Drinking and Intimate Partner Violence Severity Levels Among U.S. Ethnic Groups in an Urban Emergency Department.

BACKGROUND: Emergency departments (EDs) provide care to ethnically diverse populations with multiple health-related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines ethnic-specific 12-month rates of physical IPV by severity and their association with drinking and other sociodemographic and personality correlates in an urban ED sample. METHODS: Research assistants surveyed patients at an urban ED regarding IPV exposure as well as patterns of alcohol and drug use, psychological distress, adverse childhood experiences (ACEs), and other sociodemographic features. RESULTS: The survey (N = 1,037) achieved an 87.5% participation rate. About 23% of the sample reported an IPV event in the past 12 months. Rates were higher (p < 0.001) among blacks (34%), whites (31%), and multiethnic (46%) respondents than those among Asians (13%) and Hispanics (15%). Modeled results showed that black respondents were more likely than Hispanics (reference) to report IPV (adjusted odds ratio [AOR] = 1.69, 95% confidence interval [CI] = 1.98-2.66, p < 0.05) and that respondents' partner drinking was associated with IPV (AOR = 1.85, 95% CI = 1.25-2.73, p < 0.01) but respondents' drinking was not. Use of illicit drugs, younger age, impulsivity, depression, partner problem drinking, ACEs, and food insufficiency were all positively associated with IPV. CONCLUSIONS: There was considerable variation in IPV rates across ethnic groups in the sample. The null results for the association between respondents' drinking and IPV was surprising and may stem from the relatively moderate levels of drinking in the sample. Results for ethnicity, showing blacks as more likely than Hispanics to report IPV, support prior literature.

Catastrophic High School and Collegiate Cheerleading Injuries in the United States: An Examination of the 2006-2007 Basket Toss Rule Change.

BACKGROUND:: Cheerleading is a specialized athletic activity that can lead to catastrophic injuries. Cheerleading rules are in place to maximize safety of participants. The purpose of this study was to describe catastrophic cheerleading injuries among high school and collegiate-level participants in the United States and to explore whether the 2006-2007 basket toss rule change was effective at reducing the number of catastrophic injuries. HYPOTHESIS:: The 2006-2007 basket toss rule change contributed to a reduction in the number of catastrophic injuries among high school and collegiate cheerleaders. STUDY DESIGN:: Case series. LEVEL OF EVIDENCE:: Level 4. METHODS:: Data on catastrophic cheerleading injuries were collected by the National Center for Catastrophic Sport Injury Research from July 2002 to June 2017. Information collected included cheerleader, event, and injury characteristics. The impact of the 2006-2007 rule change banning the basket toss on any hard surfaces was assessed by comparing injury rates and 95% CIs before and after the rule change. RESULTS:: There were 54 catastrophic cheerleading injuries, or 3.6 injuries per year. From July 2002 through June 2017, the injury rate was 2.12 per 1,000,000 cheerleaders (95% CI, 1.56-2.69). Most cheerleaders sustained serious injuries (n = 27; 50%) during practice (n = 37; 69%) to the head (n = 28; 52%) and cervical spine (n = 17; 32%). From July 2002 through June 2017, basket tosses were the stunt that accounted for the highest proportion of injuries (n = 19; 35%). The basket toss injury rate decreased from 1.55 to 0.40 per 1,000,000 cheerleaders among both high school and collegiate cheerleaders after the rule change. CONCLUSION:: Catastrophic injury rates in cheerleading decreased dramatically after the 2006-2007 rule change banning basket tosses from being performed on any hard surfaces. In particular, there was a nearly 4-fold reduction in the rate of catastrophic basket toss injuries.

Epidemiology of asphyxiation suicides in the United States, 2005-2014.

BACKGROUND: From 2005 to 2014, the asphyxiation suicide rate in the United States (U.S.) increased by 45.7% from 2.45 to 3.57 per 100,000 population. The primary purpose of this cross-sectional study was to describe decedent and incident characteristics of asphyxiation suicides in the U.S. from 2005 to 2014. The secondary purpose of this study was to explore whether any demographic characteristics of asphyxia suicide decedents were associated with type of suicide incident. METHODS: Data from the National Violent Death Reporting System (NVDRS) were used to describe asphyxiation suicide mechanisms and means in 16 states. Anchor points of hanging suicides were also described. Mechanisms, means, and anchor points were determined through a text search of cause of death, coroner/medical examiner narrative, and law enforcement narrative. Multivariable logistic regression was conducted separately for females and males to estimate beta coefficients to obtain adjusted odds ratios (AORs) and 95% confidence intervals (CIs) to compare hanging-related asphyxiation and other types of asphyxiation. RESULTS: From 2005 to 2014, there were 25,270 asphyxiation suicides. Most decedents were male (79.9%) and white, non-Hispanic (76.8%). Most asphyxiation suicides involved hanging (90.7%, N = 22,931); 1717 (6.8%) involved smothering; 968 (3.8%) involved chemicals or gasses; and 145 (0.6%) involved strangulation. For hanging suicides, the three most commonly used means were power or extension cords (N = 1834), bedding (N = 873), and animal ropes (N = 578). The three most common anchor points for hanging suicides were trees (N = 2215), beams (N = 2014), and closets (N = 2009). Among females and males, odds of asphyxiation suicide were highest among those of Other, non-Hispanic race and black, non-Hispanic race, respectively [AOR (95% CI) = 3.73 (1.59, 8.79) and 2.72 (1.34, 5.50), respectively]. CONCLUSIONS: Commonly available objects are used in asphyxiation suicides. Modification of anchor points represents a potential solution for reducing hanging suicides. Changes in design and availability of grocery bags could help reduce smothering suicides. Strategies to reduce asphyxiation suicides need to be identified. Improving access to and utilization of mental health services can also reduce asphyxiation suicides. Future research should be conducted to better describe characteristics of asphyxiation suicide so that prevention efforts targeted by demographic subgroups can be implemented.

Potential Predictors of Injury Among Pre-Professional Ballet and Contemporary Dancers.

Injuries occur frequently among ballet and contemporary dancers. However, limited literature exists on injuries to pre-professional dancers in the USA. The goals of this study were to 1. provide a descriptive epidemiology of the incidence of musculoskeletal injuries in an adolescent and young adult dance population and 2. identify parsimonious regression models that could be potentially used to predict injury incidence. The study was based at the University of North Carolina School of the Arts (UNCSA) from Fall 2009 to Spring 2015. An injury was defined as any event that caused a dancer to be seen at the UNCSA Student Health Services and caused the dancer to modify or curtail dance activity for at least 1 day. Injury rate ratios (IRRs) were calculated using negative binomial generalized estimating equations. Models predicting injury rates were built using forward selection, stratified by sex. Among 480 dancers, 1,014 injuries were sustained. Most injuries were to the lower extremity and the result of overuse. There were differences in upper extremity, lower extremity, and traumatic injury rates by demographic subgroups. Among females, the most parsimonious predictive model for injury rates included a self-reported history of depression, age at time of injury, and number of injuries sustained at UNCSA prior to the semester of current injury. Among males, the most parsimonious model was a univariate model with family history of alcohol or drug problems. Strategies for traumatic injury prevention among dancers should be both sex- and style-specific. No differences were observed in overuse injury rates by sex or style, suggesting that generic overuse prevention strategies may not need to be guided by these factors. It is concluded that strategies can be implemented to reduce and mitigate the consequences of injuries if not the injuries themselves.

Traumatic Brain and Spinal Cord Fatalities Among High School and College Football Players - United States, 2005-2014.

An estimated 1.1 million high school and 75,000 college athletes participate in tackle football annually in the United States. Football is a collision sport; traumatic injuries are frequent (1,2), and can be fatal (3). This report updates the incidence and characteristics of deaths caused by traumatic brain injury and spinal cord injury (4) in high school and college football and presents illustrative case descriptions. Information was analyzed from the National Center for Catastrophic Sport Injury Research (NCCSIR). During 2005-2014, a total of 28 deaths (2.8 deaths per year) from traumatic brain and spinal cord injuries occurred among high school (24 deaths) and college football players (four deaths) combined. Most deaths occurred during competitions and resulted from tackling or being tackled. All four of the college deaths and 14 (58%) of the 24 high school deaths occurred during the last 5 years (2010-2014) of the 10-year study period. These findings support the need for continued surveillance and safety efforts (particularly during competition) to ensure proper tackling techniques, emergency planning for severe injuries, availability of medical care onsite during competitions, and assessment that it is safe to return to play following a concussion.

Does employee resistance during a robbery increase the risk of customer injury?

OBJECTIVE: Retail business robberies can lead to employee and customer injury. Previous work demonstrates that employee resistance increases employee injury risk; limited research has investigated customer injuries. This study examines associations between employee resistance against perpetrators and the risk of customer injury. METHODS: Retail and service robbery reports were obtained from a metropolitan police department. Generalized estimating equations estimated risk ratios and 95% confidence intervals (CIs). RESULTS: Customers were injured in 75 out of 697 robberies. Employees resisted the perpetrator in 32 out of 697 robberies. Customers had higher injury risk when employees resisted the perpetrator, compared with robberies where employees did not resist (adjusted risk ratio [95% CI], 2.6 [1.5 to 4.5]). CONCLUSIONS: Employee resistance against a perpetrator during a robbery increased customer injury risk. Businesses can train employees to not resist during a robbery, providing benefits for both customers and the business itself.

Association between fire-safe cigarette legislation and residential fire deaths in the United States.

BACKGROUND: Cigarettes and other tobacco-related smoking products have traditionally been a major ignition source for residential fire deaths. In the United States, all 50 states and the District of Columbia have passed laws requiring that cigarettes self-extinguish if they are not being smoked (so-called fire-safe cigarette laws). The purpose of this study was to quantify the association between state-level implementation of fire-safe cigarette legislation and the rate of residential fire death. METHODS: Poisson regression was used to analyze state-years data. Main intervention: Implementation dates for fire-safe cigarette legislation in each state. OUTCOME: Residential fire mortality rate. RESULTS: Implementation of fire-safe cigarette legislation was associated with a 19% reduction in overall residential fire mortality rates, adjusted for demographic differences between states (rate ratio = 0.81, 95% confidence interval: 0.79, 0.84). This is approximately similar to the estimated proportion of residential fire deaths in which smoking materials are an ignition source (23%). Legislation implementation was associated with a protective effect for every age, sex, race, and ethnicity strata that we examined. State-specific residential fire mortality death rates decreased (defined as a drop of at least 5%) in 32 states after fire-safe cigarette legislation was implemented. In 12 states there was either less than a 5% decrease or an increase, and seven states had insufficient deaths to evaluate state-level changes. CONCLUSIONS: Implementation of fire-safe cigarette is associated with reductions in residential fire mortality rates.

Diabetes and risk of hospitalized fall injury among older adults.

OBJECTIVE: To determine whether older adults with diabetes are at increased risk of an injurious fall requiring hospitalization. RESEARCH DESIGN AND METHODS: The longitudinal Health, Aging, and Body Composition Study included 3,075 adults aged 70-79 years at baseline. Hospitalizations that included ICD-9-Clinical Modification codes for a fall and an injury were identified. The effect of diabetes with and without insulin use on the rate of first fall-related injury hospitalization was assessed using proportional hazards models. RESULTS: At baseline, 719 participants had diabetes, and 117 of them were using insulin. Of the 293 participants who were hospitalized for a fall-related injury, 71 had diabetes, and 16 were using insulin. Diabetes was associated with a higher rate of injurious fall requiring hospitalization (hazard ratio [HR] 1.48 [95% CI 1.12-1.95]) in models adjusted for age, race, sex, BMI, and education. In those participants using insulin, compared with participants without diabetes, the HR was 3.00 (1.78-5.07). Additional adjustment for potential intermediaries, such as fainting in the past year, standing balance score, cystatin C level, and number of prescription medications, accounted for some of the increased risk associated with diabetes (1.41 [1.05-1.88]) and insulin-treated diabetes (2.24 [1.24-4.03]). Among participants with diabetes, a history of falling, poor standing balance score, and A1C level ≥8% were risk factors for an injurious fall requiring hospitalization. CONCLUSIONS: Older adults with diabetes, in particular those using insulin, are at greater risk of an injurious fall requiring hospitalization than those without diabetes. Among those with diabetes, poor glycemic control may increase the risk of an injurious fall.

Indicators of intimate partner violence: identification in emergency departments.

BACKGROUND: Intimate partner violence (IPV) is a widespread, but often unidentified, health concern. Understanding distinguishing characteristics of IPV assaults when compared to non-IPV assaults would advance IPV identification in health care settings. STUDY OBJECTIVES: We sought to determine incident-specific factors differentiating these two assault types using Emergency Department (ED) visit data from a unique active surveillance system. METHODS: New York City Department of Health and Mental Hygiene's Injury Surveillance System 2000-2007 data were analyzed to describe a sample of assault-related ED visits. Data analyses were gender specific. Bivariate analyses were conducted to estimate the crude effect of each independent variable on the outcome: IPV-related (vs. non-IPV-related) assaults. Multivariable logistic regression was conducted to compare IPV-related to non-IPV-related assaults on incident-specific factors. RESULTS: Among 5514 assault-related ED visits for women, 1530 visits were IPV related; 2040 were non-IPV related. Among 9476 assault-related visits for men, these frequencies were 395 and 2878, respectively. Among women, occurrence in the home (adjusted odds ratio [AOR] 12.8), head injury (AOR 1.6), and sexual violence (AOR 0.4) distinguished IPV- from non-IPV-related assaults. Among men, occurrence in the home (AOR 25.9) and alcohol use (AOR 2.0) distinguished IPV- from non-IPV-related assaults. CONCLUSION: For both women and men, victims assaulted at home had an elevated risk for IPV. These findings suggest that directed probing for assault incident characteristics - particularly incident location - may be an efficient, effective complement to current IPV screening practices for the busy ED provider. Incident location can be a cue to deepen inquiry about IPV among assault victims.