Innovative outpatient treatment for veterans and service members and their family members.

In 2009, Massachusetts General Hospital and the Red Sox Foundation launched Home Base, a nonprofit dedicated to providing care to veterans, service members, and their loved ones who struggle with the invisible wounds of war free of charge. Significant needs exist for mental health services in each of these populations, and a need for innovative approaches to address shortcomings in existing treatment models. Three inventive components of our programming are highlighted herein: a Veteran Outreach Team, which helps to engage patients in care, programming, and services specifically for family members, and an intensive outpatient substance use treatment program. More than 4,000 patients, 3,031 veterans and service members, and 1,025 family members have engaged in treatment at Home Base. Patients were asked to complete post-treatment self-measures, including a satisfaction questionnaire via an electronic data collection system. The vast majority of individuals who engaged in our treatment model were satisfied with the care they received (>92%) and would refer their peers to the Home Base program (>75%). Data from 78 individuals who completed the dual diagnosis services demonstrated large effect sizes in reductions in alcohol use and comorbid mental health symptoms. These data suggest that novel components to the standard outpatient mental health model might provide substantive benefits for the patients served. While internal data is prone to a lack of generalizability, these additional offerings help ameliorate patients' expressed shortcomings with existing models; present literature that describes the benefits that these additions provide is also reviewed. The lessons learned and limitations are discussed.

Firearm-Related Lead Exposure and Child Lead Levels in the United States, 2012-2018.

OBJECTIVE: To determine if firearm ownership is positively related to elevated child lead levels at a state-level, even when accounting for other sources of lead. STUDY DESIGN: For this cross-sectional ecological study, we investigated whether household firearm ownership rates (a proxy for firearm-related lead exposure) was associated with the prevalence of elevated child blood lead levels in 44 US States between 2012 and 2018. To account for potential confounding, we adjusted for other known lead exposures, poverty rate, population density, race, and calendar year. To address missing data, we used multiple imputation by chained equations. RESULTS: Prevalence of elevated child blood lead positively correlated with household firearm ownership and established predictors of lead exposure. In fully adjusted negative binomial regression models, child blood lead was positively associated with household firearm ownership and older housing; each IQR (14%) increase in household firearm ownership rate was associated with a 41% higher prevalence of childhood elevated blood lead (prevalence ratio: 1.41, 95% CI: 1.11-1.79). CONCLUSION: These data provide state-level evidence that firearms may be an important source of child lead exposure. More research is needed to substantiate this relationship and identify modifiable pathways of exposure at the individual level.

Firearm-related lead exposure and pediatric lead levels in Massachusetts: A decade of evidence (2010-2019).

The US has more firearms than any other country in the world and uses lead ammunition almost exclusively. Lead exposure is a significant public health concern and children are at the greatest risk given their exposure to take-home lead. Firearm-related take-home lead exposure may be one of the greatest influences on elevated pediatric blood lead levels. For this ecological and spatial investigation of the relationship between firearm licensure rates as a proxy for firearm-related lead exposure and prevalence of children with blood lead levels ≥5 µg/dL in 351 cities/towns in Massachusetts, we used 10 years of data (2010-2019). We examined this relationship against other known contributors to pediatric lead exposure including old housing stock (lead paint/dust), occupations, and lead in water. Pediatric blood lead levels were positively correlated with licensure, poverty, and certain occupations and negatively correlated with lead in water and police or firefighter employment. Firearm licensure was a major significant predictor of pediatric blood lead alone (ß = 0.13; 95% CI, 0.10, 0.17) and across all regression models. The final model predicted over half the variation in pediatric blood lead (Adjusted R2 = 0.51). Negative binomial analysis found cities/towns with more firearms had higher pediatric blood lead levels (highest quartile fully adjusted prevalence ratio ((aPR) = 1.18; 95% CI, 1.09, 1.30) with a significant increase in pediatric blood lead per increase in firearms (p < 0.001). There were no significant spatial effects, suggesting that although there could be other factors impacting elevated pediatric blood lead, they are unlikely to influence spatial associations. Our paper provides compelling evidence of a potential and dangerous link between lead ammunition and child blood lead levels and is the first to do so using multiple years' worth of data. More research is required to substantiate this relationship on the individual-level and into prevention/mitigation.

Firearm licenses associated with elevated pediatric blood lead levels in Massachusetts.

OBJECTIVE: To determine the association between firearm-related lead exposure and pediatric blood lead levels. METHODS: Using data available through the Massachusetts Departments of Public Health and Criminal Justice Information Services, we examined the association between active class A firearm licenses in a community with the prevalence of elevated blood lead levels in children aged 0-4. Correlational and hierarchical multiple regression analyses were conducted with potential confounders and other exposures such as lead paint, lead in water, presence of firing ranges, and social, economic, and occupational variables. RESULTS: Data from 351 Massachusetts sub-counties were examined. Sub-counties with higher rates of firearm licensure also report higher rates of lead exposure among children. Children in the highest quartile communities were 2.16 times more likely to have elevated BLLs when compared to their peers in the lower quartiles. A one standard deviation change in firearm licensure percentage was found to reflect a 0.96% increase in elevated pediatric blood lead levels. Regression analyses demonstrated that the inclusion of firearm licensure significantly improved the prediction of pediatric BLL. Models were adjusted for percent of a population employed in construction, agriculture, forestry, fishing, hunting, and mining, income distribution, and potential lead paint exposure, which were found to be the primary predictors of elevated pediatric blood lead levels. DISCUSSION: Firearm use and ownership remains one of the least researched areas in the public health sphere. While the risks of childhood lead exposure are widely understood, including the mechanisms of firearm-related lead exposure and tracking, to date no research has extensively examined it in children and on the community level. Our findings indicate a dire need for continued research on the risks associated with firearm use, ownership, and lead exposure.