULTS: 2631 children were included in the analysis. In a multivariate model controlling for the child's sex, race, household income, and insurance status, 4 variables were significant predictors of ED utilization: history of hospitalization within the last year (odds ratio [OR], 15.97; 95% confidence interval [CI], 6.64-38.41; P < 0.001), diagnosis of asthma (OR, 2.53; 95% CI, 1.17-5.44; P = 0.02), number of child's office/clinic visits within the last year (OR, 1.22; 95% CI, 1.12-1.33; P < 0.001), and number of primary caregiver ED visits within last year (OR, 1.15; 95% CI, 1.03-1.28; P = 0.01). CONCLUSIONS: History of hospitalization, outpatient visits, primary caregiver ED utilization, and diagnosis of asthma independently predict high ED utilization by 9-year-old children in fragile families. Augmented continuity of care, disease management, and caregiver education may reduce high ED utilization in this population.

Pneumonia and gastritis in a cat caused by feline herpesvirus-1.

We report a case of fatal respiratory and gastric herpesvirus infection in a vaccinated, adult cat with no known immunosuppression or debilitation. The disease was characterized by severe necrotizing bronchopneumonia, fibrinonecrotic laryngotracheitis, and multifocal necrotizing gastritis associated with eosinophilic intranuclear inclusion bodies and a large amount of feline herpesvirus-1 antigen detected with immunohistochemistry.

Pneumonie et gastrite chez un chat causées par l'herpèsvirus-1 félin. Nous signalons un cas d'atteinte respiratoire et gastrique mortel causé par l'infection à l'herpèsvirus chez un chat adulte vacciné sans immunosuppression ni affaiblissement. La maladie a été caractérisée par une bronchopneumonie nécrosante grave, une laryngotrachéite fibrinonécrosante et une gastrite nécrosante multifocale associée à des corps d'inclusion intranucléaire acidophiles et une grande quantité d'antigènes de l'herpesvirus-1 félin détectée par analyse immunohistochimique.(Traduit par Isabelle Vallières).