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Objective: Firearm injuries (FIs) hold a significant place among childhood deaths. Our study aims to raise awareness about preventable FIs by discussing deaths due to FIs in children in the light of relevant national and international studies. Method: The autopsy files of the cases under the age of 18 due to FIs occured between January 2011 and December 2021 were investigated. Sociodemographic data of the cases, location of the incident, injury site, cause of death, number of shots, shooting distance, type of the firearms used, the owner of the weapon, and the identity of the perpetrator were evaluated. Results: The study population consisted of 12 (80.0%) male, and 3 (20.0%) female pediatric cases with a mean age of 13.1±5.4 years (median age: 15.0 years). The most common cause of the death was homicide (n=6, 40.0%), and the most frequently used type of firearm was a shotgun. FIs most commonly happened at home (n=8, 53.3%), and most frequently victims died of brain hemorrhage and brain tissue damage (n=11, 31.4%). The firearms used in the incidents mostly belonged to the fathers of the deceased children (n=10, 66.6%). Conclusion: There is a need to develop multidimensional strategies, including financial support, targeting all segments of society to reduce the number of deaths due to firearms. Additionally, we believe that strict measures to control access to firearms and awareness training to prevent violence will reduce the rates of mortality due to FIs [ABSTRACT FROM AUTHOR]

Few states established assault weapon bans (AWBs) after the federal AWB expired. The effectiveness of state AWBs as well as neighboring state legislation, in reducing the local prevalence of assault weapons (AWs) or in reducing overall shooting lethality is unknown. We queried the Gun Violence Archive (2014-2021) to identify US firearm injuries and fatalities. Shooting case fatality rates were compared among states with and without AWBs, as reported in the State Firearm Laws Database. Data on recovered firearms was obtained from the ATF Firearms Trace Database and used to estimate weapon prevalence. Recovered firearms were classified as AWs based on caliber (7.62 mm, 5.56 mm, 0.223 cal). We performed spatially weighted linear regression models, with fixed effects for state and year to assess the association between geographically clustered state legislation and firearm outcomes. From 2014 to 2021, the US shooting victim case fatality rate was 8.06% and did not differ among states with and without AWBs. The proportion of AWs to total firearms was 5.0% in states without an AWB and 6.0% in states with an AWB (mean difference [95% CI] = −0.8% [−1.6% to −0.2%], P = 0.03). Most recovered firearms in AWB states originated from non-AWB states. On adjusted models, there was no association between state-level AWB and firearm case fatality; however, adjacency to states with an AWB was associated with lower case fatality (P < 0.001). Clustered AWB states with shared borders had lower AW prevalence and fatality rates than the rest of the US. Isolated state AWBs are not inversely associated with shooting case fatality rates nor the prevalence of AWs, but AWBs among multiple neighboring states may be associated with both outcomes. [ABSTRACT FROM AUTHOR]

Despite broad recognition of the physical inactivity pandemic, little to no progress has been made in the past decade in mitigating the problem. The current analysis builds upon previous research into the drivers of physical inactivity to assess the potential interactions with firearm violence in the United States. We merged county-level data on firearm fatality rates, physical inactivity prevalence, the Social Vulnerability Index, and the American nations regional cultures schematic. Counties with a physical inactivity prevalence currently above the federal government's 2030 goal (ie, ≥21.8%) had a significantly higher firearm fatality rate per 100,000 population. This finding was consistent for both the overall rate and race-based subgroups. The overall White, Hispanic, and Black firearm fatality rates were also significantly higher in the American nations group comprising Greater Appalachia, Deep South, El Norte, New France, and First Nation. Stepwise linear regression analysis revealed that the Social Vulnerability Index, American nations dichotomous grouping, and firearm fatality rate were all retained (P <.001) in predicting physical inactivity prevalence as a continuous variable. In conclusion, the United States faces myriad health and societal challenges. Unhealthy lifestyles and gun violence are two of the leaders. The current analysis in conjunction with previous findings demonstrates that solving these challenges by interacting, create complexity to finding solutions that has not been thoroughly considered. [ABSTRACT FROM AUTHOR]

Redlining began in the 1930s with the Home Owners' Loan Corporation; this discriminatory practice limited mortgage availability and reinforced concentrated poverty that still exists today. This study examines the relationship between historical redlining policies and present-day nonsuicide firearm fatalities. Visual Abstract. Historical Redlining and Present-Day Nonsuicide Firearm Fatalities: Redlining began in the 1930s with the Home Owners' Loan Corporation; this discriminatory practice limited mortgage availability and reinforced concentrated poverty that still exists today. This study examines the relationship between historical redlining policies and present-day nonsuicide firearm fatalities. Background: Redlining began in the 1930s with the Home Owners' Loan Corporation (HOLC); this discriminatory practice limited mortgage availability and reinforced concentrated poverty that still exists today. It is important to understand the potential health implications of this federally sanctioned segregation. Objective: To examine the relationship between historical redlining policies and present-day nonsuicide firearm fatalities. Design: Maps from the HOLC were overlaid with incidence of nonsuicide firearm fatalities from 2014 to 2022. A multilevel negative binomial regression model tested the association between modern-day firearm fatalities and HOLC historical grading (A ["best"] to D ["hazardous"]), controlling for year, HOLC area–level demographics, and state-level factors as fixed effects and a random intercept for city. Incidence rates (IRs) per 100 000 persons, incidence rate ratios (IRRs), and adjusted IRRs (aIRRs) for each HOLC grade were estimated using A-rated areas as the reference. Setting: 202 cities with areas graded by the HOLC in the 1930s. Participants: Population of the 8597 areas assessed by the HOLC. Measurements: Nonsuicide firearm fatalities. Results: From 2014 to 2022, a total of 41 428 nonsuicide firearm fatalities occurred in HOLC-graded areas. The firearm fatality rate increased as the HOLC grade progressed from A to D. In A-graded areas, the IR was 3.78 (95% CI, 3.52 to 4.05) per 100 000 persons per year. In B-graded areas, the IR, IRR, and aIRR relative to A areas were 7.43 (CI, 7.24 to 7.62) per 100 000 persons per year, 2.12 (CI, 1.94 to 2.32), and 1.42 (CI, 1.30 to 1.54), respectively. In C-graded areas, these values were 11.24 (CI, 11.08 to 11.40) per 100 000 persons per year, 3.78 (CI, 3.47 to 4.12), and 1.90 (CI, 1.75 to 2.07), respectively. In D-graded areas, these values were 16.26 (CI, 16.01 to 16.52) per 100 000 persons per year, 5.51 (CI, 5.05 to 6.02), and 2.07 (CI, 1.90 to 2.25), respectively. Limitation: The Gun Violence Archive relies on media coverage and police reports. Conclusion: Discriminatory redlining policies from 80 years ago are associated with nonsuicide firearm fatalities today. Primary Funding Source: Fred Lovejoy Housestaff Research and Education Fund. [ABSTRACT FROM AUTHOR]

Over 45,000 gun deaths occur annually in the United States, a country with more than 100 million gun owners and more than 350 million guns. Nevertheless, passing legislation to reduce gun violence is difficult because the issue is intensely polarized. Polls asking about general gun policies (e.g., AR-15 restrictions) demonstrate that, at least in the abstract, Americans disagree vehemently about whether civilians should be able to keep and bear arms. It is possible, however, that a hidden consensus exists in America, which has thus far escaped attention--specifically, that when the focus is on their immediate environments and daily lives, even traditionally pro-gun groups may exhibit aversion to certain types of gun ownership and storage practices. To test this, we conducted two preregistered survey experiments with a large national sample. The first was a conjoint analysis where respondents chose between neighbors (n = 33,596 choices) who randomly varied on seven attributes, including gun ownership (none, pistol, AR-15). No group of respondents, not even traditionally pro-gun groups (e.g., Republicans), exhibited a significant preference for living near gun owners, and every group was averse to AR-15-owning neighbors. The second experiment, per debates about safe-storage laws, was a picture-based factorial vignette that randomized a neighbor's gun storage practices (n = 2,098). Every group of respondents was averse to interacting with a neighbor who stored guns outside of a locked safe. Our findings demonstrate that there is widespread agreement that certain types of gun ownership and storage practices are undesirable for communities. [ABSTRACT FROM AUTHOR]

The article focuses on the intersection of gun laws and gun deaths in the U.S. and provides a theological assessment of this issue. It discusses the alarming statistics of gun-related deaths; emphasizes the Catholic Church's commitment to the sanctity of life; examines the empirical insights into how gun policies can affect gun deaths; and impactful gun control policies based on Catholic convictions regarding the common good and the preservation of life.

Abstract Background Firearm fatalities are a major public health concern, claiming the lives of 40,000 Americans each year. While firearm fatalities have pervasive effects, it is unclear how social determinants of health (SDOH) such as residential racial segregation, income inequality, and community resilience impact firearm fatalities. This study investigates the relationships between these SDOH and the likelihood of firearm fatalities. Methods County-level SDOH data from the Agency for Health Care Research and Quality for 2019 were analyzed, covering 72 Wisconsin counties. The dependent variable was the number of firearm fatalities in each county, used as a continuous variable. The independent variable was residential racial segregation (Dissimilarity Index), defined as the degree to which non-White and White residents were distributed across counties, ranging from 0 (complete integration) to 100 (complete segregation), and higher values indicate greater residential segregation (categorized as low, moderate, and high). Covariates were income inequality ranging from zero (perfect equality) to one (perfect inequality) categorized as low, moderate, and high, community resilience risk factors (low, moderate, and high risks), and rural-urban classifications. Descriptive/summary statistics, unadjusted and adjusted negative binomial regression adjusting for population weight, were performed using STATA/MPv.17.0; P-values ≤ 0.05 were considered statistically significant. ArcMap was used for Geographic Information System analysis. Results In 2019, there were 802 firearm fatalities. The adjusted model demonstrates that the risk of firearm fatalities was higher in areas with high residential racial segregation compared to low-segregated areas (IRR.:1.26, 95% CI:1.04–1.52) and higher in areas with high-income inequality compared to areas with low-income inequality (IRR.:1.18, 95% CI:1.00–1.40). Compared to areas with low-risk community resilience, the risk of firearm fatalities was higher in areas with moderate (IRR.:0.61, 95% CI:0.48–0.78), and in areas with high risk (IRR.:0.53, 95% CI:0.41–0.68). GIS analysis demonstrated that areas with high racial segregation also have high rates of firearm fatalities. Conclusion Areas with high residential racial segregation have a high rate of firearm fatalities. With high income inequality and low community resilience, the likelihood of firearm fatalities increases.

We present a theoretical model predicting that racially biased policing produces (1) more use of potentially lethal force by firearms against Black civilians than against White civilians and (2) lower fatality rates for Black civilians than White civilians. We empirically evaluate this second prediction with original officer-involved shooting data from 2010 to 2017 for eight local police jurisdictions, finding that Black fatality rates are significantly lower than White fatality rates and that this significance would survive an omitted covariate three times as strong as any of our observed covariates. Furthermore, using outcome test methodology and a comparability assumption, we estimate that at least 30% of Black civilians shot by the police would not have been shot had they been White. An omitted covariate would need to be at least three times as strong as any of our observed covariates to eliminate this finding. Finally, any omitted covariate would have to affect Black fatality rates substantially more than Hispanic fatality rates in order to be consistent with the data. [ABSTRACT FROM AUTHOR]

The mass shootings in Buffalo, New York, and Uvalde, Texas in May 2022 prompted Congress to enact the first significant federal gun legislation since the 1990s. While many commentators have framed this policy change as a remarkable break from the long‐standing pattern of inaction on gun violence, I argue that political actors perceived and responded to the problem in familiar ways. Drawing on agenda setting and information processing theories, I highlight factors that suggest no fundamental alteration in how the U.S. political system responds to gun injury and death. I also point to changes in public opinion and in the interest group landscape that have the potential (in the long term) to transform the politics of gun policy. Finally, I conclude with some near‐term expectations for policy making and its effects on the issue. Related Articles: Cagle, M. Christine, and J. Michael Martinez. 2004. "Have Gun, Will Travel: The Dispute between the CDC and the NRA on Firearm Violence as a Public Health Problem." Politics & Policy 32(2): 278–310. https://doi.org/10.1111/j.1747‐1346.2004.tb00185.x. Joslyn, Mark R., and Donald P. Haider‐Markel. 2018. "Motivated Innumeracy: Estimating the Size of the Gun Owner Population and its Consequences for Opposition to Gun Restrictions." Politics & Policy 46(6): 827–50. https://doi.org/10.1111/polp.12276. Schwartz, Noah S. 2021. "Guns in the North: Assessing the Impact of Social Identity on Firearms Advocacy in Canada." Politics & Policy 49(3): 715–818. https://doi.org/10.1111/polp.12412. [ABSTRACT FROM AUTHOR]

A recent study published in JAMA Network Open suggests that states in the US that require both universal background checks and state permits for gun purchases have lower firearm homicide rates compared to states that only require background checks at the point of sale. The researchers analyzed firearm laws and homicide rates from 1976 to 2022 in 48 states and found that states with permit requirements saw an 18% reduction in firearm homicide rates, while states without permit requirements only saw a 4% drop. The researchers suggest that the face-to-face interactions with law enforcement and the search through state databases required for obtaining a permit may contribute to the lower rates of gun violence. [Extracted from the article]

The article discusses the alarming rise in pediatric gunshot injuries in the US over the past 20 years, highlighting its distinction from similar countries and the surge in firearm circulation. Topics discussed include the increasing number of firearm-related fatalities among children, the role of background checks in firearm access, and the disproportionate impact on minority and low-resource communities.

This ethnographic study follows a group of Black teenage boys in their Philadelphia high school and online in the years following the shooting death of their friend. Within their peer group, the boys generally focus their shared memorializations on upbeat and affirming reminiscences, protecting each other from sadness but constraining their own emotional displays. In contrast, in the boys' private worlds, most spend years actively working through their grief in material and embodied ways, including through objects they keep or wear. On social media, these private and public worlds converge as the boys regularly share their private grief expressions with public audiences and define their digital identities by loss. Contrary to popular worries about adolescent social media use, this research finds that for grieving Black boys online worlds offer unusual space for emotional freedom, social support, and solidarity around loss and a counter to restrictive racialized and gendered feeling rules. [ABSTRACT FROM AUTHOR]

Background: Firearm fatalities are a major public health concern, claiming the lives of 40,000 Americans each year. While firearm fatalities have pervasive effects, it is unclear how social determinants of health (SDOH) such as residential racial segregation, income inequality, and community resilience impact firearm fatalities. This study investigates the relationships between these SDOH and the likelihood of firearm fatalities. Methods: County-level SDOH data from the Agency for Health Care Research and Quality for 2019 were analyzed, covering 72 Wisconsin counties. The dependent variable was the number of firearm fatalities in each county, used as a continuous variable. The independent variable was residential racial segregation (Dissimilarity Index), defined as the degree to which non-White and White residents were distributed across counties, ranging from 0 (complete integration) to 100 (complete segregation), and higher values indicate greater residential segregation (categorized as low, moderate, and high). Covariates were income inequality ranging from zero (perfect equality) to one (perfect inequality) categorized as low, moderate, and high, community resilience risk factors (low, moderate, and high risks), and rural-urban classifications. Descriptive/summary statistics, unadjusted and adjusted negative binomial regression adjusting for population weight, were performed using STATA/MPv.17.0; P-values ≤ 0.05 were considered statistically significant. ArcMap was used for Geographic Information System analysis. Results: In 2019, there were 802 firearm fatalities. The adjusted model demonstrates that the risk of firearm fatalities was higher in areas with high residential racial segregation compared to low-segregated areas (IRR.:1.26, 95% CI:1.04–1.52) and higher in areas with high-income inequality compared to areas with low-income inequality (IRR.:1.18, 95% CI:1.00–1.40). Compared to areas with low-risk community resilience, the risk of firearm fatalities was higher in areas with moderate (IRR.:0.61, 95% CI:0.48–0.78), and in areas with high risk (IRR.:0.53, 95% CI:0.41–0.68). GIS analysis demonstrated that areas with high racial segregation also have high rates of firearm fatalities. Conclusion: Areas with high residential racial segregation have a high rate of firearm fatalities. With high income inequality and low community resilience, the likelihood of firearm fatalities increases. [ABSTRACT FROM AUTHOR]

Postmortem computed tomography (PMCT) has been integrated into the practice of many forensic pathologists. To evaluate the utility of PMCT in supplementing and/or supplanting medicolegal autopsy, we conducted a prospective double‐blind comparison of abnormal findings reported by the autopsy pathologist with those reported by a radiologist reviewing the PMCT. We reviewed 890 cases: 167 with blunt force injury (BFI), 63 with pediatric trauma (under 5 years), 203 firearm injuries, and 457 drug poisoning deaths. Autopsy and radiology reports were coded using the Abbreviated Injury Scale and abnormal findings and cause of death (COD) were compared for congruence in consensus conferences with novel pathologists and radiologists. Overall sensitivity for recognizing abnormal findings was 71% for PMCT and 74.6% for autopsy. Sensitivities for PMCT/autopsy were 74%/73.1% for BFI, 61.5%/71.4% for pediatric trauma, 84.9%/83.7% for firearm injuries, and 56.5%/66.4% for drug poisoning deaths. COD assigned by reviewing PMCT/autopsy was correct in 88%/95.8% of BFI cases, 99%/99.5% of firearm fatalities, 82.5%/98.5% of pediatric trauma deaths, and 84%/100% of drug poisoning deaths of individuals younger than 50. Both autopsy and PMCT were imperfect in recognizing injuries. However, both methods identified the most important findings and are sufficient to establish COD in cases of BFI, pediatric trauma, firearm injuries and drug poisoning in individuals younger than 50. Ideally, all forensic pathologists would have access to a CT scanner and a consulting radiologist. This would allow a flexible approach that meets the diagnostic needs of each case and best serves decedents' families and other stakeholders. [ABSTRACT FROM AUTHOR]

Several studies have evaluated differences in firearm injury patterns among children based on regionalization. However, many of these studies exclude patients who die before arriving at a trauma center. We therefore hypothesize that important population-based differences in pediatric firearm injuries may be uncovered with the inclusion of both prehospital firearm mortalities and patients treated at a tertiary children's hospital. Patients less than 15 y of age who sustained a firearms-related injury/death between the years 2012 and 2018 were identified in: (1) death certificates from the Office of Vital Statistics State of Indiana and (2) Riley Hospital for Children at Indiana University Health Trauma Registry. Counties of injury were classified as either urban, midsized, or rural based on the National Center for Health Statistic's population data. Significant variables in univariate analysis were then assessed using multivariate logistic regression models. A total of 222 patients were identified. Median age of firearm injury survivors was 13 (interquartile range 7-14), while the median age of nonsurvivors was 14 (interquartile range 11-15), P = 0.040. The proportion of suicide was significantly higher in rural counties (P < 0.001). When controlling for shooter intent, patients from a rural or midsized county had statistically significant higher odds of dying before reaching a hospital than their urban counterpart (rural odds ratio [OR] 5.67 [95% confidence interval {CI} 2.23, 14.38]; midsized OR 6.53 [95% CI 2.43, 17.46]; P < 0.001). Important differences exist between pediatric firearm injuries based on where they occur. Public health initiatives aimed at reducing pediatric firearm injury and death should not exclude rural pediatrics patients. [ABSTRACT FROM AUTHOR]

Objective:The medical findings, characteristics and investigation information of childhood firearm deaths autopsied in Diyarbakır were examined. It was aimed to discuss the effects of possession of firearms on children and possible solutions to prevent similar incidents.Methods:Deaths due to firearm injuries in individuals under the age of 18 years, who were autopsied between 2014 and 2018 by the Council of Forensic Medicine, Diyarbakır Forensic Medicine Group Presidency, were analyzed retrospectively through autopsy reports.Results:5.7% of firearm deaths undergoing autopsy occurred in childhood. In our study, 62 cases (92.5%) were in the ages of school period. The number of male cases was 43 (64.2%), while the number of female cases was 24 (35.8%). While the suicide origin was observed more frequently in the cases (21 cases, 31.3%), origin of the murder and the accident was found less frequent (11 cases-16.4%, 8 cases 12%, respectively). In 54.1% (13 cases) of female cases, the etiology of suicide was evaluated. Short barreled weapons were used in 33 cases (49.2%), and long barreled weapons were used in 33 cases (49.2%). The number of cases with death at the scene was 42 (62.6%), and 25 (37.4%) cases died in the hospital. There was a single gunshot wound in 59 cases (88%), and more than one gunshot wounds were detected in 8 cases (12%).Conclusion:We think that the actions aimed at ensuring preventing children from accessing firearms, controlling individual armament with serious mechanisms and raising social awareness about the damages that firearms can cause will make us encounter less of such incidents.

• Pediatric wounding patterns varied by age and intent of injury (suicide, homicide, unintentional injury). • Most pediatric suicide victims had injuries to the head and were dead on scene. • Children with homicide and unintentional deaths had more wounding pattern variation and far fewer died on scene. • Public health strategies for firearm injuries should be tailored to pediatrics based on age, intent of firearm use, and wounding pattern. Pediatric firearm injury became the leading cause of death among U.S. children in 2020. Studies evaluating wounding patterns in military and mass casualty shootings have provided insights into treatment and potential salvageability in adults, however, similar studies in the pediatric population do not exist. Hence, our study aimed to analyze wounding patterns of pediatric firearm fatalities and associated demographics and characteristics, such as place of death, to better understand pediatric firearm injuries, potential salvageability, and opportunities to reduce firearm deaths among vulnerable pediatric populations. A retrospective review of the National Violent Death Reporting System from 2005-2017 was performed on patients 18 and younger. Mortalities were stratified by patient age: <12 years and 13-18 years and by intent— homicide, suicide, and unintentional. Comparative and exploratory analyses of demographics, location of death and anatomic location of wounds were performed. Of 8,527 pediatric firearm mortalities identified, 4,728 were homicides, 3,180 were suicides and 619 were unintentional injuries. Suicide victims were most likely to be dead on scene and >90% of suicide victims suffered head/neck injuries. For victims of homicide, younger children were more likely to die on scene (61% vs 44% p < 0.001). The pattern of injury in homicides differed for younger children compared to adolescents, with younger children with more head/neck injuries and older children more thoracic, thoracoabdominal, abdominal, and junctional injuries. In both age groups, children with extremity, abdominal and thoracoabdominal injuries were more likely to die later in the emergency department or inpatient setting. Wounding patterns across pediatric firearm mortalities in the U.S. vary by age and intent. The majority of pediatric firearm deaths were due to head/neck injuries. Children with homicide and unintentional deaths had more wounding pattern variation, including more injuries to the thorax and abdomen, and a much lower rate of dead-on scene than suicide victims. Our study of wounding patterns among U.S. children killed by firearms highlights the complexity of these injuries and offers opportunities for tailored public health strategies across varying vulnerable pediatric populations. [ABSTRACT FROM AUTHOR]

Disparities in gun violence across race are well documented. Studying these disparities is essential to reduce preventable gun deaths. This study evaluates the relationship between sociodemographic factors and firearms used in gun deaths. This retrospective cohort study of firearm mortalities from 2009 to 2018 used the Mortality Multiple Cause-of-Death Public Use Record from the National Center for Health Statistics. The primary outcome was the type of firearm used and the secondary outcome was autopsy status. Factors of interest include race, ethnicity, gender, marital status, age, education, and place of death. Factors significantly associated with outcomes in univariate analyses were included in separate multivariate logistic regression models for assaults, intentional self-harm, and accidents. A total of 276,127 firearm deaths from 2009 to 2018 were analyzed. Compared to White victims, Black victims were less likely to die from handguns (accident: odds ratio [OR] = 0.70, P < 0.05; self-harm: OR = 0.84, P < 0.001; assault: OR = 0.58, P < 0.001) and rifles, shotguns, or large firearms (accident: OR = 0.30, P < 0.001; self-harm: OR = 0.37, P < 0.001; assault: OR = 0.28, P < 0.001). Black decedents were more likely to undergo autopsy than White decedents (accident: OR = 2.14, P < 0.001; intentional self-harm: OR = 2.02, P < 0.001; assault: OR = 2.02, P < 0.001). Ethnicity, gender, marital status, age, education, and other racial identities were also associated with firearms used and autopsy rates (P < 0.05). Differences in firearms used and autopsy rates following gun deaths exist by race, ethnicity, gender, marital status, age, and education. Future studies should investigate the relationship between sociodemographic factors and firearms used and autopsy status following gun deaths. • Firearms used in gun deaths were likely to be known for Black than White victims. • Lack of data on Black victims may make evaluating gun control policies difficult. • Black decedents were more likely to undergo autopsy than White decedents. • Better data collection and more research are needed to understand these disparities. [ABSTRACT FROM AUTHOR]

The rise in working-age mortality rates in the United States in recent decades largely reflects stalled declines in cardiovascular disease (CVD) mortality alongside rising mortality from alcohol-induced causes, suicide, and drug poisoning; and it has been especially severe in some U.S. states. Building on recent work, this study examined whether U.S. state policy contexts may be a central explanation. We modeled the associations between working-age mortality rates and state policies during 1999 to 2019. We used annual data from the 1999–2019 National Vital Statistics System to calculate state-level age-adjusted mortality rates for deaths from all causes and from CVD, alcohol-induced causes, suicide, and drug poisoning among adults ages 25–64 years. We merged that data with annual state-level data on eight policy domains, such as labor and taxes, where each domain was scored on a 0–1 conservative-to-liberal continuum. Results show that the policy domains were associated with working-age mortality. More conservative marijuana policies and more liberal policies on the environment, gun safety, labor, economic taxes, and tobacco taxes in a state were associated with lower mortality in that state. Especially strong associations were observed between certain domains and specific causes of death: between the gun safety domain and suicide mortality among men, between the labor domain and alcohol-induced mortality, and between both the economic tax and tobacco tax domains and CVD mortality. Simulations indicate that changing all policy domains in all states to a fully liberal orientation might have saved 171,030 lives in 2019, while changing them to a fully conservative orientation might have cost 217,635 lives. [ABSTRACT FROM AUTHOR]

Background: Data are sparse about firearm fatalities among Texas schoolchildren. Purpose: Explore firearm fatalities among children ages 5-18 years from 1999 to 2020. Key Methods. We utilized publicly available Multiple Cause of Death Files from the National Center for Health Statistics (NCHS) and International Classification of Diseases (ICD) Codes (10th Edition) Accident (W32-W34), Suicide (X72-X74), Assault (X93-X95), and Undetermined Intent (Y22-Y24) to identify firearm fatality as an underlying or contributory cause. We used Annual Percent Change (APC) as a measure of the magnitude of effect and 95% confidence intervals (CIs), p values, and joinpoint regression analyses to test for statistical significance. Key Results: From 1999 to 2020 there were 4,090 firearm fatalities among Texas school-age children. Following significant declines from 1999 to 2013, firearm fatality rates significantly increased. The APC from 2013-2020 was 12.6 (95% CI 9.7, 15.6 p<0.001). The APCs were statistically significant for boys; non-Hispanic Black, non-Hispanic White, and Hispanic children; residents of Large Central Metropolitan areas, Medium Metropolitan, Large Fringe Metropolitan, and smaller areas; for residents of the Texas-Mexico Border and non-Border areas; and for residents of counties with a military base. From 2013 to 2020, rates were highest among non-Hispanic Black children, followed in order by non-Hispanic White, Hispanic, and Asian and Pacific Islander children. Public Health Significance: There are alarming increases in firearm fatalities among Texas school age children (5-18 years). Analytic epidemiologic studies designed a priori to do so are necessary to test hypotheses generated by these data. In the meanwhile, the data pose clinical and public health challenges. [ABSTRACT FROM AUTHOR]

As the epidemic of gunshot injuries and firearm fatalities continues to proliferate in the United States, knowledge regarding gunshot wound (GSW) injury and management is increasingly relevant to health-care providers. Unfortunately, existing guidelines are largely outdated, written in a time that high-velocity weapons and deforming bullets were chiefly restricted to military use. Advances in firearm technology and increased accessibility of military grade firearms to civilians has exacerbated the nature of domestic GSW injury and complicated clinical decision-making, as these weapons are associated with increased tissue damage and often result in retained bullets. Currently, there is a lack of literature addressing recent advances in the field of projectile-related trauma, specifically injuries with retained bullets. This review aims to aggregate the available yet dispersed findings regarding ballistics, GSW etiology, and treatment, particularly for cases involving retained projectiles. [ABSTRACT FROM AUTHOR]

Ample research explores individual factors associated with sexual violence, yet individual, dyadic, and environmental influences on intimate partner sexual violence (IPSV) occurring in the larger context of non-intimate partner violence (NIPSV) remain relatively unexplored. The current study aimed to determine the extent to which county-level indicators in combination with individual and dyadic factors are associated with sexual violence across relationship types. Reported IPSV and NIPSV cases were obtained from the Tennessee Bureau of Investigation's (TBI) online incident-based reporting system. County-level variables indicative of neighborhood physical disorder, violent crime, income inequality, firearm prevalence, and community alcohol use patterns were retrieved from the online resource County Health Rankings and Roadmaps. Using a nested case–control design, we determined significant sexual violence risk within younger cohorts and across relationship types, finding three significant county-level factors: 1) income inequality, 2) rate of firearm fatalities, and 3) percentage of female residents. Suggested prevention and intervention efforts include targeting younger age groups for IPSV and NIPSV education, developing resources for a range of relational partners, improving legal access and law enforcement training for reporting, and continued examination of the role of firearms. [ABSTRACT FROM AUTHOR]

Even though gun suicides account for well over half of all U.S. gun deaths each year, they largely are absent from collective attention, policy discussion, and rhetorical study. Using stories about gun suicide from Everytown for Gun Safety's website, "Moments That Survive," this essay examines how the authors depict gun suicide as a public problem and a gun problem rather than as a private problem limited only to the individual gun user. In so doing, these stories revise three of the gun debate's key terms: collective grief, character, and agency. More than simply drawing attention to gun suicide, these stories critique the dominant narrative of protection (protection from "them") and urge readers to reimagine suicide, protection, and gun violence. [ABSTRACT FROM AUTHOR]

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Suicide involves a complex set of behaviors and emotions that lead up to actions that may be based on planning and forethought or the result of impulse. While there are a host of antecedent circumstances the presence of a mood disorder, primarily depression, is the most common factor in suicide. While management of depression is recognized as important prevention strategy in depression, the means by which suicide occurs must be a critical element of prevention. Policies that lower access to the means for suicide will decrease the fatality. Guns are associated with half of suicides and the case fatality rate of gun associated suicide is over 90% compared to 7% for all other means. This emphasizes the importance of offering strategies that limit access to guns to those at higher risk for suicide. A declaration of formal self‐exclusion for access to firearms (guns and ammunition) offers the individual at greater risk for suicide to place themselves on an official list that would prevent them from purchasing lethal weapons. A person with depression, when well, might wish to enroll voluntarily to prevent themselves, when ill, from procuring a weapon to harm themselves or others. This recognizes the autonomy of the person and protects both the individual, the family, and society. [ABSTRACT FROM AUTHOR]

Background: Fatal mass shootings, defined as four or more people killed by gunfire, excluding the perpetrator, account for a small percentage of firearm homicide fatalities. Research has not extensively focused on the role of domestic violence (DV) in mass shootings in the United States. This study explores the role of DV in mass shootings in the United States. Methods: Using 2014–2019 mass shooting data from the Gun Violence Archive, we indexed our data by year and mass shooting and collected the number of deaths and injuries. We reviewed news articles for each mass shooting to determine if it was 1) DV-related (i.e., at least one victim of a mass shooting was a dating partner or family member of the perpetrator); 2) history of DV (i.e., the perpetrator had a history of DV but the mass shooting was not directed toward partners or family members); or 3) non-DV-related (i.e., the victims were not partners or family members, nor was there mention of the perpetrator having a history of DV). We conducted descriptive analyses to summarize the percent of mass shootings that were DV-related, history of DV, or non-DV-related, and analyzed how many perpetrators died during the incidents. We conducted one-way ANOVA to examine whether there were differences in the average number of injuries or fatalities or the case fatality rates (CFR) between the three categories. One outlier and 17 cases with unknown perpetrators were excluded from our main analysis. Results: We found that 59.1% of mass shootings between 2014 and 2019 were DV-related and in 68.2% of mass shootings, the perpetrator either killed at least one partner or family member or had a history of DV. We found significant differences in the average number of injuries and fatalities between DV and history of DV shootings and a higher average case fatality rate associated with DV-related mass shootings (83.7%) than non-DV-related (63.1%) or history of DV mass shootings (53.8%). Fifty-five perpetrators died during the shootings; 39 (70.9%) died by firearm suicide, 15 (27.3%) were killed by police, and 1 (1.8%) died from an intentional overdose. Conclusions: Most mass shootings are related to DV. DV-related shootings had higher CFR than those unrelated to DV. Given these findings, restricting access to guns by perpetrators of DV may affect the occurrence of mass shootings and associated casualties. [ABSTRACT FROM AUTHOR]

Introduction: Cases of gunshot injuries among trauma patients admitted in the emergency room are fatal cases in Turkey as much as all over the world. It is perhaps the most complex group among trauma patients. Because the route of the bullet fragment, how much damage it causes on its way and which organ or organs will be harmed cannot be understood immediately so long-term follow-up may be required. Case report: A 48-year-old civilian male patient brought to our hospital after gunshot injury. It was found that he was injured with pellets in many parts of his body. He was not operated on to prevent possible bleeding and to remove the pellets. Instead, vital signs were followed. Results and Conclusion: Most of the patients who are injured by guns die. The most important reason for this is acute and large amount of bleeding. In this article, we will present a patient who has been exposed to multiple pellet shots but survived. [ABSTRACT FROM AUTHOR]

Injuries and fatalities due to firearms are a major burden on public health in the US. The rise in gun violence in popular movies has been suggested as a potential cultural influence on this behavior. Nevertheless, homicide rates have not increased over recent decades in the US, suggesting that media portrayals have had little influence on gun violence. Here we challenge this interpretation by examining trends in the proportion of violence that are attributable to firearms, a measure that should be more sensitive to media violence. In addition, we examine trends in the portrayal of guns in popular television (TV) dramas, which are viewed more frequently than movies. We ask (a) whether gun violence has increased in these TV shows not only on an absolute basis but also as a proportion of violent scenes and (b) whether trends in gun portrayal on these shows are associated with corresponding trends in the proportion of real-world violence attributable to firearms in the US from 2000 to 2018. To answer these questions, we coded annual instances of violence, gun violence, and proportion of violence involving guns for each 5-minute segment of 33 popular TV dramas in the police, medical, and legal genres from 2000 to 2018. Trends in annual rates of violence, gun violence and proportion of violence involving guns were determined over the study period and were compared to annual rates of homicide attributable to firearms in three age groups: 15–24, 25–34 and 35 and older. Although violence on TV dramas peaked in 2011, gun use steadily increased over the study period both in absolute terms and in relation to other violent methods. The latter metric paralleled trends in homicides attributable to firearms for all three age groups, with the strongest relationship for youth ages 15–24 (R2 =.40, P =.003). The positive relation between relative amount of TV violence involving guns and actual homicides due to firearms, especially among youth, is consistent with the hypothesis that entertainment media are contributing to the normative acceptance of guns for violent purposes. Future research is needed to study the influence of media violence on gun acquisition at the individual level. [ABSTRACT FROM AUTHOR]

Despite thousands of gun deaths annually, the United States has failed to reach consensus on any means of addressing the public health crisis that is gun violence. The issue has become politically polarized, constitutionalized, and an object of pessimism and despair. We propose a regulatory system in which gun manufacturers would be strictly liable to a federal fund for deaths caused by their guns, paired with a subsidy that will serve to ensure the availability of guns sufficient to meet the rights the Supreme Court has found in the Second Amendment. While strict liability of this kind can indeed serve its traditional purposes of spreading costs and incentivizing better designs and processes, our primary goal is to alter the political economy around the issue of gun violence more generally. If manufacturers bear an increasing share of the costs created by their products, they will endeavor not only to produce products and advertise them in ways likely to reduce those costs but also to advocate for regulations that may do the same. While our proposal may not depolarize the issue entirely, it at least attempts to focus the minds and experience of those who know guns best on effective means of reducing guns' social costs. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The benefits of a comparatively inexpensive radiographic system such as the Lodox® scanner in forensic facilities where CT-imaging and radiologist support is not financially viable will be explored. Prodigious caseloads in many under-resourced mortuaries preclude the use of advanced radiological modalities. The aim of this research is to examine the utilization of the Lodox® scanner in one of the busiest mortuaries in South Africa in relation to the nature of the cases scanned and, furthermore, to provide case studies where this imaging modality proved vital in the examination of the deceased and in the approach to the autopsy. The research is a retrospective epidemiological review on the use of the Lodox® scanner at the Salt River Medico-legal Laboratory, Cape Town, South Africa, from 1 January 2017 to 31 December 2017. A total of 3885 cases was admitted to the mortuary; the majority was scanned. A large proportion of cases were male. Ages ranged from foetuses to the elderly. The manner of death in more than a third of the cases was homicide which mainly involved firearm fatalities. This was followed by natural deaths. Pertinent case studies are presented to demonstrate that the use of the Lodox® scanner as an adjunct (or even obviating autopsy) proves to save time and labour and is financially beneficial. In conclusion, the Lodox® scanner is an indispensable tool in mortuaries with heavy caseloads because its use improves quality assurance, saves time, and is cost effective in the examination of both natural and unnatural deaths. [ABSTRACT FROM AUTHOR]