Surveillance for Violent Deaths - National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2021.

Problem/Condition: In 2021, approximately 75,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 48 states, the District of Columbia, and Puerto Rico in 2021. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. This report introduces additional incident and circumstance variables, which now include child victim-specific circumstance information. This report also incorporates new U.S. Census Bureau race and ethnicity categories, which now account for more than one race and Native Hawaiian or other Pacific Islander categories and include updated denominators to calculate rates for these populations. Period Covered: 2021. Description of System: NVDRS collects data regarding violent deaths from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2021. Data were collected from 48 states (all states with exception of Florida and Hawaii), the District of Columbia, and Puerto Rico. Forty-six states had statewide data, two additional states had data from counties representing a subset of their population (31 California counties, representing 64% of its population, and 13 Texas counties, representing 63% of its population), and the District of Columbia and Puerto Rico had jurisdiction-wide data. NVDRS collates information for each violent death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. Results: For 2021, NVDRS collected information on 68,866 fatal incidents involving 70,688 deaths that occurred in 48 states (46 states collecting statewide data, 31 California counties, and 13 Texas counties), and the District of Columbia. The deaths captured in NVDRS accounted for 86.5% of all homicides, legal intervention deaths, suicides, unintentional firearm injury deaths, and deaths of undetermined intent in the United States in 2021. In addition, information was collected for 816 fatal incidents involving 880 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 70,688 deaths, the majority (58.2%) were suicides, followed by homicides (31.5%), deaths of undetermined intent that might be due to violence (8.2%), legal intervention deaths (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm injury deaths (<1.0%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.Demographic patterns and circumstances varied by manner of death. The suicide rate was higher for males than for females. Across all age groups, the suicide rate was highest among adults aged ≥85 years. In addition, non-Hispanic American Indian or Alaska Native (AI/AN) persons had the highest suicide rates among all racial and ethnic groups. Among both males and females, the most common method of injury for suicide was a firearm. Among all suicide victims, when circumstances were known (84.4%), suicide was most often preceded by a mental health, intimate partner, or physical health problem or by a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was higher for males than for females. Among all homicide victims, the homicide rate was highest among persons aged 20-24 years compared with other age groups. Non-Hispanic Black or African American (Black) males experienced the highest homicide rate of any racial or ethnic group. Among all homicide victims, the most common method of injury was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Nearly all victims of legal intervention deaths were male, and the legal intervention death rate was highest among men aged 30-34 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in the majority of legal intervention deaths. When circumstances were known, the most frequent circumstances reported for legal intervention deaths were as follows: the victim used a weapon in the incident and the victim had a substance use problem (other than alcohol use). Other causes of death included unintentional firearm injury deaths and deaths of undetermined intent. Unintentional firearm injury deaths were most frequently experienced by males, non-Hispanic White (White) persons, and persons aged 15-24 years. These deaths most frequently occurred while the shooter was playing with a firearm and were precipitated by a person unintentionally pulling the trigger. The rate of deaths of undetermined intent was highest among males, particularly among AI/AN and Black males, and among adults aged 30-54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances. Interpretation: This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2021. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black males. Intimate partner violence precipitated a large proportion of homicides for females. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary precipitating circumstances for multiple types of deaths examined. Public Health Action: Violence is preventable, and data can guide public health action. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. NVDRS data can be used to enhance prevention efforts into actionable strategies. States or jurisdictions have used their Violent Death Reporting System (VDRS) data to guide suicide prevention efforts and highlight where additional focus is needed. For example, North Carolina VDRS program data have played a significant role in expanding activities related to firearm safety and injury prevention. The program served as a primary data source for partners, which led to the creation of the Office of Violence Prevention in the state, focusing on combatting firearm-related deaths. In Maine, the VDRS provided data on law enforcement officer suicides that were used to help support a bill mandating mental health resiliency and awareness training in the state's law enforcement training academy, along with plans for similar training addressing mental health, substance use, and alcohol problems among corrections officers. In addition, states and jurisdictions have also used their VDRS data to examine factors related to homicide in their state or jurisdiction. For example, Georgia VDRS collaborated with the City of Atlanta Mayor's Office of Violence Reduction to develop two public dashboards that not only offer comprehensive data on violent deaths but also present data on the geographic distribution of populations disproportionately affected by violence to help inform violence prevention interventions.

Surveillance for Violent Deaths - National Violent Death Reporting System, 34 States, Four California Counties, the District of Columbia, and Puerto Rico, 2017.

PROBLEM/CONDITION: In 2017, approximately 67,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 34 states, four California counties, the District of Columbia, and Puerto Rico in 2017. Results are reported by sex, age group, race/ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. PERIOD COVERED: 2017. DESCRIPTION OF SYSTEM: NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner reports, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2017. Data were collected from 34 states (Alaska, Arizona, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), four California counties (Los Angeles, Sacramento, Shasta, and Siskiyou), the District of Columbia, and Puerto Rico. NVDRS collates information for each death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. RESULTS: For 2017, NVDRS collected information on 45,141 fatal incidents involving 46,389 deaths that occurred in 34 states, four California counties, and the District of Columbia; in addition, information was collected on 961 fatal incidents involving 1,027 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 46,389 deaths in the 34 states, four California counties, and District of Columbia, the majority (63.5%) were suicides, followed by homicides (24.9%), deaths of undetermined intent (9.7%), legal intervention deaths (1.4%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). (The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Demographic patterns and circumstances varied by manner of death. The suicide rate was higher among males than among females and was highest among adults aged 45-64 years and ≥85 years and non-Hispanic American Indians/Alaska Natives and non-Hispanic Whites. The most common method of injury for suicide was a firearm among males and poisoning among females. Suicide was most often preceded by a mental health, intimate partner, or physical health problem or a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was highest among persons aged 20-24 years and was higher among males than females. Non-Hispanic Black males had the highest homicide rate of any racial/ethnic group. The most common method of injury for homicide was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Among intimate partner violence-related homicides, the largest proportion occurred among adults aged 35-54 years, and the most common method of injury was a firearm. When the relationship between an intimate partner violence-related homicide victim and a suspect was known, most female victims were killed by a current or former intimate partner, whereas approximately half of male victims were killed by a suspect who was not their intimate partner. Almost all legal intervention deaths were among males, and the legal intervention death rate was highest among men aged 25-29 years. Non-Hispanic American Indian/Alaska Native males had the highest legal intervention death rate, followed by non-Hispanic Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault/homicide. The most frequent circumstances for legal intervention deaths were reported use of a weapon by the victim in the incident and a mental health or substance use problem (other than alcohol use). Unintentional firearm deaths more frequently occurred among males, non-Hispanic Whites, and persons aged 15-24 years. These deaths most often occurred while the shooter was playing with a firearm and most frequently were precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded. The rate of death when the manner was of undetermined intent was highest among males, particularly among non-Hispanic Black and non-Hispanic American Indian/Alaska Native males, and persons aged 30-34 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances. INTERPRETATION: This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2017. The suicide rate was highest among non-Hispanic American Indian/Alaska Native and non-Hispanic White males, whereas the homicide rate was highest among non-Hispanic Black males. Intimate partner violence precipitated a large proportion of homicides for females. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. PUBLIC HEALTH ACTION: NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs and policies to reduce and prevent violent deaths. For example, South Carolina VDRS and Colorado VDRS are using their data to support suicide prevention programs through systems change and the Zero Suicide framework. North Carolina VDRS and Kentucky VDRS data were used to examine intimate partner violence-related deaths beyond homicides to inform prevention efforts. Findings from these studies suggest that intimate partner violence might also contribute to other manners of violent death, such as suicide, and preventing intimate partner violence might reduce the overall number of violent deaths. In 2019, NVDRS expanded data collection to include all 50 states, the District of Columbia, and Puerto Rico, providing more comprehensive and actionable violent death information for public health efforts to reduce violent deaths.

Patterns of trauma across Andean South America: New discoveries and advances in interpretation.

In his review article John W. Verano covered trauma, warfare, trophy taking, and human sacrifice, but his discussion mostly focused on the results of studies of museum or private collections and the recent discovery of the mass human sacrifice from Huaca de la Luna. Due to the renewed interest in the paleopathology of South America, a trend which Verano observed, these types of investigations have grown exponentially in the past twenty years since his initial publication. Here we synthesize the published data on the study and interpretation of traumatic injuries across time and space and we tease out some of the themes that have emerged in the twenty odd years since the seminal paper written by Verano. We searched and analyzed publications from 1997 to 2017 that pertained specifically to Andean South America through the review of library databases and then narrowed our search to trauma-related topics. In our literature review and meta-analysis of published studies on traumatic injuries, we found that nearly one-third of publications related to the field of paleopathology in Andean South America dealt with subjects we classified under trauma (N = 116/378), such as trephination, violence, sacrifice, warfare, etc. Large sample sizes, population-focused research, advances in methods of analysis, and hypothesis driven investigations have led to sophisticated and nuanced interpretations along a wide range of themes so that we understand a great deal more about violence, sacrifice, trephination, warfare and their sociopolitical and environmental contexts in prehistoric and early colonial Andean South America.

Mortalidad por lesiones de causas externas: CABA 2016 / Mortality from injuries of external causes: CABA 2016

Las Lesiones de Causas Externas (LCE) se definen como el daño físico que resulta de la exposición del cuerpo humano en forma súbita a niveles intolerables de energía. La energía causante de la lesión puede provenir de diversas fuentes: mecánica, radiante, térmica, eléctrica, química. Del mismo modo, pueden producirse lesiones funcionales que se originan ante la falta de elementos vitales (ej. agua, aire, calor) como en el caso del ahogamiento, la estrangulación y el congelamiento. son clasificadas según el mecanismo y la intencionalidad que las origina. Según la Clasificación Internacional de las Enfermedades y Problemas Relacionados con la Salud (CIE-10) se dividen en: No intencionales, Intencionales (Suicidios y Agresiones), Indeterminadas y Complicaciones de la Atención Médica y Quirúrgica. Si bien estas últimas integran el mencionado capítulo no corresponden a la categoría de muertes violentas, por lo cual no se incluyen en el presente informe. Para el cálculo de las tasas de mortalidad ajustadas por edad según comunas se utilizaron los denominadores poblacionales provistos por la Dirección General de Estadística y Censos del Ministerio de Hacienda del Gobierno de la CABA (DGEyC) según proyecciones Censo 2010 realizados por el INDEC. Solo para el análisis según residencia, se incluyeron todos los fallecidos en 2016 por LCE en la Ciudad de Buenos Aires, abarcando tanto residentes como no residentes. (AU) .

The relationship between pay day and violent death in Guatemala: a time series analysis.

OBJECTIVE: To assess if violent deaths were associated with pay days in Guatemala. DESIGN: Interrupted time series analysis. SETTING: Guatemalan national autopsy databases. PARTICIPANTS: Daily violence-related autopsy data for 22 418 decedents from 2009 to 2012. Data were provided by the Guatemalan National Institute of Forensic Sciences. Multiple pay-day lags and other important days such as holidays were tested. OUTCOME MEASURES: Absolute and relative estimates of excess violent deaths on pay days and holidays. RESULTS: The occurrence of violent deaths was not associated with pay days. However, a significant association was observed for national holidays, and this association was more pronounced when national holidays and pay days occurred simultaneously. This effect was observed mainly in males, who constituted the vast majority of violent deaths in Guatemala. An estimated 112 (coefficient=3.12; 95% CI 2.15 to 4.08; p<0.01) more male violent deaths occurred on holidays than were expected. An estimated 121 (coefficient=4.64; 95% CI 3.41 to 5.88; p<0.01) more male violent deaths than expected occurred on holidays that coincided with the first 2 days following a pay day. CONCLUSIONS: Men in Guatemala experience violent deaths at an elevated rate when pay days coincide with national holidays. Efforts to be better prepared for violence during national holidays and to prevent violent deaths by rescheduling pay days when these days co-occur with national holidays should be considered.

Injury-related hospitalizations in 2002 and 2012 in a Mexican rural hospital: differences between indigenous and non-indigenous inpatients.

Data are lacking on the extent and distribution of injuries in rural areas. This study aimed at comparing injury-related hospitalizations between 2002 and 2012 at a rural hospital of northern Mexico focusing on differences between indigenous (IP) and non-indigenous patients (NIP). A retrospective design based on the review of records of patients hospitalized with injury diagnoses was used. Information extracted included ethnicity, sex, age, hospital duration, surgical procedures, complications and discharge outcome. Injury data comprised of main diagnosis, mechanism and body part affected. Patterns were stratified by year and ethnicity. Logistic regression was used to determine the probability of being hospitalized for >1 day. Injury-related mortality increased from 0.4% in 2002 to 3.1% in 2012. The proportion of non-indigenous patients hospitalized also increased by 4.5%. Men accounted for two-thirds of all inpatients. Weapon involvement doubled from 16.6% to 33.6%. Almost half of the patients in 2012 were victims of interpersonal violence. Indigenous patients had a 2.7 higher adjusted odds ratios of being hospitalized for >1 day in 2002 (95% CI 1.2-5.7), though the gap was reduced to 1.9 (1.1-3.5) in 2012. While indigenous patients continue to be more disadvantaged than the non-indigenous, the gaps closed in 2012; the reasons behind these disparities need to be further investigated.

Accidents involving Brazilian indigenous treated at urgent and emergency services of the Unified Health System. / Acidentes envolvendo indígenas brasileiros atendidos em serviços de urgência e emergência do Sistema Único de Saúde.

Abstract We analyzed the accidents with Brazilian indigenous treated at urgent and emergency services of the Unified Health System (SUS). Data were obtained from the 2014 Viva Survey, which included 86 services from 24 capitals and the Federal District. The demographic profile of the indigenous, the event and the attendance were characterized. Most of the attended people were male in the 20-39 years age group. Falls and traffic accidents were the main reasons for attendance. Alcohol use was informed by 5.6% of the attended people, a figure that increases to 19.1% in traffic accidents, 26.1% among drivers and 22.8% among motorcyclists. There was a statistical difference between genders in relation to age, disability, place of occurrence of the event, work-related event and victim's condition in the traffic accident. We emphasize the importance of providing visibility to accidents with indigenous and engage them in the prevention of such events. Data reliability depends on the adequate completion in indigenous health information systems.

Morbi-mortalidad por lesiones de causas externas en adultos mayores residentes en CABA. Serie histórica 2006-2015 / Morbidity and mortality from external causes in elderly residents at CABA: Historical series 2006-2015

La morbi-mortalidad por Lesiones de Causas Externas (LCE) representa una problemática de Salud Pública creciente a nivel mundial ya que afecta a la población en su conjunto tanto en su desarrollo social, cultural y económico. Se observa que la llamada transición demográfica se ha acompañado de un complejo y heterogéneo proceso de transición epidemiológica. En términos generales, este proceso conlleva el aumento de enfermedades crónico-degenerativas que pueden ocasionar algún tipo de discapacidad. Existe una relación recíproca entre transición epidemiológica y transición demográfica que se refleja en el acceso a la protección en salud y nuevas demandas para la Salud Pública. En la Ciudad de Buenos Aires, el 20,4% de la población es mayor de 60 años, mientras que a nivel nacional esta proporción alcanza el 14,27%. Se analiza la mortalidad por LCE en Adultos Mayores residentes de la Ciudad de Buenos Aires a lo largo del periodo 2006-2015, según las siguientes variables: edad, sexo, intencionalidad de las lesiones, mecanismo de muerte.

Pattern of law enforcement-related injuries in the United States.

BACKGROUND: The pattern of law enforcement-related injuries of police and civilians in the United States is unknown. METHODS: Data were aggregated from the Federal Bureau of Investigations, the Bureau of Justice Statistics, the Centers for Disease Control (CDC) Web-based Injury Statistics Query and Reporting System, and the Nationwide Inpatient Sample (NIS) from 2003 to 2011. Law enforcement-related injuries in the CDC Web-based Injury Statistics Query and Reporting System and the NIS were identified using E-codes 970-976, which are meant to identify "injuries inflicted by the police or other law-enforcing agents, including military on duty, in the course of arresting or attempting to arrest lawbreakers, suppressing disturbances, maintaining order, and other legal action." RESULTS: The CDC reported a total of 715,118 nonfatal injuries and 3,156 fatal injuries from 2003 to 2011. In contrast, for the same period, the NIS identified a total of 3,958 patients, ranging from 348 to 572 per year. Among the injured, 1,548 (48.0%) were white, 866 were black (26.8%), and 605 were Hispanic (18.8%); 1,011 patients (25.5%) were injured by firearms, while 2,304 (58.2%) experienced blows or manhandling. Firearm-injured hospitalized patients are more likely to be male, black or Hispanics, and in the age group of 18 years to 39 years. CONCLUSION: The majority of law enforcement-related injuries are among white or black young men. Hispanic patients are more likely to be injured by a firearm than struck. When injured by firearm, white and black patients are more likely to die compared with Hispanic patients. Unfortunately, data about these injuries are scattered across multiple data systems. A uniform national system to aggregate these data sources is needed to better understand the scope of the problem, for both law enforcement personnel and civilians. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Acidentes envolvendo indígenas brasileiros atendidos em serviços de urgência e emergência do Sistema Único de Saúde / Accidents involving Brazilian indigenous treated at urgent and emergency services of the Unified Health System

Resumo Foram analisados os acidentes ocorridos com indígenas brasileiros atendidos em serviços de urgência e emergência do Sistema Único de Saúde (SUS). Os dados provêm do Viva Inquérito de 2014, que incluiu 86 serviços de 24 capitais e do Distrito Federal. Caracterizou-se o perfil sociodemográfico dos indígenas, o evento e o atendimento. A maioria dos atendidos era do sexo masculino e tinha entre 20-39 anos. Acidentes de transporte e quedas foram os principais motivos dos atendimentos. O uso de bebida alcoólica foi informado por 5,6% dos atendidos. Nos acidentes de transporte esse uso sobe para 19,1%; 26,1% entre condutores e 22,8% nos motociclistas. Houve diferença estatística entre os sexos em relação à faixa etária, deficiência, local de ocorrência do evento, evento relacionado ao trabalho e condição da vítima no acidente de transporte. Destaca-se a importância de dar visibilidade aos acidentes com indígenas e de envolvê-los na prevenção desses eventos. A fidedignidade desses dados depende do seu adequado preenchimento nos sistemas de informações sobre saúde de indígenas.

Abstract Abstract We analyzed the accidents with Brazilian indigenous treated at urgent and emergency services of the Unified Health System (SUS). Data were obtained from the 2014 Viva Survey, which included 86 services from 24 capitals and the Federal District. The demographic profile of the indigenous, the event and the attendance were characterized. Most of the attended people were male in the 20-39 years age group. Falls and traffic accidents were the main reasons for attendance. Alcohol use was informed by 5.6% of the attended people, a figure that increases to 19.1% in traffic accidents, 26.1% among drivers and 22.8% among motorcyclists. There was a statistical difference between genders in relation to age, disability, place of occurrence of the event, work-related event and victim's condition in the traffic accident. We emphasize the importance of providing visibility to accidents with indigenous and engage them in the prevention of such events. Data reliability depends on the adequate completion in indigenous health information systems.

Inpatient hospital outcomes following injury in Suriname: lessons for prevention.

Traumatic injury is an important and indiscriminant contributor to mortality. Hypothesizing that outcomes from severe injuries do not vary by demographic factors or socioeconomic status, this research analyzed the relationship between race, ethnicity, injury characteristics, and fatality following hospitalization in Suriname. Data were obtained for all hospital episodes in 2008 from the only hospital within the greater Paramaribo area that provides emergency department services. A logistic regression was used to analyze the subset of 544 non-elderly adult trauma victims to assess the contribution of patient demographics and anatomic injury severity to outcome, which was defined as mortality during acute hospitalization. The specific demographics included were patient age, gender, race, and insurance status. Injury severity was measured using the International Classification Injury Severity Score. The results indicate that age, insurance status, injury type, and injury severity were significant predictors for survival. While the uninsured experienced a higher rate of mortality, the model suggests this result is not due to physiologic reasons but behavioral and socioeconomic. The higher mortality is driven by greater injury severity, which increases not only the mortality rate but also the cost of care. Injury severity itself, independent of all other factors, is the most important contributor. The results suggest that a reduction of 10% in injury severity, around the mean, would reduce the probability of mortality by 70%. This suggests that targeting risk-taking behavior, perhaps relating to compliance with safety practices (e.g. seat belt and helmet laws), driver education, and road safety measures can play important roles in reducing mortality and morbidity from injury in Suriname.

Mexican immigrant survivors of intimate partner violence: conceptualization and descriptions of abuse.

This phenomenological qualitative study examines intimate partner violence (IPV) experienced by a sample of 29 Mexican immigrant women residing in New York and St. Louis. The findings reveal important insights about culturally specific abuse tactics employed by batterers and the forms of abuse that are experienced as most hurtful to the survivors. Ten different abusive tactics emerged: verbal, economic, physical, sexual, and extended family abuse, social isolation, physical abuse of children, stalking and monitoring, stolen bride, and sex trafficking. Cultural values and expectations appear to be inextricably linked to how the participants characterized the severity of each of the abusive tactics as evidenced by which abusive behaviors the participants found most hurtful. The findings will help service providers have a better understanding of the role cultural context plays in the IPV experiences of Mexican immigrant women.

Contextualizing the trauma experience of women immigrants from Central America, South America, and Mexico.

Trauma has been understudied among Latina immigrants from Central and South America. This study examined the types and context of trauma exposure experienced by immigrant women from Central America, South America, and Mexico living in the United States. Twenty-eight women seeking care in primary care or social service settings completed life history interviews. The majority of the women reported some type of trauma exposure in their countries of origin, during immigration, and/or in the United States. In the interviews, we identified types of trauma important to the experience of these immigrants that are not queried by trauma assessments typically used in the United States. We also identified factors that are likely to amplify the impact of trauma exposure. The study highlights the importance of utilizing a contextualized approach when assessing trauma exposure among immigrant women.

[Violence and accidents among older and younger adults: evidence from the Surveillance System for Violence and Accidents (VIVA), Brazil]. / Violências e acidentes entre adultos mais velhos em comparação aos mais jovens: evidências do Sistema de Vigilância de Violências e Acidentes (VIVA), Brasil.

Data from the Brazilian Surveillance System for Violence and Accidents (VIVA) in 2009 were used to examine socio-demographic characteristics, outcomes, and types of accidents and violence treated at 74 sentinel emergency services in 23 Brazilian State capitals and the Federal District. The analysis included 25,201 individuals aged > 20 years (10.1% > 60 years); 89.3% were victims of accidents and 11.9% victims of violence. Hospitalization was the outcome in 11.1% of cases. Compared to the general population, there were more men and non-white individuals among victims of accidents, and especially among victims of violence. As compared to younger adults (20-59 years), accidents and violence against elderly victims showed less association with alcohol, a higher proportion of domestic incidents, more falls and pedestrian accidents, and aggression by family members. Policies for the prevention of accidents and violence should consider the characteristics of these events in the older population.

Violências e acidentes entre adultos mais velhos em comparação aos mais jovens: evidências do Sistema de Vigilância de Violências e Acidentes (VIVA), Brasil / Violence and accidents among older and younger adults: evidence from the Surveillance System for Violence and Accidents (VIVA), Brazil

Dados do Sistema de Vigilância de Violências e Acidentes (VIVA) de 2009 foram utilizados para examinar características sociodemográficas, desfechos e tipos de acidentes e violências que levaram a atendimento em 74 serviços sentinela situados em 23 capitais brasileiras e no Distrito Federal. A análise incluiu 25.201 indivíduos com idade > 20 anos (10,1 por cento com > 60 anos), dos quais 89,3 por cento foram vítimas de acidentes e 11,9 por cento de violências. A hospitalização foi o desfecho de 11,1 por cento dos casos. Em comparação à população geral, observou-se ainda um excesso de homens e da cor da pele não branca entre vítimas de acidentes e, sobretudo, de violência. O perfil desses eventos entre os mais velhos diferiu dos mais jovens (20-59 anos), com destaque para a menor contribuição do álcool, o predomínio de ocorrências no domicílio, a maior importância relativa das quedas e a maior vulnerabilidade a atropelamentos e a agressões por familiares. Políticas para a prevenção de acidentes e violências devem levar em conta as especificidades desses eventos na população mais velha.

Data from the Brazilian Surveillance System for Violence and Accidents (VIVA) in 2009 were used to examine socio-demographic characteristics, outcomes, and types of accidents and violence treated at 74 sentinel emergency services in 23 Brazilian State capitals and the Federal District. The analysis included 25,201 individuals aged > 20 years (10.1 percent > 60 years); 89.3 percent were victims of accidents and 11.9 percent victims of violence. Hospitalization was the outcome in 11.1 percent of cases. Compared to the general population, there were more men and non-white individuals among victims of accidents, and especially among victims of violence. As compared to younger adults (20-59 years), accidents and violence against elderly victims showed less association with alcohol, a higher proportion of domestic incidents, more falls and pedestrian accidents, and aggression by family members. Policies for the prevention of accidents and violence should consider the characteristics of these events in the older population.

Health concerns of migrant backstretch workers at horse racetracks.

BACKGROUND: Backstretch workers are part of an itinerant labor community that cares for horses at racetracks across the U.S. Since the 1970s, this workforce has increasingly been composed of migrants, especially from Mexico and Guatemala. No studies have focused systematic attention on health concerns of this population and how illness is influenced by unique working and living conditions. METHODS: We administered a survey orally to 84 backstretch workers at a Florida racetrack to understand self-reported medical history and current major health concerns. RESULTS: The most frequent responses related to musculoskeletal injury or pain. This was followed by gastrointestinal illnesses and other chronic conditions (e.g., hypertension, diabetes). DISCUSSION: Health concerns reflected the interplay between occupation and structural factors of poverty, stress, poor living conditions, and diet. Future studies should further examine food security, substance use, and other high-risk behaviors. Our study provides a preliminary picture of major health concerns and points to the need for enhanced regulation.

Trauma, posttraumatic stress symptoms, and alcohol-use initiation in children.

OBJECTIVE: This study examined initiation of alcohol use among adolescents, in relation to their earlier traumatic experiences and symptoms of posttraumatic stress disorder (PTSD). METHOD: Data were from a longitudinal study of children of Puerto Rican background living in New York City's South Bronx and in San Juan, Puerto Rico. The subsample (n = 1,119; 51.7% male) of those who were 10-13 years old and alcohol naive at baseline was used in the analyses. RESULTS: Alcohol-use initiation within 2 years after baseline was significantly more common among children reporting both trauma exposure and 5 or more of a maximum of 17 PTSD symptoms at baseline (adjusted odds ratio = 1.84, p < .05) than among those without trauma exposure, even when potentially shared correlates were controlled for. Children with trauma exposure but with fewer than five PTSD symptoms, however, did not differ significantly from those without trauma exposure, with regard to later alcohol use. CONCLUSIONS: PTSD symptoms in children 10-13 years old may be associated with early onset of alcohol use. It is important to identify and treat PTSD-related symptoms in pre-adolescent children.

Self care and health-seeking behavior of migrant farmworkers.

There are an estimated three million migrant and seasonal farmworkers (MSFW) in the United States. In addition to the inherent dangers of farm work, numerous factors place MSFW at even greater risk for work-related injuries. Little is known about how MSFW care for work-related injuries, and how the decision to seek professional care is made. A prospective survey using face-to-face structured interviews was used to explore the type and frequency of occupational injuries as well as self-care and health-care seeking practices of MSFW. Musculoskeletal injuries were the most commonly reported injuries, followed by injuries of the skin and chemical exposure. Self care with over-the-counter remedies was the predominant method of dealing with injuries, and, with the exception of chemical exposure, was found to be for the most part, appropriate. The reported use of alternative medicine or herbal remedies was low. Future research efforts should focus on ergonomic modifications and farmworker education to reduce or prevent musculoskeletal injuries. The number of reported chemical exposures and inappropriate treatment draw attention to the need for continued efforts for both primary prevention of exposure and optimal treatment once exposure occurs.

Diferenciais de raça/cor da pele em anos potenciais de vida perdidos por causas externas / Race/skin color differentials in potential years of life lost due to external causes

OBJETIVO: As mortes por causas externas representam um dos mais importantes desafios para a saúde pública, sendo a segunda causa de óbito no Brasil. O objetivo do estudo foi analisar os diferenciais de mortalidade por causas externas segundo raça/cor da pele. MÉTODOS:Estudo descritivo realizado em Salvador (BA), com 9.626 registros de óbitos por causas externas entre 1998 e 2003. Dados foram obtidos do Instituto Médico Legal e Instituto Brasileiro de Geografia e Estatística. O indicador "anos potenciais de vida perdidos" foi utilizado para identificar diferenciais entre grupos etários, de raça/cor da pele e sexo. RESULTADOS: As mortes por causas externas determinaram perda de 339.220 anos potenciais de vida, dos quais 210.000 foram devidos aos homicídios. Indivíduos negros morreram em idades mais precoces e perderam 12,2 vezes mais anos potenciais de vida devido a mortes por homicídio que indivíduos brancos. Embora a população negra (pardos e pretos) fosse três vezes maior que a população branca, o número de anos perdidos daquela foi 30 vezes superior. A população de pretos era 11,4% menor que a população branca, mas apresentou anos perdidos quase três vezes mais. Mesmo após a padronização por idade, mantiveram-se as diferenças observadas no indicador de anos potenciais perdidos/100.000 hab e nas razões entre estratos segundo raça/cor. CONCLUSÕES: Os resultados mostram diferenciais na mortalidade por causas externas segundo raça/cor da pele em Salvador. Os negros tiveram maior perda de anos potenciais de vida, maior número médio de anos não vividos e morreram, em média, em idades mais precoces por homicídios, acidentes de trânsito e demais causas externas.

OBJECTIVE: Deaths by external causes represent one of the most important challenges for public health and are the second cause of death in Brazil. The aim of this study was to analyze differentials in mortality by external causes according to race/skin color. METHODS: A descriptive study was carried out in Salvador, Northeastern Brazil, using 9,626 cases of deaths by external causes between 1998 and 2003. Data were obtained from the Forensic Medicine Institute and from Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). The indicator "potential years of life lost" was utilized to identify the existence of differences among age groups, sex groups and race/skin color groups. RESULTS:Deaths by external causes provoked the loss of 339,220 potential years of life, of which 210,000 were due to homicides. Nonwhite individuals died at earlier ages and lost 12.2 times as much potential years of life due to deaths by homicidies than white individuals. Although the nonwhite (black and mixed) population was three times larger than the white population, its number of potential years of life lost was 30 times higher. The population of blacks was 11.4% smaller than the white population, but its loss of potential years of life was almost three times higher. Even after the adjustment for age, the differences observed in the indicator potential years of life lost/100,000 inhabitants and in the ratios between strata according to race/skin color were maintained. CONCLUSIONS: The results showed differentials in mortality by external causes according to race/skin color in Salvador. The nonwhite population had greater loss of potential years of life, higher average number of years not lived and, on average, they died at an earlier age due to homicides, traffic accidents an all other external causes.

OBJETIVO: Las muertes por causas externas representan uno de los más importantes desafíos para la salud pública, siendo la segunda causa de óbito en Brasil. El objetivo del estudio fue analizar los diferenciales de mortalidad por causas externas según raza/color de la piel. MÉTODOS: Se realizó estudio descriptivo en Salvador, BA, con 9.626 registros de óbitos por causas externas entre 1998 y 2003. Los datos se obtuvieron del Instituto Médico Legal e Instituto Brasilero de Geografía y Estadística. El indicador "años potenciales de vida perdidos" fue utilizado para identificar diferenciales entre grupos erarios, de raza/color de la piel y sexo. RESULTADOS: Las muertes por causas externas determinaron pérdida de 339.220 años potenciales de vida, de los cuales 210.000 fueron debidos a los homicidios. Individuos negros murieron en edades más precoces y perdieron 12,2 veces más años potenciales de vida debido a homicidios que individuos blancos. A pesar de que la población negra (pardos y negros) era tres veces mayor que la población blanca, el número de años perdidos de la primera fue 30 veces superior. La población de negros era 11,4% menor que la población blanca, pero presentó años perdidos casi tres veces mayor. Aún después de la estandarización por edad, se mantuvo las diferencias observadas en el indicador de años potenciales perdidos/100.000 hab y en las razones entre estratos según raza/color. CONCLUSIONES: Los resultados muestran diferenciales en la mortalidad por causas externas según raza/color de la piel en Salvador. Los negros tuvieron mayor pérdida de años potenciales de vida, mayor número promedio de años no vividos y murieron, en promedio, en edades más precoces por homicidios, accidentes de tránsito y demás causas externas.