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1.
BMJ ; 370: m2829, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32699044
4.
BMJ ; 370: m2436, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32699008

RESUMO

OBJECTIVE: To evaluate the association between US state policies that establish age 18 or 21 years as the minimum purchaser age for the sale of handguns and adolescent suicide rate. DESIGN: Regression discontinuity and difference-in-differences analyses. SETTING: 46 US states without policy changes between 2001 and 2017; Missouri and South Carolina, which lowered the age for handgun sales in 2007 and 2008, respectively; and West Virginia and Wyoming, which increased the age for handgun sales in 2010. PARTICIPANTS: Adolescents aged 13 to 20 years(554 461 961 from 2001 to 2017) in the regression discontinuity analysis, and adolescents aged 18 to 20 years (168 934 041 from 2002 to 2014) in the main difference-in-differences analysis. MAIN OUTCOME MEASURE: Suicide rate per 100 000 adolescents. RESULTS: In the regression discontinuity analysis, state policies that limited the sale of handguns to those aged 18 or older (relative to 21 or older) were associated with an increase in suicide rate among adolescents aged 18 to 20 years equivalent to 344 additional suicides in each state where they were in place between 2001 and 2017. In the difference-in-differences analysis, state policies that limited the sale of handguns to those aged 21 or older were associated with 1.91 fewer suicides per 100 000 adolescents aged 18 to 20 years (95% confidence interval -3.13 to -0.70, permutation adjusted P=0.025). In the difference-in-differences analysis, there were 1.83 fewer firearm related suicides per 100 000 adolescents (-2.66 to -1.00, permutation adjusted P=0.002), with no association between age 21 handgun sales policies and non-firearm related suicides. Separate event study estimates indicated increases in suicide rates in states that lowered the age of handgun sales, with no association in states that increased the age of handgun sales. CONCLUSIONS: A clear discontinuity was shown in the suicide rate by age at age 18 in states that limited the sale of handguns to individuals aged 18 or older. State policies to limit the sale of handguns to individuals aged 21 or older were associated with a reduction in suicide rates among adolescents. Increases in suicide rates were observed after states lowered the age of handgun sales, but no effect was found in states that increased the age of handgun sales.


Assuntos
Comércio/legislação & jurisprudência , Comportamento do Consumidor/economia , Armas de Fogo/legislação & jurisprudência , Suicídio/estatística & dados numéricos , Adolescente , Fatores Etários , Comércio/tendências , Comportamento do Consumidor/estatística & dados numéricos , Estudos de Avaliação como Assunto , Armas de Fogo/economia , Humanos , Missouri/epidemiologia , Políticas , Análise de Regressão , South Carolina/epidemiologia , Suicídio/etnologia , West Virginia/epidemiologia , Wyoming/epidemiologia , Adulto Jovem
7.
N Engl J Med ; 382(23): 2220-2229, 2020 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-32492303

RESUMO

BACKGROUND: Research has consistently identified firearm availability as a risk factor for suicide. However, existing studies are relatively small in scale, estimates vary widely, and no study appears to have tracked risks from commencement of firearm ownership. METHODS: We identified handgun acquisitions and deaths in a cohort of 26.3 million male and female residents of California, 21 years old or older, who had not previously acquired handguns. Cohort members were followed for up to 12 years 2 months (from October 18, 2004, to December 31, 2016). We used survival analysis to estimate the relationship between handgun ownership and both all-cause mortality and suicide (by firearm and by other methods) among men and women. The analysis allowed the baseline hazard to vary according to neighborhood and was adjusted for age, race and ethnic group, and ownership of long guns (i.e., rifles or shotguns). RESULTS: A total of 676,425 cohort members acquired one or more handguns, and 1,457,981 died; 17,894 died by suicide, of which 6691 were suicides by firearm. Rates of suicide by any method were higher among handgun owners, with an adjusted hazard ratio of 3.34 for all male owners as compared with male nonowners (95% confidence interval [CI], 3.13 to 3.56) and 7.16 for female owners as compared with female nonowners (95% CI, 6.22 to 8.24). These rates were driven by much higher rates of suicide by firearm among both male and female handgun owners, with a hazard ratio of 7.82 for men (95% CI, 7.26 to 8.43) and 35.15 for women (95% CI, 29.56 to 41.79). Handgun owners did not have higher rates of suicide by other methods or higher all-cause mortality. The risk of suicide by firearm among handgun owners peaked immediately after the first acquisition, but 52% of all suicides by firearm among handgun owners occurred more than 1 year after acquisition. CONCLUSIONS: Handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm. (Funded by the Fund for a Safer Future and others.).


Assuntos
Armas de Fogo , Violência com Arma de Fogo/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propriedade , Fatores de Risco , Suicídio/prevenção & controle , Análise de Sobrevida , Adulto Jovem
9.
JMIR Public Health Surveill ; 6(2): e19369, 2020 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-32437329

RESUMO

BACKGROUND: In the past, national emergencies in the United States have resulted in increased gun preparation (ie, purchasing new guns or removing guns from storage); in turn, these gun actions have effected increases in firearm injuries and deaths. OBJECTIVE: The aim of this paper was to assess the extent to which interest in gun preparation has increased amid the coronavirus disease (COVID-19) pandemic using data from Google searches related to purchasing and cleaning guns. METHODS: We fit an Autoregressive Integrated Moving Average (ARIMA) model over Google search data from January 2004 up to the week that US President Donald Trump declared COVID-19 a national emergency. We used this model to forecast Google search volumes, creating a counterfactual of the number of gun preparation searches we would expect if the COVID-19 pandemic had not occurred, and reported observed deviations from this counterfactual. RESULTS: Google searches related to preparing guns have surged to unprecedented levels, approximately 40% higher than previously reported spikes following the Sandy Hook, CT and Parkland, FL shootings and 158% (95% CI 73-270) greater than would be expected if the COVID-19 pandemic had not occurred. In absolute terms, approximately 2.1 million searches related to gun preparation were performed over just 34 days. States severely affected by COVID-19 appear to have some of the greatest increases in the number of searches. CONCLUSIONS: Our results corroborate media reports that gun purchases are increasing amid the COVID-19 pandemic and provide more precise geographic and temporal trends. Policy makers should invest in disseminating evidence-based educational tools about gun risks and safety procedures to avert a collateral public health crisis.


Assuntos
Infecções por Coronavirus/epidemiologia , Armas de Fogo/estatística & dados numéricos , Internet/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Ferramenta de Busca/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Humanos , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/mortalidade
10.
South Med J ; 113(5): 219-223, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358616

RESUMO

OBJECTIVES: The aims of this study were to assess parent acceptance of firearms education delivered by clinical providers, determine whether parents engage in firearms safety dialog with their children, and evaluate reasons for ownership and storage behaviors. METHODS: The parents of children ages 0 to 18 years completed surveys while in a pediatric inpatient setting in Texas. Demographics, acceptability, current behaviors, and storage practices were queried. Responses between firearms owners and nonowners were analyzed using the Fisher exact and χ2 tests. RESULTS: Of the 115 parents who completed surveys, 41% reported owning firearms. Most parents were likely or highly likely to follow their pediatrician's gun safety advice (67%), were accepting of safety videos in waiting rooms (59%), and accepted firearms locks distributed by clinical providers (69%). Nonowners were less likely than owners to have spoken to their children about gun safety (P = 0.004). Parents owned firearms for self-protection and recreation (50%), self-protection only (38%), or recreation only (12%). Owners stored them unloaded (75%), used safety devices (95%), and stored them in the closet of the master bedroom (54%). CONCLUSIONS: Talking about firearms safety in a healthcare setting was not a contentious issue in the majority of our sample. Parents were accepting of provider-led firearms guidance regardless of ownership status. This provides an opportunity for providers to focus on effective messaging and time-efficient delivery of firearms safety education.


Assuntos
Atitude Frente a Saúde , Armas de Fogo , Pais , Aceitação pelo Paciente de Cuidados de Saúde , Educação de Pacientes como Assunto , Pediatras , Feminino , Humanos , Masculino , Papel do Médico , Segurança , Texas
11.
PLoS One ; 15(4): e0232252, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353022

RESUMO

INTRODUCTION AND OBJECTIVE: The United States (US) has the highest rate of firearm suicides in the world. The US and Canada are comparable countries with markedly different rates of firearm ownership, providing an opportunity to estimate suicide fatalities that could be averted in the US with a lower rate of firearm ownership. METHODS: We compared 2016 US suicide fatality rates-standardized within fourteen sex-specific age groups to reflect the ethnic composition of Canada-to 2016 Canadian suicide rates. We then calculated the number and proportion of suicides that could be averted in the US if the US had the same rates of suicide as in Canada. RESULTS: If the US had the same suicide rates as in Canada, we estimate there would be approximately 25.9% fewer US suicide fatalities, equivalent to 11,630 suicide fatalities averted each year. This decline would be driven by a 79.3% lower rate of firearm-specific suicide fatalities. The male suicide fatality rate would be 28.8% lower and equivalent to 9,992 fewer suicide fatalities each year. The female suicide fatality rate would be 16.0% lower and equivalent to 1,638 fewer suicide fatalities each year. While 36% of firearm suicide fatalities could be replaced by non-firearm suicide fatalities, 64% of firearm fatalities could be averted entirely. CONCLUSIONS: US policymakers may wish to consider policies that would reduce rates of firearm ownership, given that that about 26% of US suicide fatalities might be averted if the US had the same suicide rates as in Canada, a country with drastically lower firearm ownership rates.


Assuntos
Armas de Fogo/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Canadá , Criança , Pré-Escolar , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Propriedade/estatística & dados numéricos , Gravidez , Estados Unidos , Adulto Jovem
14.
Mar Pollut Bull ; 154: 111072, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32319903

RESUMO

Understanding the interactions between human activity in the ocean and marine mammals is a fundamental step to developing responsible mitigation measures and informing policy. Here, the response of migrating humpback whales to vessels towing seismic air gun arrays (on or off) was quantified as a reduction in their likelihood of socially interacting (joining together). Groups were significantly less likely to participate in a joining interaction in the presence of a vessel, regardless of whether or not the air guns were active. This reduction was especially pronounced in groups within a social environment that favored joining, that is, when singing whales or other groups were nearby. Seismic survey mitigation practices are designed primarily to prevent damage to whales' hearing from close-by sources. Here, we found potentially detrimental behavioral changes at much greater ranges, and much lower received levels, than those used for current mitigation recommendations.


Assuntos
Armas de Fogo , Jubarte , Animais , Relações Interpessoais , Ruído , Navios
16.
Am Surg ; 86(3): 208-212, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223799

RESUMO

Gun-related injuries are a hotly debated sociopolitical topic in the United States. Annually, more than 33 million Americans seek heathcare services for mental health issues. These conditions are the leading cause of combined disability and death among women and the second highest among men. Our study's main objective was to identify cases of self-inflicted penetrating firearm injuries with reported pre-existing psychiatric conditions as defined in the 2013-2016 National Trauma Data Standard. The 2013-2016 Research Data Sets (RDSs) were reviewed. Cases were identified using the ICD-9 external cause codes 955-955.4, and ICD 10th Edition Clinical Modification external cause codes X72-X74. Odds ratios were calculated, and categorical data were analyzed by using the chi-squared test, with significance defined as P < 0.05. The 2013-2016 Research Data Set consists of 3,577,168 reported cases, with 15,535 observations of self-inflicted penetrating firearms injuries. Of those patients, 18.4 per cent had major psychiatric illnesses, 7.5 per cent had alcohol use disorder, 6.4 per cent had drug use disorder, and 0.6 per cent had dementia. An upward trend in the proportion of patients with major psychiatric illnesses was observed, from 15.5 per cent in 2013 to 18.6 per cent in 2016, peaking in 2015 at 20.9 per cent. Nearly one in three self-inflicted penetrating firearm injuries in the United States is associated with pre-existing behavioral health conditions. Advances in understanding the behavioral and social determinants leading to these conditions, and strategies to improve the diagnosis of mental illness and access to mental health care are required.


Assuntos
Violência com Arma de Fogo/psicologia , Violência com Arma de Fogo/estatística & dados numéricos , Cobertura de Condição Pré-Existente/estatística & dados numéricos , Comportamento Autodestrutivo/epidemiologia , Ferimentos por Arma de Fogo/epidemiologia , Adulto , Idoso , Alcoolismo/epidemiologia , Bases de Dados Factuais , Demência/epidemiologia , Feminino , Armas de Fogo , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Comportamento Autodestrutivo/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia
17.
Am J Public Health ; 110(5): 685-688, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32191527

RESUMO

Temporary transfers of firearms from suicidal persons is a strategy to reduce the incidence of suicide deaths. We discuss a barrier to the effective operation of voluntary temporary firearm transfer laws: the dearth of guidance on the liability for returning firearms to persons who voluntarily surrender them. We examine the laws of all 50 US states that regulate temporary surrenders of firearms and evaluate whether any provisions govern liability for returning temporarily surrendered firearms.Although 14 states create background check exceptions to permit temporary transfers of firearms from an owner to family, friends, retailers, or law enforcement, no states prescribe procedures for returning those firearms.ability for returning the firearms to people who voluntarily surrendered them.We recommend amending state laws to clarify the process and liability for returning temporarily surrendered firearms to the original owner. Such amendments would be intended to mitigate the potential chilling effect that lack of clarity and presumption of liability may impose on efficiently reducing firearm access to protect firearm owners at risk for suicide.


Assuntos
Armas de Fogo/legislação & jurisprudência , Responsabilidade Legal , Ideação Suicida , Humanos , Governo Estadual , Estados Unidos
18.
Pediatr Clin North Am ; 67(2): 397-411, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32122568

RESUMO

Anticipatory guidance should be provided to families on identifying and addressing common adjustment reactions after a school shooting. Although adjustment difficulties may be related to post-traumatic and grief reactions, many will not be directly attributable to the school shooting. Understanding how to cope with associated worries and reactions can help children better adjust. Pediatricians can assist with guidance about the development of a reasonable timeline for emotional and academic recovery, traumatic stress/loss, coping strategies, support for students with special needs, identification of students most in need of support, identification of staff who are most likely impacted, and appropriate preparedness activities.


Assuntos
Adaptação Psicológica , Armas de Fogo , Incidentes com Feridos em Massa , Pediatras , Papel do Médico , Instituições Acadêmicas , Estudantes/psicologia , Luto , Criança , Humanos , Apoio Social , Estados Unidos
19.
Bull World Health Organ ; 98(3): 170-176, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32132751

RESUMO

Objective: To assess the effect of a permanent gun-carrying restriction on gun-related mortality in Colombia between 2008 and 2014, and determine differences in the effect of the restriction by place of death and sex. Methods: In 2012, Bogotá and Medellín introduced a permanent gun-carrying restriction. We compared gun-related mortality rates in these cities (intervention cities) with the rates in all other Colombian cities with more than 500 000 inhabitants (control cities). We used data from the Colombian National Department of Statistics to calculate monthly gun-related mortality rates between 2008 and 2014 for intervention and control cities. We used a differences-in-differences method with fixed effects to assess differences in gun-related mortality in intervention and control cities before and after the introduction of the gun-carrying restriction. We stratified effects by place of death (public area or residence) and sex. We made robustness checks to test the assumptions of the models. Findings: Gun-related deaths in the control and intervention cities decreased between 2008 and 2014; however, the decrease was greater in the intervention cities (from 20.29 to 14.93 per 100 000 population; 26.4%) than in the control cities (from 37.88 to 34.56 per 100 000 population; 8.8%). The restriction led to a 22.3% reduction in the monthly gun-related mortality rate in Bogotá and Medellín. The reduction was greater in public areas and for males. Robustness checks supported the assumptions of the models. Conclusion: The permanent restriction on carrying guns reduced gun-related deaths. This policy could be used to reduce gun-related injuries in urban centres of other countries with large numbers of gun-related deaths.


Assuntos
Armas de Fogo/legislação & jurisprudência , Homicídio/estatística & dados numéricos , Mortalidade , Suicídio/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Colômbia , Feminino , Humanos , Masculino , Propriedade
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