Extreme risk protection orders in King County, Washington: the epidemiology of dangerous behaviors and an intervention response.

BACKGROUND: Extreme Risk Protection Order (ERPO) laws are a promising gun violence prevention strategy. ERPO laws allow specific categories of people (law enforcement in all states, family in most) to petition a court to request that an individual be temporarily prohibited from purchasing and possessing firearms because that individual is behaving dangerously and at risk of violence, either to themselves or others. In 2017 Washington State's ERPO law took effect. King County developed a comprehensive approach to implementing the ERPO law. The early experience of King County offers important insight into how early adopters of these laws are incorporating EPROs into their approach to gun violence prevention. METHODS: We systematically reviewed, abstracted and coded data from every ERPO petition filed in King County in 2017 and 2018, and all ERPO court records associated with those petitions. We conducted descriptive analyses of the coded data. RESULTS: Seventy-five ERPO petitions were filed in King County during the study period. Judges granted a temporary ERPO in all 75 cases; 65 (87%) of these cases resulted in a one-year ERPO. Law enforcement initiated 73 (97%) of these petitions, and family members filed the remaining two. The 75 petitions filed described respondents' risk as to "themselves only" in 30 cases (40%), to "others only" in 20 cases (27%) and "to themselves and others" in 25 cases (33%). Five cases where the threat was to "others only" met a definition of mass shooting threat. For 95% of the temporary ERPOs issued, the courts' reasoning for issuing ERPOs included either current violence or brandishing a firearm. Court records for the 75 cases detail firearms removed and/or include receipts for removed firearms in 61 cases (81%) either as part of ERPO precipitating events (n = 13, 17%) or in conjunction with ERPO service (n = 48, 64%). CONCLUSIONS: These findings suggest that Washington's ERPO law is being applied when someone is threatening violence to self or others, or brandishing a gun and at least one other risk factor is present. The early experience of King County provides insight into how this law is being implemented in one jurisdiction and how courts are evaluating such cases.

Limiting access to lethal means: applying the social ecological model for firearm suicide prevention.

This paper outlines a novel application of the social ecological model (SEM) for firearm suicide prevention. It focuses on four levels of intervention (societal, relationship, community and individual) to reduce access to firearms, a practical contributor to the capacity to attempt suicide, from individuals when they are at an elevated risk for suicide. There is substantive research linking easy access to firearms with an increased risk of firearm suicide, and suicide prevention interventions that address access to lethal means are critical components of a comprehensive suicide prevention strategy. Potential interventions using the SEM framework include: at the policy level-extreme risk laws, voluntary self-prohibition policies and policies that reduce the availability of firearms; at the community level-gun shop projects; at the relationship level-lethal means safety counselling; and at the individual level-safer storage. Taken together with upstream interventions, such as increased access to mental health services and substance use treatment, a multilevel approach for suicide prevention that addresses access to firearms can save lives.

Parental social networks during childhood and offspring depression in early adulthood: a lifecourse approach.

BACKGROUND: Little is known on how parental social relationships may affect their children's mental health. We sought to examine the relation between parental social relationship characteristics and subsequent offspring depression in young adulthood. METHODS: We used 2009 Trajectoires Épidémiologiques en Population (TEMPO) study data from 1087 French young adults ages 22 to 35 and parental data from the corresponding Gaz et Eléctricité (GAZEL) study in 1991. Multivariable logistic regression was used to examine parental social networks, quality of parental relationships, and reciprocity of parental social support measured in 1991 in relation to offspring depression in young adulthood measured using the Adult Self Report in 2009. Analyses were stratified by participant sex. RESULTS: In adjusted models, daughters of parents who reported giving more support to others than they received had 1.72 higher odds (95% CI, 1.09-2.70) of depression in young adulthood. Daughters of parents who were unsatisfied with their social relationships had 2.14 (95% CI, 1.22-3.76) higher odds of depression. Among male participants, there was no statistically significant association between parental relationship satisfaction, reciprocity of parental exchanges, and depression. CONCLUSIONS: Parental relationships during mid-childhood have long-term associations with offspring depression. Results suggest that enhancing social support for parents may have positive implications for their children's mental health.

Disparities in human papillomavirus vaccine awareness among U.S. parents of preadolescents and adolescents.

BACKGROUND: Improved parental awareness of human papillomavirus (HPV) vaccines could increase uptake of vaccines early in the life course, thereby reducing adolescents' later risk for HPV infection and cancer. As such, we sought to determine factors related to parental awareness of HPV vaccines, using a nationally representative population-based sample. METHODS: We examined data on 5735 parents of preadolescents and adolescents aged 8 to 17 years from the 2010 National Health Interview Survey. Parents were asked if they had ever heard of HPV vaccines or shots. Multivariable logistic regression analyses were used to examine the odds of parental awareness of HPV vaccines, controlling for relevant covariates. RESULTS: Most US parents (62.6%) heard of HPV vaccines. Multivariable results revealed parents of children who were older, female, and insured were more likely to have heard of HPV vaccines; parents who were female, white (non-Hispanic), English speakers, born in the United States, married or living with a partner, more educated, and had higher income were also more likely to be aware of HPV vaccines. Notably, parents of children who had a well-child checkup in the last 12 months were significantly more likely to have heard of HPV vaccines (odds ratio, 1.23; 95% confidence interval, 1.04-1.46). CONCLUSIONS: Given the significant disparities in parental awareness of HPV vaccines, improving access to preventive pediatric health care could offer an opportunity to increase parental awareness. In addition, public health efforts that provide culturally sensitive information in a variety of languages may be an effective way to reach vulnerable groups.

Parental depressive symptoms and childhood cancer: the importance of financial difficulties.

PURPOSE: Research suggests a relationship between caring for a child with cancer and psychological distress in caregivers. Less evident is the role which financial difficulties might play in this relationship. We sought to determine if caring for a child with cancer was related to clinically relevant depressive symptoms among parents, whether or not financial difficulties mediated this relationship, and if financial difficulties were independently associated with symptoms of depression among parents of children with cancer. METHODS: Data are from 215 parents of children diagnosed with cancer or brain tumors (n = 75) and a comparison group of parents of healthy children (n = 140). Multiple logistic regression analyses were used to assess the factors associated with reporting clinically relevant depressive symptoms. RESULTS: Caring for a child with cancer was associated with increased odds of clinically relevant depressive symptoms in parents (OR = 4.93; 95 % CI 1.97-12.30), controlling for covariates. The mediating effect of financial burden on this relationship was not statistically significant. However, among parents of children with cancer, negative financial life events increased the likelihood of reporting symptoms of depression (OR = 4.89; 95 % CI 1.26-18.96). CONCLUSIONS: Caring for a child with cancer was associated with depressive symptoms for parents. Financial difficulties were the strongest correlate of these symptoms among parents of children with cancer. Our results suggest that it may not only be the burden of caring for the child with cancer but also the associated financial difficulties that contribute to a higher likelihood of depressive symptoms in parents.