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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., Author(s): Patricia G. Schnitzer [sup.1] , Heather K. Dykstra [sup.1] , Theodore E. Trigylidas [sup.2] , Richard Lichenstein [sup.3] Author Affiliations: (Aff1) 0000 0001 0028 3686, grid.415507.2, National Center for [...]

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 [...]

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)

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 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. Pediatrics 2002; 109:615-621; epidemiology, injury, child abuse and neglect, fatalities, mortality, maltreatment, case-control study, death, risk factors, behavior. ABBREVIATIONS. CFRP, Missouri Child Fatality Review Panel; SIDS, sudden infant death syndrome; aOR, adjusted odds ratio; CI, confidence interval., Maltreatment of children causes an estimated 2000 deaths annually in the United States. (1) Ninety percent of these deaths occur among children Several studies have identified the following maternal risk [...]

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. (Am J Public Health. 1993;83:685-688), The fatality rate in Alaska's fishing industry is five to eight times greater than that found in other high-risk industries in the state. Review of death certificates indicated a five-year average of 414.6 deaths per 100,0000 fishermen. This fatality rate is considerably higher than Alaska's overall occupational death rate of 34.2 per 100,000 and than the average combined rate for all 50 states, which is 7.8 deaths per 100,000 workers. Deaths related to the fishing industry are often underestimated for a variety of reasons including the seasonal nature of the work and the exclusion of presumptive death certificates in mortality statistics. Presumptive certificates are issued by judges when no bodies are found. They often fail to indicate a cause of death. More accurate statistics will need to include data from several sources in addition to standard death certificates.

Presently, there are three national sources of data on fatal occupational injuries in the United States--the Bureau of Labor Statistics (BLS) annual survey of occupational injury and illness by industry, […]

Background: Determining a community's health care access needs and testing interventions to improve access are difficult. This challenge is compounded by the task of translating the relevant data into a format that is clear and persuasive to policymakers and funding agencies. Geographic information systems can analyze and transform complex data from various sources into maps that illustrate problems effortlessly for experts and nonexperts. Objective: To combine the patient data of a community health center (CHC) with health care survey data to display the CHC service area, the community's health care access needs, and relationships among access, poverty, and political boundaries. Design: Georeferencing, analyzing, and mapping information from 2 databases. Setting: Boone County, Missouri. Participants: Community health center patients and survey respondents. Main Outcome Measures: Maps that define the CHC service area and patient demographics and show poor health care access in relation to the CHC service area, CHC utilization in relation to poverty, and rates of health care access by geopolitical region. Results: The CHC serves a distinctly different area than originally targeted. Subpopulations with unmet health care access needs and poverty were identified by census tract. These underserved populations fell within geopolitical boundaries that were easily linked to their elected officials. Conclusions: Geographic information systems are powerful tools for combining disparate data in a visual format to illustrate complex relationships that affect health care access. These systems can help evaluate interventions, inform health services research, and guide health care policy. Arch Fam Med. 2000;9:971-978

Although thought to be significant, the extent of work-related pesticide poisonings in this country remains largely undocumented.[1] Historically, this has been due primarily to a lack of reporting mechanisms for […]

Objective. To determine the role of household composition as an independent risk factor for fatal inflicted injuries among young children and describe perpetrator characteristics. Design, Setting, and Population. A population-based, case-control study of all children Main Outcome Measure. Inflicted-injury death. Household composition of case and control children was compared by using multivariate logistic regression. We hypothesized that children residing in households with adults unrelated to them are at higher risk of inflicted-injury death than children residing in households with 2 biological parents. Results. We identified 149 inflicted-injury deaths in our population during the 8-year study period. Children residing in households with unrelated adults were nearly 50 times as likely to die of inflicted injuries than children residing with 2 biological parents (adjusted odds ratio: 47.6; 95% confidence interval: 10.4-218). Children in households with a single parent and no other adults in residence had no increased risk of inflicted-injury death (adjusted odds ratio: 0.9; 95% confidence interval: 0.6-1.9). Perpetrators were identified in 132 (88.6%) of the cases. The majority of known perpetrators were male (71.2%), and most were the child's father (34.9%) or the boyfriend of the child's mother (24.2%). In households with unrelated adults, most perpetrators (83.9%) were the unrelated adult household member, and only 2 (6.5%) perpetrators were the biological parent of the child. Conclusions. Young children who reside in households with unrelated adults are at exceptionally high risk for inflicted-injury death. Most perpetrators are male, and most are residents of the decedent child's household at the time of injury. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2005-0296; inflicted injury, child abuse, fatality, risk factors, case-control study.