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In response to fears regarding high-profiled school shootings and firearm violence, schools transformed dramatically, implementing school safety measures such as school police, armed security, metal detectors, and active shooter drills. This study used nationally representative data to assess the relationship between school safety policies and student perceptions of school safety for Youth of Color in comparison to non-Hispanic, White youth. Results show that an increase in the total number of school safety policies -- as well as specific types of school safety policies (i.e. armed security personnel and student search practices) -- are associated with lower perceptions of school safety for Youth of Color relative to White youth. Findings may inform school administrators' decisions regarding implementation of school safety policies to prevent school violence, including school-level decisions around firearm injury prevention efforts.

Firearm injury is a significant public health concern among youth living in the United States. Youth with exposure to violence (ETV) are more susceptible to carrying and using a firearm. Few researchers, however, have examined psychological mechanisms undergirding the association between ETV and firearm aggression. Retaliatory attitudes have been discussed as a potential mediator linking ETV with firearm aggression. Moreover, organized activity participation may disrupt direct and indirect pathways connecting ETV to firearm aggression. We tested: (a) the mediating role of retaliatory attitudes in the ETV-firearm aggression link, and (b) the moderating role of organized activity participation among 570 youth with past year illicit drug use and seeking emerging department care in an urban emergency department (ages 14-24; 58.8% males). Using multigroup path analysis, ETV indirectly influenced firearm aggression through retaliatory attitudes for youth not involved organized activities. Organized activities also buffered the association between retaliatory attitudes (mediator) and firearm aggression (outcome). Organized activities may, therefore, prevent firearm aggression by reducing retaliatory attitudes among youth contending with ETV.

Preventing opioid misuse and opioid use disorder is critical among at-risk adolescents and young adults (AYAs). An Emergency Department (ED) visit provides an opportunity for delivering interventions during a rapidly changing opioid landscape. This paper describes pilot data and the protocol for a 2 × 2 factorial randomized controlled trial testing efficacy of early interventions to reduce escalation of opioid (prescription or illicit) misuse among at-risk AYAs. Interventions are delivered using technology by health coaches. AYAs ages 16-30 in the ED screening positive for prescription opioid use (+ ≥ 1 risk factor) or opioid misuse will be stratified by risk severity, sex, and age group. Participants will be randomly assigned to a condition at intake, either a live video health coach-delivered single session or a control condition of an enhanced usual care (EUC) community resource brochure. They are also randomly assigned to one of two post-intake conditions: health coach-delivered portal-like messaging via web portal over 30 days or EUC delivered at 30 days post-intake. Thus, the trial has four groups: health coach-delivered session+portal, health coach-delivered session+EUC, EUC + portal, and EUC + EUC. Outcomes will be measured at 3-, 6-, and 12-months. The primary outcome is opioid misuse based on a modified Alcohol Smoking and Substance Involvement Screening Test. Secondary outcomes include other opioid outcomes (e.g., days of opioid misuse, overdose risk behaviors), other substance misuse and consequences, and impaired driving. This study is innovative by testing the efficacy of feasible and scalable technology-enabled interventions to reduce and prevent opioid misuse and opioid use disorder. Trial Registration:ClinicalTrials.gov University of Michigan HUM00177625 NCT Registration: NCT04550715.

Cannabis-using youth are a large epidemiologic subgroup whose age and smoking-related risks underscore the importance of examining the impact of the COVID-19 pandemic in this population. Within a clinical trial (n = 36 received an intervention prior to data collection reported herein), we surveyed cannabis-using emerging adults (ages 18-25) about perceived COVID-19 impacts. Participants (n = 141) reporting weekly cannabis use (M = 18.6 use days in the past 30) were enrolled and completed online surveys as part of either their baseline or 3 month assessment. COVID-19-related measures included symptoms, substance use, mood, etc. Participants were 57% female (mean age = 21, standard deviation = 2.2), with 21% Hispanic/Latinx, 70% White, 20% Black/African American, and 10% of other races. Most participants (86%) reported quarantine/self-isolation (M = 59 days). Several had COVID-19 symptoms (16%), but none reported testing COVID-19 positive. Many respondents felt their cannabis use (35%-50%, across consumption methods) and negative emotions (e.g., loneliness, stress, and depression; 69.5%, 69.5%, and 61.8%, respectively) increased. They reported decreased in-person socialization (90.8%) and job losses (23.4%). Reports of increased cannabis smoking were associated with increased negative emotions. On an open-response item, employment/finances and social isolation were frequently named negative impacts (33.3% and 29.4%, respectively). Although cannabis-using emerging adults' reports of increases in cannabis use, coupled with mental health symptoms and social isolation, are concerning, the full impact of the pandemic on their health and well-being remains unknown. Future studies examining the relationship between social isolation, mental health, and cannabis use among young people are needed.

Introduction: Prescription opioid use and driving is a public health concern given the risks associated with drugged driving, but the issue remains under-studied. We examined the prevalence and correlates of driving after taking prescription opioids (DAPO) among adults seeking emergency department (ED) treatment.Methods: Participants (aged 25-60) seeking ED care at a Level I trauma center completed a computerized survey. Validated instruments measured prescription opioid use, driving behaviors, and risky driving. Patients who reported past three-month prescription opioid use and drove at least twice weekly were administered an extended study survey measuring DAPO, depression, pain, and substance use.Results: Among participants completing the screening survey (n = 756; mean age = 42.8 [standard deviation {SD} =10.4]), 37.8% reported past three-month prescription opioid use (30.8% of whom used daily), and 14.7% reported past three-month DAPO. Of screened participants, 22.5% (n = 170) were eligible for the extended study survey. Unadjusted analyses demonstrated that participants reporting DAPO were more likely to use opioids daily (51.1% vs 15.9%) and had higher rates of opioid misuse (mean Current Opioid Misuse Measure score 3.4 [SD = 3.8] vs 1.1 [SD = 2.1]) chronic pain (80.7% vs 42.7%), and driving after marijuana or alcohol use (mean intoxicated driving score 2.1 [SD = 1.3] vs 0.3 [SD = 0.8]) compared to patients not reporting DAPO (all p

This article from the New England Journal of Medicine discusses the urgent health crisis of firearm-related injuries in the United States and the role that clinicians can play in prevention efforts. It highlights the lack of research and funding in this area and provides evidence-based strategies for clinicians to reduce patients' risks of firearm-related injury and death. The article also addresses the barriers and challenges that clinicians face in implementing these interventions and calls for improved training and support for clinicians. It emphasizes the importance of promoting locked storage practices and tailoring counseling to individual patients. The article also discusses the availability and access to firearms in the United States, as well as the increased risk of firearm-related injuries and deaths associated with household firearm ownership. It suggests that clinicians should initiate conversations about firearm safety and storage with their patients, particularly for intimate partners, children, and teens. The article also provides guidance on firearm storage and safety measures, as well as evidence-based strategies for preventing suicide, community violence, intimate partner violence, and addressing firearm safety concerns specific to older adults. The document discusses the importance of healthcare systems in implementing prevention strategies and supporting broader agendas. It emphasizes the need for training healthcare professionals, providing safety programs, and ensuring access to mental health and social work services. The document also highlights the role of research in generating new knowledge and identifying effective prevention methods. It calls for efforts at multiple levels, including individual, community, and policy, to address the underlying factors contributing to firearm injuries. The document provides resources for accessing information on firearm injuries and costs [Extracted from the article]

The objective of this study was to assess parents' firearm storage behaviors during the COVID-19 pandemic and characterize reasons why some parents made their firearms more accessible during this time. In June-July 2020, the study team conducted the FACTS National Survey-a cross-sectional, web-based, survey of 2,924 parents and their teens (ages14-18) regarding firearm-related practices. We weighted descriptive analyses to be nationally representative of parents of teens in the United States. We utilized qualitative thematic analysis to identify parents' reasons for making firearms more accessible. Five percent of firearm-owning parents of teens reported making their firearms more accessible during the beginning of the COVID-19 pandemic. Reasons why parents increased the ease of firearm access included: (1) Increased civil unrest and riots; (2) Threat of home invasion and/or crime victimization; (3) Fear of panic and the unknown; and (4) Easier access and greater protection, threat unspecified. Some parents-largely motivated by fear-chose to store firearms in a more accessible manner during the beginning of the COVID-19 pandemic to protect their family against possible external threats. Understanding the fear that motivates parents' decisions regarding storage practices might aid interventions focused on harm reduction and safer storage., Author(s): Rebeccah L. Sokol [sup.1] , Lea Marineau [sup.2] , Marc A. Zimmerman [sup.3] [sup.4] [sup.5] , Laney A. Rupp [sup.3] [sup.5] , Rebecca M. Cunningham [sup.3] [sup.4] [sup.6] , [...]

To describe and identify the correlates of firearm purchasing at the beginning of the COVID-19 pandemic among US families with teenagers. In June-July 2020, we conducted a national survey of 2924 parents and their teenagers in the US. We report results from this survey to describe firearm purchasing behaviors following the start of the COVID-19 pandemic and investigate correlates of purchasing. Between the beginning of the pandemic and July 2020, 10% of households with teenagers purchased a firearm, and 3% became first-time firearm-owning households. Among firearm-owning households, firearm storage was associated with purchasing such that households that stored at least one firearm loaded and unlocked were more likely to purchase a firearm (OR: 2.02[1.07-3.79]) compared to households that stored all firearms unloaded and/or locked. Firearms purchased at the beginning of the pandemic were more likely to go to homes where at least one firearm was stored loaded and unlocked, which may contribute to increased risk for teen firearm injury and death., Author(s): Rebeccah L. Sokol [sup.1] , Marc A. Zimmerman [sup.2] [sup.3] , Laney Rupp [sup.2] [sup.3] , Justin E. Heinze [sup.2] , Rebecca M. Cunningham [sup.3] [sup.4] , Patrick M. [...]

Study objectiveTo identify critical emergency medicine-focused firearm injury research questions and develop an evidence-based research agenda.MethodsNational content experts were recruited to a technical advisory group for the American College of Emergency Physicians Research Committee. Nominal group technique was used to identify research questions by consensus. The technical advisory group decided to focus on 5 widely accepted categorizations of firearm injury. Subgroups conducted literature reviews on each topic and developed preliminary lists of emergency medicine-relevant research questions. In-person meetings and conference calls were held to iteratively refine the extensive list of research questions, following nominal group technique guidelines. Feedback from external stakeholders was reviewed and integrated.ResultsFifty-nine final emergency medicine-relevant research questions were identified, including questions that cut across all firearm injury topics and questions specific to self-directed violence (suicide and attempted suicide), intimate partner violence, peer (nonpartner) violence, mass violence, and unintentional ("accidental") injury. Some questions could be addressed through research conducted in emergency departments; others would require work in other settings.ConclusionThe technical advisory group identified key emergency medicine-relevant firearm injury research questions. Emergency medicine-specific data are limited for most of these questions. Funders and researchers should consider increasing their attention to firearm injury prevention and control, particularly to the questions identified here and in other recently developed research agendas.

Youth interpersonal firearm violence disproportionately affects Black youth, with residential racial segregation as a key determinant. Racially segregated neighborhoods, which are economically isolated (e.g., neighborhood disadvantage), are linked to increased exposure to violence. This exposure, in turn, is a determinant of youth firearm aggression (i.e., using a gun on someone else). Mechanisms from residential racial segregation to firearm aggression, however, have not been evaluated. Therefore, we tested neighborhood disadvantage and exposure to violence as mediators in the association between residential racial segregation and youth firearm aggression. Participants were 338 Black youth who had used drugs in the past 6 months and sought care in an urban emergency department. Using serial mediation analysis, residential racial segregation was indirectly associated with youth firearm aggression via neighborhood disadvantage and then exposure to violence. While researchers have documented the association between structural racism and firearm violence injury and incidents, our study assessed multiple socioecological mechanisms simultaneously. Identifying the downstream socioecological consequences of residential segregation can guide the development of firearm aggression prevention programs addressing the consequences of racism. [ABSTRACT FROM AUTHOR]

Firearm suicides among adolescents have increased in the US and rates vary across racial and ethnic groups. In this study, we examined contextual information around adolescent firearm suicides and analyzed how incident characteristics vary across racial and ethnic groups. We analyzed firearm suicides among adolescents (ages 10–18 years) from 2004 to 2020 using data from the National Fatality Review-Case Reporting System (NFR-CRS). There were 4,153 firearm suicides during that period. Suicides often involved males, older adolescents (15–18 years), and handguns. Most firearms belonged to the primary caregiver and incidents frequently occurred at home. However, we found that characteristics varied substantially across racial and ethnic groups. Overall, we provide new information on firearm suicides among adolescents in the US using a larger dataset than previous studies and found significant differences in characteristics and demographics across racial and ethnic groups. This finding suggests the need for tailored prevention strategies. [ABSTRACT FROM AUTHOR]

This article discusses the association between the SaFETy score, a clinical screening tool for firearm violence, and self-reported firearm violence among young adults in three cities. The study found that higher SaFETy scores were associated with higher rates of firearm violence, victimization, and aggression. Additionally, individuals with higher SaFETy scores had a higher prevalence of firearm violence in the past 6 months. The findings suggest that the SaFETy score may be useful in identifying individuals at risk for firearm violence and allocating preventive resources, but further research is needed to validate the findings and determine the effectiveness of the SaFETy score in preventing firearm violence. [Extracted from the article]

Five teams of FACTS researchers conducted a series of rigorous scoping reviews of the existing published scientific literature from the fields of medicine, public health, psychology, behavioral health, and criminology from January of 1985 through April of 2018 utilizing the Preferred Reporting Items for Scoping Reviews (Tricco et al., Ann Intern Med 169:467-473, 2018 (See CR23)) framework to guide the search strategy, study selection, data abstraction, and analysis process. These scoping reviews characterize the existing scientific literature in five key areas related to Firearm Injury Prevention among children and adolescents (age 0-17): (1) Adolescent Firearm Carriage; (2) Risk and Protective Factors for Firearm Injury; (3) Primary Prevention Initiatives; (4) Long-term consequences and secondary prevention of negative outcomes after a firearm injury; and, (5) Effects of existing law and policy interventions on pediatric firearm outcomes. In this special issue of the Journal of Behavioral Medicine, we present these five scoping review articles., Author(s): Rebecca M. Cunningham [sup.1] [sup.2] [sup.3] , Patrick M. Carter [sup.1] [sup.2] [sup.3] , Marc Zimmerman [sup.2] [sup.3] Author Affiliations: (1) https://ror.org/00jmfr291, grid.214458.e, 0000 0004 1936 7347, Department of [...]

Risk and protective factors for firearm assault (FA) have been established, but little is known about factor preceding transitions in FA behavior. We modeled covariate effects on individuals' transitions in FA behavior (Yes/No) using inhomogeneous, continuous-time, Markov Chains. 3287 assessments were made across five initial biannual follow-ups, and two additional biannual follow-ups (an average of 2.2 years later) from a follow-on study; 2687 pairs of transitions were observed (2414 No-FA [right arrow] No-FA; 89 No-FA [right arrow] FA; 121 FA [right arrow] No-FA; 63 FA [right arrow] FA). Non-firearm peer violence (HR = 2.31, 95% CI [1.28,4.21]), firearm victimization (HR = 2.57, 95% CI [1.31,5.04]), and marijuana ASSIST sum (HR = 1.27, 95% CI [1.05,1.54]) all preceded transitions into FA, but not transitions out of FA. Delinquent peer associations both hastened transitions into FA (HR = 1.19, 95% CI [1.00,1.40]) and slowed transitions out of FA (HR = 0.84, 95% CI:[0.72,1.00]), with analogous findings regarding attitudes favoring retaliation. Efforts to prevent FA initiation should focus on those currently reporting firearm violence victimization, and on factors indicating an escalating delinquency trajectory (e.g. non-firearm violence, substance use), while programs focusing on peer influences and social norms may be effective at preventing FA regardless of current FA status., Author(s): Jason E. Goldstick [sup.1] [sup.2] , Patrick M. Carter [sup.1] [sup.2] [sup.3] , Justin E. Heinze [sup.2] [sup.3] [sup.4] , Maureen A. Walton [sup.2] [sup.5] [sup.6] , Marc Zimmerman [...]

Youth living in areas with high concentrations of vacant properties may be at particular risk for poor health outcomes given the associations between deteriorated vacant properties, poor mental health, and community violence. Vacant lot greening has emerged as a key strategy to mitigate the harms of deteriorated properties. Youth engagement in greening has documented benefits for youth, yet few organizations responsible for managing vacant properties currently engage youth. Further, few researchers have examined the best practices that organizations can employ to effectively engage youth in greening programs. The purpose of this study was to understand how high functioning vacant land management organizations with robust youth engagement capabilities engage youth in their greening work. Based on in‐depth interviews with staff from vacant land management organizations, we explored three research questions: (1) what are their identified best practices for youth engagement?; (2) what are the major challenges that impede their youth engagement work?; (3) what solutions are these organizations employing to address these challenges? Findings from this study emphasize the important themes of engaging youth in vacant lot greening in areas of planning, leadership, and decision‐making. Youth engagement in vacant lot greening may be a key mechanism for preventing violence through cultivating youth empowerment and development. Highlights: Youth engagement in greening may be a key mechanism for preventing violence.Valuing of youth driven spaces and cultivating youth leadership is supported by empowerment theory.Examples of how organizations engage youth to address concentrated vacancy and neighborhood decline are discussed. [ABSTRACT FROM AUTHOR]