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BACKGROUND AND OBJECTIVES: Suicide is a leading cause of death among youth in the United States. The coronavirus disease 2019 (COVID-19) pandemic raised concerns that suicide rates will increase. The National Fatality Review-Case Reporting System documents circumstances of child deaths reviewed by multidisciplinary teams. In April 2021, a question asking whether COVID-19 directly or indirectly impacted the child's death was added to the National Fatality Review-Case Reporting System. The objective of this study was to identify factors related to suicide deaths among youth during the COVID-19 pandemic. METHODS: This exploratory study of youth aged 10 to 17 years occurring during 2020 to 2021 compared demographic and incident characteristics, life stressors, social/mental health histories, and pandemic-related disruptions to school, health, and mental health for COVID-19-impacted suicides and non-COVID-19-impacted suicides using descriptive statistics. χ² statistics assessed statistical significance in differences across the 2 groups. RESULTS: A total of 552 suicides were included for study. Higher proportions of COVID-19-impacted suicides (n = 144) were by hanging (51% vs 40%) and occurred in suburban areas (57% vs 45%) compared with non-COVID-19-impacted suicides (n = 408). COVID-19-impacted youth also experienced significantly more isolation (60% vs 14%), school problems (42% vs 19%), depression (43% vs 24%), and/or anxiety disorder (23% vs 12%) diagnoses. CONCLUSIONS: A subset of youth experienced significant effects of the pandemic and associated measures implemented to mitigate the spread of COVID-19. They were proportionally more likely to experience isolation, school and mental health care disruptions, behavior changes, and severe emotional distress; all signs of increased risk for suicide. [ABSTRACT FROM AUTHOR]

Introduction: This study seeks to describe the circumstances of fire deaths among children, identify deaths related to fireplay, and compare children whose deaths were related to fireplay with non-fireplay-related deaths.Methods: Children aged 1-14 years who died in a fire during 2004-2016 were identified from the National Fatality Review Case Reporting System. Social, demographic, and fire characteristics were described and then compared for children who died in fires caused by fireplay versus non-fireplay-related deaths. Unadjusted ORs and 95% CIs were calculated. Data were collected 2004-2018 and analyzed in 2019.Results: A total of 1,479 children who died in fires were identified. They were predominantly male (54%) and White (47%); 34% were Black. Two or more children died in 54% of incidents. Fires occurred most frequently in single-family homes (52%) and rental properties (37%); 23% were started by smoking materials or candles. Smoke alarm information was largely missing (42%) and noted to be present and working for only 82 deaths. Fireplay was responsible for 175 (12%) of the deaths. Compared with non-fireplay-related deaths, children who died in fireplay fires were more likely to be aged 1-4 years (OR=2.6, 95% CI=1.5, 4.3), male (OR=1.6, 95% CI=1.2, 2.2), have supervision documented as no, but needed (OR=8.8, 95% CI=4.1, 18.8), and have an open Child Protective Services case (OR=1.8, 95% CI=1.1, 3.0).Conclusions: This study provides data on supervision and the role of fireplay in fatal fires among young children, offering information for the development of innovative primary prevention strategies and future research. [ABSTRACT FROM AUTHOR]

Suicide is a leading cause of death among children in the United States; firearms cause 37% of these deaths. Research is needed to better understand firearm accessibility among youth at risk for suicide. We reviewed data from the National Fatality Review Case Reporting System (NFR-CRS). Firearm suicide deaths of children ages 10–18 occurring 2004 through 2015 with completed suicide-specific section were included. Children who had talked about, threatened or attempted suicide were identified as "Greater Risk" (GR). Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. Of the 2106 firearm suicide deaths, 1388 (66%) had a completed NFR-CRS suicide section. Of these, 36% (494/1388) met the criteria for GR. Firearms were less likely to be stored in a locked location for GR children [adjusted OR 0.62, (95%CI 0.49–0.98)]. Strategies to limit firearm access, particularly for GR youth, should be a focus of suicide prevention efforts. [ABSTRACT FROM AUTHOR]

Background: Child maltreatment is a major public health problem, but population-based surveillance and research is hindered by limitations of official child welfare data. The present study used a promising complementary data source, hospital discharge data, to investigate risk factors for infant injuries suggestive of maltreatment.Methods: Discharge data from all hospital births to New York City residents from 1995 to 2004 were linked to birth certificates and to subsequent infant hospitalizations within 12 months after delivery. Probable maltreatment of infants was identified with 33 injury diagnosis codes highly correlated with maltreatment. Modified Poisson regression estimated the association of sociodemographic factors and pregnancy/birth characteristics with subsequent infant admission for probable maltreatment.Results: Risk factors for maltreatment included neonatal intensive care unit stays of more than 11 days (adjusted risk ratio [aRR] = 1.8; 95% confidence interval [CI]: 1.1-2.8), preterm birth (aRR = 1.6; 95% CI: 1.2-2.1), maternal age less than 20 years (aRR = 1.5; 95% CI: 1.2-1.9), and public insurance (aRR = 1.5; 95% CI: 1.2-1.9). Factors associated with reduced maltreatment risk included mother born outside the United States (aRR = 0.7; 95% CI: 0.6-0.8) and female infant (aRR = 0.7; 95% CI: 0.6-0.9).Conclusions: Sociodemographic factors and challenges at birth (preterm, neonatal intensive care unit stays) are important risk factors for subsequent maltreatment-related hospitalization, with potential implications for prevention targeting. [ABSTRACT FROM AUTHOR]

Accurate estimation of the incidence of maltreatment-related child mortality depends on reliable child fatality review. We examined the inter-rater reliability of maltreatment designation for two Alaskan Child Death Review (CDR) panels. Two different multidisciplinary CDR panels each reviewed a series of 101 infant and child deaths (ages 0–4 years) in Alaska. Both panels independently reviewed identical medical, autopsy, law enforcement, child welfare, and administrative records for each death utilizing the same maltreatment criteria. Percent agreement for maltreatment was 64.7% with a weighted Kappa of 0.61 (95% CI 0.51, 0.70). Across maltreatment subtypes, agreement was highest for abuse (69.3%) and lowest for negligence (60.4%). Discordance was higher if the mother was unmarried or a smoker, if residence was rural, or if there was a family history of child protective services report(s). Incidence estimates did not depend on which panel's data were used. There is substantial room for improvement in the reliability of CDR panel assessment of maltreatment related mortality. Standardized decision guidance for CDR panels may improve the reliability of their data. [ABSTRACT FROM AUTHOR]

While risk factors have been identified among infants and young children, less is known about child maltreatment fatalities among older children. To describe the social and demographic characteristics of children where abuse or neglect was determined to cause or contribute to their death, compare characteristics and circumstances of the deaths by cause and manner of death and type of maltreatment, and explore the role of abuse and neglect in child suicides. Secondary analysis of deaths due to child abuse or neglect among children ages 5–17 years old occurring during 2009–2018 and documented in the National Fatality Review-Case Reporting System. Child, family, and social characteristics were compared by child age (5–10 years vs. 11–17 year-olds), and by cause and manner of death. Frequencies and proportions were reported and compared using chi-square statistics. 1478 maltreatment-related deaths were identified. Higher proportions of older children were non-Hispanic white, had a history of chronic disease or disability, had problems in school, and had a history of mental health issues. Forty-three percent of the maltreatment deaths were due to homicide and 10 % by suicide. Higher proportions (65 %) of younger children (5–10 years old) died by homicide, compared to older children (35 % among ages 11-17y). While 58 % of deaths overall were related to neglect, 68 % of deaths in older children were related to neglect, including 80 % of suicides. The causes of child maltreatment deaths among children 5–17y vary by age. Child neglect caused and/or contributed to most child suicides. [ABSTRACT FROM AUTHOR]

Objective Assess the association between caregiver supervision and acute unintentional injury in young children; evaluate whether lower levels of supervision result in more severe injury. Methods A case cross-over study was conducted. Parents of children aged ≤4 years whose injuries required emergency department (ED sample) treatment or admission to the hospital (inpatient sample) were interviewed. Information on supervision (3 dimensions: proximity, attention, continuity) at the time of injury and 1 h before the injury (control time) was collected. An overall supervision score was created; a higher score indicates closer supervision. Hospital admission served as a proxy for injury severity. ORs and 95% CIs were calculated. Results Interviews were completed by 222 participants; 50 (23%) were in the inpatient sample. For each supervision dimension the inpatient sample had higher odds of injury, indicating effect modification requiring separate analyses for inpatient and ED samples. For both samples, proximity ‘beyond reach' was associated with the highest odds of injury; compared with 1 h before injury, children were more likely to be beyond reach of their caregiver at the time of injury (inpatient sample: OR 11.5, 95% CI 2.7 to 48.8; ED sample: OR 2.9, 95% CI 1.8 to 4.9). Children with lower supervision scores had the greatest odds of injury (inpatient sample: OR 8.0, 95% CI 2.4 to 26.6; ED sample: OR 3.3, 95% CI 1.9 to 5.6). Conclusions Lower levels of adult supervision are associated with higher odds of more severe injury in young children. Proximity is the most important supervision dimension for reducing injury risk. [ABSTRACT FROM AUTHOR]

Fatal child maltreatment is a compelling problem in the United States. National estimates of fatal child maltreatment, based largely on child welfare data, have fluctuated around 1,500 deaths annually for the past ten years. However, the limitations of child welfare and other mortality data to accurately enumerate fatal child maltreatment are well documented. As a result of these limitations, the true magnitude of fatal child maltreatment remains unknown. Public health surveillance has been proposed as a mechanism to improve estimation of fatal child maltreatment, as well as to collect and analyze relevant risk factor data for the ultimate goal of developing prevention strategies. his paper describes public health surveillance efforts undertaken to improve estimation of fatal child maltreatment, and presents the unique challenges of identifying fatal child neglect. The strengths and limitations of existing sources of child maltreatment fatality data are reviewed and broad recommendations for strategies to advance public health surveillance of fatal child maltreatment are presented. [ABSTRACT FROM AUTHOR]

Objectives. We sought to describe the characteristics and sleep circumstances of infants who die suddenly and unexpectedly and to examine similarities and differences in risk factors among infants whose deaths are classified as resulting from sudden infant death syndrome (SIDS), suffocation, or undetermined causes. Methods. We used 2005 to 2008 data from 9 US states to assess 3136 sleep-related sudden unexpected infant deaths (SUIDs). Results. Only 25% of infants were sleeping in a crib or on their back when found; 70% were on a surface not intended for infant sleep (e.g., adult bed). Importantly, 64% of infants were sharing a sleep surface, and almost half of these infants were sleeping with an adult. Infants whose deaths were classified as suffocation or undetermined cause were significantly more likely than were infants whose deaths were classified as SIDS to be found on a surface not intended for infant sleep and to be sharing that sleep surface. Conclusions. We identified modifiable sleep environment risk factors in a large proportion of the SUIDs assessed in this study. Our results make an important contribution to the mounting evidence that sleep environment hazards contribute to SUIDs. [ABSTRACT FROM AUTHOR]

Most unintentional injury deaths among young children result from inadequate supervision or failure bycaregivers to protect the child from potential hazards. Determining whether inadequate supervision or failure to protect could be classified as child neglect is a component of child death review (CDR) in most states. However, establishing that an unintentional injury death was neglect related can be challenging as differing definitions, lack of standards regarding supervision, and changing norms make consensus difficult. The purpose of this study was to assess CDR team members' categorisation of the extent to which unintentional injury deaths were neglect related. CDR team members were surveyed and asked to classify 20 vignettesdpresented in 10 pairsdthat described the circumstances of unintentional injury deaths among children. Vignette pairs differed by an attribute that might affect classification, such as poverty or intent. Categories for classifying vignettes were: (1) caregiver not responsible/not neglect related; (2) some caregiver responsibility/somewhat neglect related; (3) caregiver responsible /definitely neglect related. CDR team members from five states (287) completed surveys. Respondents assigned the child's caregiver at least some responsibility for the death in 18 vignettes (90%). A majority of respondents classified the caregiver as definitely responsible for the child's death in eight vignettes (40%). This study documents attributes that influence CDR team members' decisions when assessing caregiver responsibility in unintentional injury deaths, including supervision, intent, failure to use safety devices, and a pattern of previous neglectful behaviour. The findings offer insight for incorporating injury prevention into CDR more effectively. [ABSTRACT FROM AUTHOR]

Objective: In order to be reimbursed for the care they provide, hospitals in the United States are required to use a standard system to code all discharge diagnoses: the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9). Although ICD-9 codes specific for child maltreatment exist, they do not identify all maltreatment-related hospital and emergency department discharges. To increase the usefulness of medical data for public health surveillance of child maltreatment, this project sought to identify ICD-9 codes that are suggestive of child maltreatment. Methods: After review of the literature and discussions with experts, injuries and conditions that should raise suspicion of child maltreatment (physical or sexual abuse or neglect) were identified and a list of corresponding ICD codes was compiled. Using a statewide electronic database of hospital discharges and emergency department (ED) visits for the year 2000, visits by children assigned these ICD codes were identified, a sample of visits was selected, and medical records were reviewed to assess the circumstances of the injury or illness that led to the visit. Based on information in the medical record, the injury or illness was classified as maltreatment-related, or not. Results: There were 3,684 visits selected for review. Of these, 2,826 records were reviewed and classified; 1,200 (43%) records met the criteria for being maltreatment-related, 1,419 (50%) contained adequate information indicating the injury/condition was not likely maltreatment-related, and 207 (7%) records did not contain enough information to classify. Sixty-eight ICD codes had >66% of visits classified as maltreatment-related, the a priori criteria for a code to be considered suggestive of maltreatment. Codes suggestive of maltreatment include specific fractures, burns, and injuries of undetermined intent, among others. Conclusion: Several ICD codes were found that, when used with age restrictions and other specific exclusion criteria, are suggestive of maltreatment. This information may increase the usefulness of hospital discharge data for public health surveillance of child maltreatment. Practice implications: Use of these suggestive codes facilitates identifying conditions and injuries that are likely maltreatment-related in hospital discharge and ED visit data. When used in conjunction with ICD maltreatment-specific codes, these suggestive codes may enhance the use of medical data for monitoring child maltreatment trends. [Copyright &y& Elsevier]

Abstract: Injuries are a leading cause of childhood morbidity and are also common manifestations of child maltreatment, especially among young children. In an effort to determine whether injury-related Emergency Department (ED) visits among children aged 0 to 4 years were associated with child maltreatment reports, we identified all children with at least one injury-related ED visit in Missouri during 2000. Data on these injured children were linked to Missouri Child Protective Services (CPS) child abuse and neglect reports for 2000 and 2001. There were 50,068 children with at least one injury-related ED visit. Using children with one injury-related ED visit as the reference category, we calculated the relative risk of having a CPS report (or a substantiated report) for children with two, three, and four or more ED visits before a CPS report (or substantiated report). Compared to children with one visit, children with two visits were more likely to have a CPS report (relative risk [RR] 1.9; 95% confidence interval [CI] 1.8–2.0) and a substantiated report (RR 2.5; 95% CI 2.1–2.9). For children with four or more visits, the relative risk of a report and substantiated report was 3.8 (95% CI 3.0–4.7) and 4.7 (95% CI 2.4–9.2), respectively. Children with two or more injury-related ED visits in 1 year are more likely to be reported for child maltreatment and to have a substantiated report. [Copyright &y& Elsevier]

Objectives. We sought to describe approaches to surveillance of fatal child maltreatment and to identify options for improving case ascertainment. Methods. Three states — California, Michigan, and Rhode Island — used multiple data sources for surveillance. Potential cases were identified, operational definitions were applied, and the number of maltreatment deaths was determined. Results. These programs identified 258 maltreatment deaths in California, 192 in Michigan, and 60 in Rhode Island. Corresponding maltreatment fatality rates ranged from 2.5 per 100000 population in Michigan to 8.8 in Rhode Island. Most deaths were identified by child death review teams in Rhode Island (98%), Uniform Crime Reports in California (56%), and child welfare agency data in Michigan (44%). Compared with the total number of cases identified, child welfare agency (the official source for maltreatment reports) and death certificate data underascertain child maltreatment deaths by 55% to 76% and 80% to 90%, respectively. In all 3 states, more than 90% of cases ascertained could be identified by combining 2 data sources. Conclusions. No single data source was adequate for thorough surveillance of fatal child maltreatment, but combining just 2 sources substantially increased case ascertainment. The child death review team process may be the most promising surveillance approach. (Am J Public Health. 2008;98:296-303. doi:10.2105/AJPH.2006.087783) [ABSTRACT FROM AUTHOR]

Background: Public health surveillance was established for nonfatal child maltreatment in Missouri using two data sources. This paper describes the epidemiology of nonfatal child maltreatment using this surveillance system, and assesses the usefulness of combining medical data with child protective services (CPS) reports for child maltreatment surveillance. Methods: Child abuse and neglect reports for children aged <10 years for 2000 were obtained from the Missouri Division of Family Services (DFS) and linked to hospital discharge and emergency department (ED) data for 2000. Children were classified as maltreated if they had an International Classification of Disease (ICD) maltreatment code for a hospital or ED visit, or a substantiated report to DFS. Validity of the ICD maltreatment codes was assessed in a 10% random sample of the hospital/ED visits. Medical records were reviewed to determine the accuracy of the maltreatment code assigned. The data analyses reported here were conducted in 2002 and 2003. Results: In the linked data, 5657 children met the case definition of maltreatment, providing a nonfatal maltreatment rate of 7.4/1000 children. Rates were higher among children aged <1 year (8.4/1000), females (7.7/1000), African Americans (11.8/1000), and children residing in rural counties (8.7/1000). The hospital/ED data identified proportionately more children who were African American, urban, physically abused, or infants, and uniquely identified only 10% of the total cases. In the validation sample, maltreatment was documented in 110 (87%) of the 127 records reviewed. Conclusions: CPS and medical data can be linked for surveillance. However, the medical data add few unique cases and identify only a subset of maltreated children. [Copyright &y& Elsevier]

: BackgroundChild death review (CDR) is a mechanism to more accurately describe the causes and circumstances of death among children. The number of states performing CDR has more than doubled since 1992, but little is known about the characteristics of these programs. The purpose of this study was to describe the current status of CDR in the United States and to document variability in program purpose, scope, organization, and process.: MethodsInvestigators administered a written survey to CDR program representatives from 50 states and the District of Columbia (DC), followed by a telephone interview.: ResultsAll 50 states and DC participated; 48 states and DC have an active CDR program. A total of 94% of programs agreed that identifying the cause of and preventing future deaths are important purposes of CDR. Assistance with child maltreatment prosecution was cited as an important purpose by only 13 states (27%). Twenty-two states (45%) review deaths from all causes, while six states (12%) review only deaths due to child maltreatment. CDR legislation exists in 33 states. Fifty-three percent of the CDR programs were implemented since 1996, and 59% report no or inadequate funding. CDR contributes to the death investigation process in seven states (14%), but the majority (59%) of reviews are retrospective, occurring months to years after the child’s death.: ConclusionsCDR programs in the United States share commonalities in purpose and scope. Without national leadership, however, the wide variation in organization and process threatens to limit CDR effectiveness. [Copyright &y& Elsevier]

Objective. Approximately 2000 children die annually in the United States from maltreatment. Although maternal and child risk factors for child abuse have been identified, the role of household composition has not been well-established. Our objective was to evaluate household composition as a risk factor for fatal child maltreatment. Methodology. Population-based, case-control study using data from the Missouri Child Fatality Review Panel system, 1992-1994. Households were categorized based on adult residents' relationship to the deceased child. Cases were all maltreatment injury deaths among children <5 years old. Controls were randomly selected from natural-cause deaths during the same period and frequency-matched to cases on age. The main outcome measure was maltreatment death. Results. Children residing in households with adults unrelated to them were 8 times more likely to die of maltreatment than children in households with 2 biological parents (adjusted odds ratio [aOR]: 8.8; 95% confidence interval [CI]: 3.6-21.5). Risk of maltreatment death also was elevated for children residing with step, foster, or adoptive parents (aOR: 4.7; 95% CI: 1.6-12.0), and in households with other adult relatives present (aOR: 2.2; 95% CI: 1.1-4.5). Risk of maltreatment death was not increased for children living with only 1 biological parent (aOR: 1.1; 95% CI: 0.8-2.0). Conclusions. Children living in households with 1 or more male adults that are not related to them are at increased risk for maltreatment injury death. This risk is not elevated for children living with a single parent, as long as no other adults live in the home. epidemiology, injury, child abuse and neglect, fatalities, mortality, maltreatment, case-control study, death, risk factors, behavior. [ABSTRACT FROM AUTHOR]

Describes the growth from 1987 through 1996 of the Occupational Pesticide Surveillance Program at the Texas Department of Health. Reasons most work-related pesticide illness is underreported; History of the program; Details on the improvement of the program.

OBJECTIVES. Studies from other countries have identified fishing as a hazardous industry, but little is known about occupational injury mortality related to fishing in the United States. Alaska was chosen for this study because approximately 45,000 people annually participate in Alaska's fishing industry and fishing is thought to be a major contributor to occupational injury mortality in the state. METHODS. Work-related injury deaths in Alaska's fishing industry were identified by means of death certificates and US Coast Guard mortality data. Fatality rates were calculated by using average annual fishing industry employment estimates. RESULTS. The 5-year average annual fishing-related fatality rate was 414.6 per 100,000 fishermen. The majority of the decedents were Caucasian men who drowned while fishing. CONCLUSIONS. This study emphasizes that fishing is a dangerous industry in Alaska and demonstrates the benefit of using multiple data sources to identify fishing-related deaths in the state. [ABSTRACT FROM AUTHOR]

Summarizes the descriptive epidemiology of injuries among women in the United States. Focus on the most frequent causes of injury in the context of overall mortality and morbidity; Calculation of death mortality rates from 1984-1988; Less accessibility to data on non-fatal injuries; Societal impact of injuries; Causes of injuries; Motor vehicles; Falls; Violence.

Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www.editorialmanager.com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at men6@nyu.edu. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Occupational Injury Deaths in Alaska's Fishing Industry, 1980 Through 1988," by P. G. Schnitzer and D. D. Landen, which appeared in the 1993 issue.

OBJECTIVES: Sudden infant death syndrome (SIDS) is a major cause of infant mortality and is associated with the prone sleeping position. Our goal was to determine changes in newborn nursery policies and practices regarding infant sleeping position between 1992 and 1999. STUDY DESIGN: We conducted telephone interviews with the head nurses in all of the newborn nurseries in Missouri. POPULATION: In 1992 there were 79 hospitals in Missouri with newborn nurseries; in 1999 that number had decreased to 75. OUTCOMES MEASURED: During the interviews, we solicited nursery infant sleep position policy and practice, head nurses' opinions about the supine sleep recommendation, and nurses' advice to parents regarding sleep position. RESULTS: In 1992, 32% of the nurseries used the prone position for sleep, and 58% of the head nurses interviewed disagreed with the recommendations of the American Academy of Pediatrics (AAP). By 1999, all newborn nurseries in Missouri placed infants on their backs or sides for sleep. The rate of disagreement with the AAP recommendation had decreased, with 25% of respondents indicating that they disagreed. CONCLUSIONS: From 1992 to 1999 nurseries in Missouri have changed from predominantly using prone and lateral positioning to lateral and supine positioning for newborns. Some nurses continue to voice concern about placing infants on their backs and expressed a willingness to place babies prone. Since there is agreement between nurses' usual infant positioning and the advice given to parents, and because both are important influences on infant positioning by parents, future campaigns to decrease SIDS should emphasize correcting nurses' positioning behavior and advising parents to increase infant supine positioning. [ABSTRACT FROM AUTHOR]