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Armas de Fuego , Suicidio , Heridas por Arma de Fuego , Homicidio , Humanos , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: The majority of homicides (79%) and suicides (53%) in the United States involved a firearm in 2020. High firearm homicide and suicide rates and corresponding inequities by race and ethnicity and poverty level represent important public health concerns. This study examined changes in firearm homicide and firearm suicide rates coinciding with the emergence of the COVID-19 pandemic in 2020. METHODS: National vital statistics and population data were integrated with urbanization and poverty measures at the county level. Population-based firearm homicide and suicide rates were examined by age, sex, race and ethnicity, geographic area, level of urbanization, and level of poverty. RESULTS: From 2019 to 2020, the overall firearm homicide rate increased 34.6%, from 4.6 to 6.1 per 100,000 persons. The largest increases occurred among non-Hispanic Black or African American males aged 10-44 years and non-Hispanic American Indian or Alaska Native (AI/AN) males aged 25-44 years. Rates of firearm homicide were lowest and increased least at the lowest poverty level and were higher and showed larger increases at higher poverty levels. The overall firearm suicide rate remained relatively unchanged from 2019 to 2020 (7.9 to 8.1); however, in some populations, including AI/AN males aged 10-44 years, rates did increase. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: During the COVID-19 pandemic, the firearm homicide rate in the United States reached its highest level since 1994, with substantial increases among several population subgroups. These increases have widened disparities in rates by race and ethnicity and poverty level. Several increases in firearm suicide rates were also observed. Implementation of comprehensive strategies employing proven approaches that address underlying economic, physical, and social conditions contributing to the risks for violence and suicide is urgently needed to reduce these rates and disparities.
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COVID-19 , Armas de Fuego , Suicidio , Causas de Muerte , Homicidio , Humanos , Masculino , Pandemias , Vigilancia de la Población , Estados Unidos/epidemiología , Signos VitalesRESUMEN
BACKGROUND: Exposure to injury and violence early in life increases the risk of experiencing injury and violence later in life. In 2019, the top 3 leading causes of death among 15- to 18-year-olds in the United States were unintentional injury, suicide, and homicide. This study examines the extent to which schools promote injury and violence prevention. METHODS: This study examined injury- and violence-related school policies and practices using nationally representative data from the 2014 School Health Policies and Practices Study. The social ecological model served as the theoretical framework to identify level of impact. RESULTS: For many injury-related topics, more than 75% of schools nationwide had relevant policies and practices to address those topics. However, this study showed differences in schools' injury-related policies and practices by urbanicity. CONCLUSIONS: Understanding and identifying gaps in school policies and practices is essential for reducing and preventing the injury and violence children experience. Collecting data on school policies and practices allows for better monitoring and evaluation to determine which are efficacious and aligned with the best available evidence.
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Servicios de Enfermería Escolar , Instituciones Académicas , Niño , Política de Salud , Humanos , Encuestas y Cuestionarios , Estados Unidos , Violencia/prevención & controlRESUMEN
Importance: The association between online activities and youth suicide is an important issue for parents, clinicians, and policy makers. However, most information exploring potential associations is drawn from survey data and mainly focuses on risk related to overall screen time. Objective: To evaluate the association between a variety of online risk factors and youth suicide-related behavior using real-world online activity data. Design, Setting, and Participants: A matched case-control study was conducted from July 27, 2019, to May 26, 2020, with the sample drawn from more than 2600 US schools participating in an online safety monitoring program via the Bark online safety tool. For 227 youths having a severe suicide/self-harm alert requiring notification of school administrators, cases were matched 1:5 to 1135 controls on location, the amount of follow-up time, and general volume of online activity. Exposures: Eight potential online risk factors (cyberbullying, violence, drug-related, hate speech, profanity, sexual content, depression, and low-severity self-harm) through assessment of text, image, and video data. Main Outcomes and Measures: Severe suicide/self-harm alert requiring notification of school administrators; severe suicide alerts are statements by youths indicating imminent or recent suicide attempts and/or self-harm. Results: The 1362 participants had a mean (SD) age of 13.3 (2.41) years; 699 (51.3%) were male. All 8 online risk factors studied exhibited differences between case and control populations and were significantly associated with subsequent severe suicide/self-harm alerts when examining total direct and indirect pathways. These associations ranged from an adjusted odds ratio (aOR) of 1.17 (95% CI, 1.09-1.26) for drug-related content to an aOR of 1.82 (95% CI, 1.63-2.03) for depression-related content. When considering the total number of different types of online risk factors among the 8 measured, there was an exponentially larger risk of severe suicide/self-harm alerts; youths with 5 or more of the 8 risk factors present in their online activity had a more than 70-fold increased odds of subsequently having a severe suicide/self-harm alert (aOR, 78.64; 95% CI, 34.39-179.84). Conclusions and Relevance: The findings of this study suggest that many discrete types of risk factors are identifiable from online data and associated with subsequent youth suicide-related behavior. Although each risk factor carries a specific association with suicide-related behavior, the greatest risk is evident for youths demonstrating multiple types of online risk factors.
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Uso de Internet , Asunción de Riesgos , Intento de Suicidio/psicología , Adolescente , Estudios de Casos y Controles , Ciberacoso , Depresión/psicología , Femenino , Humanos , Masculino , Factores de Riesgo , Autoimagen , Conducta Autodestructiva/psicología , Trastornos Relacionados con Sustancias/psicología , ViolenciaRESUMEN
Preadolescents' involvement in religious congregations may serve as a distal protective factor against aggression. Interviews were conducted to explore Puerto Rico (PR) Christian church and faith-based organization (FBO) leaders' knowledge and perceptions about preadolescent violence, and the role of congregations in its prevention. Bullying was perceived as the most common type of aggression among PR preadolescents. Education, positive role modeling, and relationships with pro-social adults are considered important in its prevention. While willing to engage in violence prevention efforts, congregations may possess limited knowledge on the topic and its relevance. Findings can help inform the development of collaborative research and prevention efforts at the family and community levels.
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Agresión , Cristianismo , Adulto , Humanos , Protestantismo , Puerto Rico , ViolenciaRESUMEN
Naloxone administration is an important component of resuscitation attempts by emergency medical services (EMS) for opioid drug overdoses. However, EMS providers must first recognize the possibility of opioid overdose in clinical encounters. As part of a public health response to an outbreak of opioid overdoses in Rhode Island, we examined missed opportunities for naloxone administration and factors potentially influencing EMS providers' decision to administer naloxone. We reviewed medical examiner files on all individuals who died of an opioid-related drug overdose in Rhode Island from January 1, 2012 through March 31, 2014, underwent attempted resuscitation by EMS providers, and had records available to assess for naloxone administration. We evaluated whether these individuals received naloxone as part of their resuscitation efforts and compared patient and scene characteristics of those who received naloxone to those who did not receive naloxone via chi-square, t-test, and logistic regression analyses. One hundred and twenty-four individuals who underwent attempted EMS resuscitation died due to opioid overdose. Naloxone was administered during EMS resuscitation attempts in 82 (66.1%) of cases. Females were nearly three-fold as likely not to receive naloxone as males (OR 2.9; 95% CI 1.2-7.0; p-value 0.02). Additionally, patients without signs of potential drug abuse also had a greater than three-fold odds of not receiving naloxone (OR 3.3; 95% CI 1.2-9.2; p-value 0.02). Older individuals, particularly those over age 50, were more likely not to receive naloxone than victims younger than age 30 (OR 4.8; 95% CI 1.3-17.4; p-value 0.02). Women, older individuals, and those patients without clear signs of illicit drug abuse, were less likely to receive naloxone in EMS resuscitation attempts. Heightened clinical suspicion for opioid overdose is important given the recent increase in overdoses among patients due to prescription opioids.
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Sobredosis de Droga/tratamiento farmacológico , Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Adulto , Estudios Transversales , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , ResucitaciónRESUMEN
BACKGROUND: Influenza vaccination is recommended annually for all persons 6 months and older. Reports of increased influenza-related morbidity and mortality during the 2013-2014 influenza season raised concerns about low adult influenza immunization rates in Puerto Rico. In order to inform public health actions to increase vaccination rates, we surveyed adults in Puerto Rico regarding influenza vaccination-related attitudes and barriers. METHODS: A random-digit-dialing telephone survey (50% landline: 50% cellphone) regarding influenza vaccination, attitudes, practices and barriers was conducted November 19-25, 2013 among adults in Puerto Rico. Survey results were weighted to reflect sampling design and adjustments for non-response. RESULTS: Among 439 surveyed, 229 completed the survey with a 52% response rate. Respondents' median age was 55 years; 18% reported receiving 2013-2014 influenza vaccination. Among 180 unvaccinated respondents, 38% reported barriers associated with limited access to vaccination, 24% reported they did not want or need influenza vaccination, and 20% reported safety concerns. Vaccinated respondents were more likely to know if they were recommended for influenza vaccination, to report greater perceived risk of influenza illness, and to report being less concerned about influenza vaccine safety (p-value<0.05). Of the 175 respondents who saw a healthcare provider (HCP) since July 1, 2013, 38% reported their HCP recommended influenza vaccination and 17% were offered vaccination. Vaccination rates were higher among adults who received a recommendation and/or offer of influenza vaccination (43% vs. 14%; p-value<0.01). CONCLUSIONS: Failure of HCP to recommend and/or offer influenza vaccination and patient attitudes (low perceived risk of influenza virus infection) may have contributed to low vaccination rates during the 2013-2014 season. HCP and public health practitioners should strongly recommend influenza vaccination and provide vaccinations during clinical encounters or refer patients for vaccination.
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Utilización de Medicamentos , Conocimientos, Actitudes y Práctica en Salud , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Aceptación de la Atención de Salud , Vacunación/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Puerto Rico , Adulto JovenRESUMEN
During November 2013-March 2014, twice as many all-intent drug overdose deaths were reported in Rhode Island as were reported during the same period in previous years. Most deaths were among injection-drug users, and a large percentage involved fentanyl, a synthetic opioid that is 50-100 times more potent than morphine. Clusters of fentanyl-related deaths have been reported recently in several states. From April 2005 to March 2007, time-limited active surveillance from CDC and the Drug Enforcement Administration identified 1,013 deaths caused by illicit fentanyl use in New Jersey; Maryland; Chicago, Illinois; Detroit, Michigan; and Philadelphia, Pennsylvania. Acetyl fentanyl, an illegally produced fentanyl analog, caused a cluster of overdose deaths in northern Rhode Island in 2013.
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Sobredosis de Droga/mortalidad , Fentanilo/envenenamiento , Causas de Muerte/tendencias , Centers for Disease Control and Prevention, U.S. , Humanos , Drogas Ilícitas/envenenamiento , Rhode Island/epidemiología , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
Youth violence is a critical public health problem across races/ethnicities in the United States. Although the differential association between substance use and physical aggression has been empirically proven, no tests have assessed the moderating effects of sociocultural differences in such associations. The purpose of this study is to test the moderating impact of race/ethnicity-as an indicator of sociocultural differences--on the associations between substance use and adolescent aggression, by conducting a validity assessment of a physical aggression measure for high school students with emphasis on Hispanics and other minorities. A cross-sectional, secondary data analysis of the 2007 national Youth Risk Behavior Survey, with a representative sample of all U.S. high school students, was conducted. Contingency table and chi-square test evaluated the statistical relationship between substance use (alcohol, marijuana, either, or both) and self-reports of physical aggression, race/ethnicity, age, and sex of the respondent. Three logistic regression analyses assessed the effect of race/ethnicity on the likelihood of reporting physical aggression by overall substance use and type of substance use. Statistical significant associations were found between physical aggression and alcohol and/or marijuana use. The self-report of substance use (marijuana or alcohol) and alcohol use significantly increased the likelihood of physical aggression across races/ethnicities, highest among racial/ethnic minorities (Blacks > Hispanic > Others > Whites). The differential impact of substance use on physical aggression was confirmed, and such impact was moderated by the sociocultural context (race/ethnicity) of the adolescent. In-depth validity assessments are needed to confirm this study's predictive validity findings.