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Researchers have documented that vacant lot greening can reduce community-level crime and violence. Busy Streets Theory (BST) suggests that residents who are involved in the greening process can help to improve physical environments and build social connections that deter crime and violence. Yet few researchers have explored how community engagement in the greening process may affect crime and violence outcomes. We applied BST to test the effects of community-engaged vacant lot greening compared to vacant lots that received either professional mowing or no treatment, on the density of violent crime around study lots. Using mixed effects regression models, we analyzed trends in violent crime density over the summer months from 2016 to 2018 at 2102 street segments in Youngstown, OH. These street segments fell within 150 meters of an intervention parcel that was classified as one of three conditions: community-engaged maintenance, professional mowing, or no treatment (control). We found that street segments in areas receiving community-engaged maintenance or professional mowing experienced greater declines in violent crime density than street segments in areas receiving no treatment, and more decline occurred in the community-engaged condition compared to the professional mow condition. Our findings support BST and suggest that community-engaged greening of vacant lots in postindustrial cities with a concentrated vacancy can reduce crime and violence.

BACKGROUND AND OBJECTIVES Limiting firearm access is essential to decreasing teen suicide. Previous efforts have focused on household firearms; however, less is known about firearm access and possession among teens at increased suicide risk. Our objective was to estimate prevalence of firearm possession and access among high school-aged teens with recent depression and/or lifetime history of suicidality (DLHS). METHODS We conducted a probability-based, cross-sectional Web survey of 1914 parent–teen dyads between June 24, 2020, and July 22, 2020, with data weighted to generate a nationally representative sample of US teenagers (aged 14–18). Logistic regression analyses examined the difference between teens with and without DLHS for: (1) personal firearm possession, (2) perceived firearm access, and (3) method of firearm attainment. RESULTS Among high school-aged teens, 22.6% (95% confidence interval [CI], 19.4–25.8) reported DLHS, 11.5% (95% CI, 8.7–14.3) reported personal firearm possession, and 44.2% (95% CI, 40.2–48.2) endorsed firearm access. Teens experiencing DLHS had increased perceived access (adjusted odds ratio, 1.56; 95% CI, 1.07–2.28) compared with non-DLHS peers. There was no association between DLHS and personal firearm possession (adjusted odds ratio, 0.97; 95% CI, 0.47–2.00). Among teens reporting firearm possession, those with DLHS were more likely to have acquired it by buying/trading for it (odds ratio, 5.66; 95% CI, 1.17–27.37) and less likely receiving it as a gift (odds ratio, 0.06; 95% CI, 0.01–0.36). CONCLUSIONS High school-aged teens experiencing DLHS have higher perceived firearm access compared with lower-risk peers. Providers should speak directly to high school-aged teens at increased suicide risk about firearm access, in addition to counseling parents.

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. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Firearms are the leading cause of death for high-school age teens. To inform prevention efforts, we characterize the prevalence of healthcare provider (HCP) counseling of caregivers of teens around firearm safety, safety conversation elements, and caregiver receptivity towards counseling. A cross-sectional web survey (6/24/2020-7/22/2020) was conducted among caregivers (n = 2924) of teens (age:14-18). Weights were applied to generate nationally representative estimates. Bivariate analyses and multivariate regressions were examined. Among respondents, 56.0% were women, 75.1% were non-Hispanic White, and mean (SD) age was 47.4. Firearm safety was the least discussed topic among caregivers reporting their teen received HCP preventative counseling (14.9%). For caregivers receiving counseling, the most common issues discussed were household firearms screening (75.7%); storing firearms locked (66.8%); and storing firearms unloaded (53.0%). Only 24.6% of caregivers indicated firearm safety was an important issue for teen HCPs to discuss and only 21.9% trusted teen HCPs to counsel about firearm safety. Female caregivers (aOR = 1.86;95%CI = 1.25-2.78), those trusting their teen's HCP to counsel on firearm safety (aOR = 9.63;95%CI = 6.37-14.56), and those who received teen HCP firearm safety counseling (aOR = 5.14;95%CI = 3.02-8.72) were more likely to favor firearm safety counseling. Caregivers of teens with prior firearm safety training (aOR = 0.50;95%CI = 0.31-0.80) were less likely to agree that firearm safety was an important preventative health topic. In conclusion, few caregivers receive preventive counseling on firearm safety from their teen's HCP, with trust a key barrier to effective intervention delivery. Future research, in addition to understanding barriers and establishing effective strategies to increase safety practices, should focus on increasing provider counseling competency.

This Viewpoint argues that academic medical centers should address firearm violence through clinical care, education of health care professionals, research, and public policy discussions.

Unmaintained vacant land in urban areas is associated with a number of negative outcomes for residents of urban areas, including mental and physical health, safety, and quality of life. Community programs which promote land parcel maintenance in urban neighborhoods have been found to reverse some of the effects that unmaintained land has on nearby residents. We explored how land parcel maintenance is associated with mental health outcomes using data collected in Flint, MI in 2017–2018. Trained observers assessed the maintenance of approximately 7200 land parcels and surveyed 691 residents (57% Female, 53% Black, M age = 51). We aggregated resident and parcel rating data to 463 street segments and compared three structural equation models (SEM) to estimate the mediating effects of fear of crime on the association of parcel qualities on mental distress for residents. We found that fear of crime mediated the association between parcel maintenance values and mental distress indicating that poor maintenance predicted more fear of crime which was associated with mental distress. Our findings add to our understanding about the mechanism by which vacant lot improvements may operate to enhance psychological well-being of residents who live on streets with vacant and unkept lots.

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.

Research has identified the United States (U.S.) as a global outlier in its firearm ownership rates, with a correspondingly higher risk of youth firearm violence compared to other countries. The relative extent of disparities in youth firearm violence within the U.S. has been less clear. Little is known about factors in the social ecology driving these disparities and whether current firearm violence prevention approaches sufficiently address them. Method: Applying a health disparities framework, we synthesized epidemiological, sociological, and prevention science literatures, emphasizing structural inequalities in youth sociocultural positionality in life course developmental context. We also highlighted findings from national injury data and other studies regarding the magnitude and impacts of youth firearm violence disparities. Results: The burden of firearm violence varied markedly at intersections of gender, race, place, developmental stage, and homicidal or suicidal intent. Firearm homicide among Black boys and young men (ages 15–24) was an outlier levels many times greater than the rates of any other demographic group, developmental stage, or violence intent, particularly in urban settings. Recent research has operationalized structural racism and implicated historically racialized spaces as a root cause of this disparity. In contrast, elevated firearm suicide rates were found among Native and White boys and young men in rural settings; firearm-related cultural attitudes and gender socialization were points of consideration to explain these disparities. We highlighted research-based youth firearm violence preventive interventions, and emphasized gaps in efforts focused on structural and sociocultural factors. Conclusions: More explicit attention to reducing firearm homicide among Black boys and young men and firearm suicide among Native and rural White boys and young men is urgently needed and has potential to substantially lower overall rates of firearm violence in the U.S.

Firearm possession increases the likelihood of hospital visits among adolescents and emerging adults for both males and females. To better inform prevention practices, we examine data among adolescents and emerging adults (A/EAs; ages 16 to 29) presenting to an urban emergency department for any reason to understand the differences in firearm possession between males and females (N = 1312; 29.6% male; 50.5% Black). Regression identified firearm possession correlates, such as male sex (AOR = 2.26), firearm attitudes (AOR = 1.23), peer firearm possession (AOR = 9.84), and community violence exposure (AOR = 1.02). When stratified by sex (e.g., male vs female), regression results yielded differences in correlates for firearm possession: in males, peer firearm possession (AOR = 8.96) were significant, and in females, firearm attitudes (AOR = 1.33) and peer firearm possession (AOR = 11.24) were significant. An interaction between sex and firearm attitudes demonstrated that firearm attitudes were differentially associated with firearm possession between female and male A/EAs (AOR = 1.28). Overall, we found that females are more likely to endorse retaliatory firearm attitudes, and both males and females are highly influenced by their perception of peer firearm possession. These results help inform prevention strategies across multiple settings, especially for hospital-based violence interventions, and suggest that tailored approaches addressing differences between male and female A/EAs are appropriate when addressing firearm violence and injury risk among A/EAs.

ObjectivesTo evaluate motivations for firearm possession among urban young adults and determine if differences emerge between parents and non-parents, and to identify if storage practices differed according to motivation for firearm possession and parenting status.MethodsWe used cross-sectional data among young adults seeking urban emergency department treatment at Hurley Medical Center between 2017 and 2018. Our analyses, completed in 2020, included 194 firearm-possessing young adults, 95 of whom were young parents.ResultsFirearm-possessing parents were more likely to have a firearm for protection, than for any other motivation, compared with firearm-possessing non-parents (OR: 2.38, 95% CI 1.06 to 5.46). A significant interaction between parenting status and motivation for possession indicated the association between protective motivations and locked storage was significantly different between parents and non-parents, whereby there was a decreased odds of locked storage among non-parents who were motivated to possess a firearm for protection compared with any other motivation, but this association did not exist for parents (interaction OR=10.57, pConclusionParental motivation for possessing a firearm most often lies in the desire to protect families. This motivation, however, does not necessitate unsafe storage.

Telomeres protect chromosomes from degradation during cellular replication. In humans, it is well-documented that excessive telomere degradation is one mechanism by which cells can become cancerous. Increasing evidence from wildlife studies suggests that telomere length is positively correlated with survival and health and negatively correlated with disease infection intensity. The recently emerged devil facial tumor disease (DFTD) has led to dramatic and rapid population declines of the Tasmanian devil throughout its geographic range. Here, we tested the hypothesis that susceptibility to DFTD is negatively correlated with telomere length in devils across three populations with different infection histories. Our findings suggest telomere length is correlated with DFTD resistance in three ways. First, devils from a population with the slowest recorded increase in DFTD prevalence (West Pencil Pine) have significantly longer telomeres than those from two populations with rapid and exponential increases in prevalence (Freycinet and Narawantapu). Second, using extensive mark-recapture data obtained from a long-term demographic study, we found that individuals with relatively long telomeres tend to be infected at a significantly later age than those with shorter telomeres. Third, a hazard model showed devils with longer telomeres tended to become infected at a lower rate than those with shorter telomeres. This research provides a rare study of telomere length variation and its association with disease in a wildlife population. Our results suggest that telomere length may be a reliable marker of susceptibility to DFTD and assist with future management of this endangered species.

Introduction Exposure to violence is a risk factor for firearm carriage. Youth exposed to violence also have difficulty envisioning positive future outcomes (e.g., educational outcomes), which can increase the likelihood of firearm carriage over time. Researchers, however, have not yet examined whether changes in exposure to violence over time can influence the developmental trajectories of firearm carriage. To address this gap, we (1) examined the longitudinal association between exposure to violence and firearm carriage (grades 9 to 12) and then (2) examined whether changes in future expectations mediated this longitudinal association. Method The longitudinal association between exposure to violence and firearm carriage through future expectations was examined among 850 adolescents from the Flint Adolescent Study. Participants were recruited from four high schools in a midwestern city in the United States. Parallel latent growth models and latent growth mediation models were estimated. Results A positive association was observed between the rate of change in exposure to violence and firearm carriage. Exposure to violence also indirectly increased the risk for firearm carriage over time by decreasing future expectation in the 9th grade. Conclusions Our results support the idea that helping youth develop positive attitude about educational success may help reduce firearm carriage. Increasing positive expectations about future may help prevent firearm carriage within the context of violence exposure.

Pediatric residents report lack of confidence in providing firearm safety anticipatory guidance. A self-paced online curriculum, including video demonstration of firearms, safe storage options, and counseling methods for families improved resident self-efficacy, confidence, and knowledge surrounding firearm injury prevention counseling.

The classical two-arm randomized clinical trial (RCT) is designed to test the efficacy or effectiveness of an intervention, which may consist of one or more components. However, this approach does not enable the investigator to obtain information that is important in intervention development, such as which individual components of the intervention are efficacious, which are not and possibly should be removed, and whether any components interact. The Multiphase Optimization Strategy (MOST) is a new framework for development, optimization, and evaluation of interventions. MOST includes the RCT for purposes of evaluation, but inserts a phase of research before the RCT aimed at intervention optimization. The optimization phase requires one or more separate trials similar in scope to an RCT, but employing a different experimental design. The design of the optimization trial is selected strategically so as to maximize the amount of scientific information gained using the available resources. One consideration in selecting this experimental design is the type of intervention to be optimized. If a fixed intervention, i.e. one in which the same intervention content and intensity is provided to all participants, is to be optimized, a factorial experiment is often appropriate. If an adaptive intervention, i.e. one in which intervention content or intensity is varied in a principled manner, is to be optimized, a sequential multiple-assignment randomized trial (SMART) is often a good choice. The objective of this article is to describe MOST and the scientific rationale for its use; describe two current applications of MOST in emergency medicine research, one using a factorial experiment and the other using a SMART; and discuss funding strategies and potential future applications in studying the care of individuals with acute illness, injury, or behavioral disorders.

Background and objectivesYouth violence is an alarming public health problem, yet, violence screening and interventions are not systematically offered in primary care (PC). This paper describes data from a pilot effectiveness-implementation trial of an efficacious youth violence prevention programme (SafERteens).MethodsThe study was conducted in two PC clinics: a university-affiliated satellite clinic and a community health centre. In phase 1, we obtained stakeholder feedback to customise the SafERteens package and enrolled a comparison group of adolescents (age 14–18) seeking care in two clinics. In phase 2, clinical staff delivered the SafERteens-PC intervention with adolescents, which is a single, behavioural health therapy session delivered one-on-one from clinic providers to youth patients, followed by text message (TM) reminders. In phase 3, we assessed planned maintenance. All participants reported past-year violent behaviour at intake and completed a 3-month follow-up assessment.ResultsBased on stakeholder interviews (n=13), we created a web-based SafERteens-PC programme package, including a three-item past-year violence screen, 30 min motivational interviewing-based brief intervention delivery tool, training videos and 2 months of TM boosters. We enrolled a comparison group (n=49) first, then an intervention group (n=61). Intervention delivery characteristics varied by clinic, including completion of intervention (75.9%; 62.5%), modality (100% delivered via telehealth; 60% via telehealth/40% in-person) and enrolment in TMs (81.8%; 55.0%); 91.8% completed the follow-up. Using an intention-to-treat approach, the intervention group showed significantly greater reductions in severe peer aggression (pConclusionsIf these challenges could be addressed, routine provision of behavioural health services for violence prevention in PC could have high impact on health outcomes for adolescents.

Background A pediatric injury prevention course has not been available as a massive open online course (MOOC). Creating a comprehensive topic course is particularly challenging because the traditional, week-by-week linear curriculum design is often a barrier to learners interested in only specific topics. We created a novel, flexible course as both a ‘choose your topic’ MOOC for the public learner and a Small Private Online Course (SPOC) for medical students. Methods We describe creating ‘Injury Prevention for Children and Teens’, a course of 59 video learning segments within eight modules taught by a multidisciplinary panel of 25 nationally-recognized experts. Completion tracking and course evaluations were collected. Results In 2.5 years, 4,822 learners from 148 countries have enrolled. Two-thirds of learners were female. Median age of learners was 31 years. For engagement, 19.3% (n = 932) of learners attempted quizzes, and 5.2% (n = 252) participated in online forum discussions. Medical professionals (n = 162) claimed an average of 13 credit hours per learner. Over 200 senior medical students have taken the SPOC. Conclusion ‘Injury Prevention for Children and Teens’ is a novel approach to injury prevention education that is broad, science-based, accessible, and not cost-prohibitive for a diverse group of global learners.

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.

Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for older adult populations. To inform prevention efforts, we conducted a probability-based web survey (12/1/2019-12/23/2019) of 2048 older adults (age 50-80) to characterize national estimates of firearm ownership, safety practices, and attitudes about health screening, counseling, and policy initiatives. Among older U.S. adults, 26.7% [95%CI = 24.8%-28.8%] report owning one or more firearms. The primary motivation for ownership was protection (69.5%), with 90.4% highlighting a fear of criminal assault. 39.4% of firearm owners reported regularly storing firearm(s) unloaded and locked, with 24.2% regularly storing at least one loaded and unlocked. While most firearm owners found healthcare screening (69.2% [95%CI: 64.9-73.1]) and safety counseling (63.2% [95%CI = 58.8-67.3]) acceptable, only 3.7% of older adults reported being asked about firearm safety by a healthcare provider in the past year. Among firearm owners, there was support for state-level policy interventions, including allowing family/police to petition courts to restrict access when someone is a danger to self/others (78.9% [95%CI = 75.1-82.3]), comprehensive background checks (85.0% [95%CI = 81.5-87.9]), restricting access/ownership under domestic violence restraining orders (88.1%; 95%CI = 84.9-90.7], and removing firearms from older adults with dementia/confusion (80.6%; 95%CI = 76.8-84.0]. Healthcare and policy-level interventions maintained higher support among non-owners than owners (p's 0.001). Overall, data highlights opportunities exist for more robust firearm safety prevention efforts among older adults, particularly healthcare-based counseling and state/federal policies that focus on addressing lethal means access among at-risk individuals.

Firearm injuries are the second-leading cause of death for US children and adolescents (ages 1–18). This analysis quantified the federal dollars granted to research for the leading US causes of death for this age group in 2008–17. Several federal data sources were queried. On average, in the study period, $88 million per year was granted to research motor vehicle crashes, the leading cause of death in this age group. Cancer, the third-leading cause of mortality, received $335 million per year. In contrast, $12 million—only thirty-two grants, averaging $597 in research dollars per death—went to firearm injury prevention research among children and adolescents. According to a regression analysis, funding for pediatric firearm injury prevention was only 3.3 percent of what would be predicted by mortality burden, and that level of funding resulted in fewer scientific articles than predicted. A thirtyfold increase in firearm injury research funding focused on this age group, or at least $37 million per year, is needed for research funding to be commensurate with the mortality burden.

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 → No-FA; 89 No-FA → FA; 121 FA → No-FA; 63 FA → 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.

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) 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.

Firearm carriage is a key risk factor for interpersonal firearm violence, a leading cause of adolescent (age \ 18) mortality. However, the epidemiology of adolescent firearm carriage has not been well characterized. This scoping review examined four databases (PubMed; Scopus; EMBASE; Criminal Justice Abstracts) to summarize research on patterns, motives, and underlying risk/protective factors for adolescent firearm carriage. Of 6156 unique titles, 53 peer-reviewed articles met inclusion criteria and were reviewed. These studies mostly examined urban Black youth, finding that adolescents typically carry firearms intermittently throughout adolescence and primarily for self-defense/protection. Seven future research priorities were identified, including: (1) examining adolescent carriage across age, gender, and racial/ethnic subgroups; (2) improving on methodological limitations of prior research, including disaggregating firearm from other weapon carriage and using more rigorous methodology (e.g., random/systematic sampling; broader population samples); (3) conducting longitudinal analyses that establish temporal causality for patterns, motives, and risk/protective factors; (4) capitalizing on m-health to develop more nuanced characterizations of underlying motives; (5) increasing the study of precursors for first-time carriage; (6) examining risk and protective factors beyond the individual-level; and, (7) enhancing the theoretical foundation for firearm carriage within future investigations.

Background Youth violence is a leading cause of adolescent mortality, underscoring the need to integrate evidence-based violence prevention programs into routine emergency department (ED) care. Objectives To examine the translation of the SafERteens program into clinical care. Methods Hospital staff provided input on implementation facilitators/barriers to inform toolkit development. Implementation was piloted in a four-arm effectiveness-implementation trial, with youth (ages 14–18 years) screening positive for past 3-month aggression randomized to either SafERteens (delivered remotely or in-person) or enhanced usual care (EUC; remote or in-person), with follow-up at post-test and 3 months. During maintenance, ED staff continued in-person SafERteens delivery and external facilitation was provided. Outcomes were measured using the RE-AIM implementation framework. Results SafERteens completion rates were 77.6% (52/67) for remote and 49.1% (27/55) for in-person delivery. In addition to high acceptability ratings (e.g., helpfulness), post-test data demonstrated increased self-efficacy to avoid fighting among patients receiving remote (incidence rate ratio [IRR] 1.22, 95% confidence interval [CI] 1.09–1.36) and in-person (IRR 1.23, 95% CI 1.12–1.36) SafERteens, as well as decreased pro-violence attitudes among patients receiving remote (IRR 0.83, 95% CI 0.75–0.91) and in-person (IRR 0.87, 95% CI 0.77–0.99) SafERteens when compared with their respective EUC groups. At 3 months, youth receiving remote SafERteens reported less non-partner aggression (IRR 0.52, 95% CI 0.31–0.87, Cohen's d −0.39) and violence consequences (IRR 0.47, 95% CI 0.22–1.00, Cohen's d −0.49) compared with remote EUC; no differences were noted for in-person SafERteens delivery. Barriers to implementation maintenance included limited staff availability and a lack of reimbursement codes. Conclusions Implementing behavioral interventions such as SafERteens into routine ED care is feasible using remote delivery. Policymakers should consider reimbursement for violence prevention services to sustain long-term implementation.

Development Finance Institutions (DFIs) are frequently asked to demonstrate their additionality — meaning that they make investments that the private sector would not — but what evidence of additionality would look like is rarely articulated. This paper examines potential quantitative and qualitative evidence. We investigate whether it is possible to infer additionality from observational investment data, and show how the demand-led nature of DFIs’ business model can create bias in standard statistical techniques used to identify causal effects. Having established that rigorous evidence of additionality may continue to elude us, we discuss circumstantial evidence that would increase confidence that additionality is present, and propose a probabilistic approach to additionality.

Statement of purpose The purpose of this study was to explore how land parcel maintenance is associated with positive mental health outcomes using data collected during community greening efforts conducted in Flint, MI in 2017–2018. Unmaintained vacant land in urban areas is associated with a number of negative outcomes for residents of urban areas, including mental and physical health, safety, and quality of life. Community programs which promote land parcel maintenance in urban neighborhoods have been found to reverse some of the effects that unmaintained land has on nearby residents. Methods/Approach Trained observers assessed the maintenance of approximately 7200 land parcels and surveyed 691 residents (57% Female, 53% Black, M age = 51). We grouped land parcels and aggregated resident data to 397 street segments and compared three structural equation models (SEM) to estimate the relationships between parcel maintenance, fear of crime, and mental distress for residents when controlling for a set of individual-, neighborhood-, and Census-level variables. Results We found a negative association between parcel maintenance values and fear of crime, and a positive association between fear of crime and mental distress at the street segment level. Conclusions Our results supported our hypothesis that the general land maintenance is related to mental distress through its relationship with residents’ fear of crime. Significance Continued development and support of community greening programs are likely to be associated with positive health and safety outcomes for residents in maintained neighborhoods.

Statement of purposePreventing opioid misuse and opioid use disorder (OUD) is necessary given the opioid epidemic Prevention programs for adolescents/young adults are needed to alter risk trajectories We developed interventions using telemedicine (synchronous video conference) and a patient portal-like messaging system to address risk factors for opioid misuse/OUD among young Emergency Department (ED) patients Our presentation describes these promising interventions and their feasibility and acceptability Methods/ApproachIn Spring 2020, N = 40 ED patients ages 16–30 who were at risk for opioid misuse/OUD enrolled in a pilot trial involving screening/baseline assessments, motivational interviewing-based remote interventions (baseline telemedicine brief intervention [BI], 1-month of portal messaging), and a 1-month follow-up Before COVID-19, N = 10 enrolled in the ED (in-person cohort: IPC);during COVID-19, N = 30 recent ED patients enrolled via phone recruitment (remote cohort: RC) Feasibility data are presented by cohort;acceptability data are combined ResultsAmong the N=40, the sample had a mean age of 22 9 years Gender was: 70% female, 5% non-conforming, 25% male Race was: 75% White, 15% Black/African American, and 10% other racial identities;17 5% were Hispanic/Latinx Regarding feasibility, eligibility rates were similar (IPC: 17%, RC: 15%);consenting rates differed (IPC: 100%, RC: 56%), likely due to the RC’s telephone approach Portal engagement increased from the IPC (60%) to the RC (93%), possibly due to addressing technical difficulties and IPC user feedback BI and portal satisfaction were high (M = 9 3 on a 1–10 scale and M = 8 5, respectively) Interventions exceeded motivational interviewing fidelity thresholds (adapted for portal messaging) Follow-up rates were high (IPC: 80%, RC: 93%) SignificancePreventing opioid misuse is critical to avoiding escalation of opioid use and overdoses, and emergency department patients are at increased risk This study demonstrates the feasibility and acceptability of these intervention approaches via telemedicine for preventing future injuries

Statement of purposeTo use data from a state-wide opioid overdose surveillance system in Michigan to evaluate changes in opioid overdose frequency during the COVID-19 pandemic Methods/ApproachThe System for Opioid Overdose Surveillance (SOS) is a near real-time overdose surveillance system in the state of Michigan run out of the University of Michigan Injury Prevention Center, in collaboration with the Michigan HIDTA SOS receives daily data feeds containing all EMS encounters involving naloxone administration, and daily data on suspected fatal overdoses from medical examiners covering ∼80% of the state’s population We used SOS data to compare spatial and temporal changes in suspected opioid overdoses after 3/1/20, the approximate timing of the intensification of the COVID-19 pandemic, and compared those changes to those seen at the same time in 2019 ResultsFrom 3/1/20–9/16/20, suspected fatal overdoses were 15 0% higher than during the same time in 2019, and naloxone administrations by EMS were 28 8% higher;a majority of counties and cities saw analogous changes, though the magnitude varied Rates of both suspected fatal overdoses and EMS naloxone administrations were higher in 2020 prior to March, but the difference increased following the start of the pandemic By late August, rates of suspected fatal overdoses returned to 2019 levels, but EMS naloxone administration rates remained nearly 40% higher than the same time in 2019 ConclusionsEvidence suggests that overdose and the COVID-19 pandemic are interwoven crises, and resources are required to address both the isolation and stress of the pandemic, and the medical system excess burdens, which all may intensify substance use, and reduce the likelihood of seeking treatment SignificanceOverdose remains a leading cause of death, and that burden has increased during the pandemic in Michigan Approaches are needed to address secondary effects of the COVID-19 pandemic

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.

Marker-assisted seedling selection (MASS) has much potential to improve the efficiency of traditional apple breeding. Theoretical and empirical evaluation of selection cost and theoretical evaluation of genetic gain in previous studies support this promise. However, there is a lack of empirical validation of MASS efficiency reported in tree fruit crops for genetic gain and cost nor even genetic gain alone. To determine the optimal way of conducting MASS especially when genotypic information is less predictive than phenotypic information, which is the case for many quantitative traits, this study evaluated the genetic gain and cost of applying a multi-locus DNA test targeting fruit acidity, crispness, and firmness in a multi-family apple seedling population. Variance component analysis indicated that the DNA test explained 12%, 16%, and 17% of the additive variance of apple acidity, crispness, and firmness, respectively. Two-stage seedling selection was estimated to outperform traditional seedling selection for both genetic and cost efficiency: when 70% of the total seedlings were selected in the first stage based on marker score and 20% in the second stage based on phenotype, compared to phenotypic selection, two-stage selection identified 4% more individuals with breeding values within target ranges for acidity and firmness while achieving selection cost savings at DNA testing prices of less than $4.5/sample. This empirical validation of MASS suggested that when predictiveness of a DNA test is lower than heritabilities of the traits, properly weighting genotypic and phenotypic information through two-stage selection can lead to a higher genetic gain while reducing selection cost compared to phenotypic seedling selection.

Firearm injury is a significant public health problem in the United States. Almost 40,000 people died and 134,000 were injured in the United States in 2017. Two-thirds of U.S. firearm deaths in 2017 were suicides, just as in every year in the last decade. Although the majority of firearm deaths are White men, the epidemic disproportionately affects young (age 15–34) minority men, for whom firearm injury is the leading cause of death. Due to limitations in federal funding for firearm injury prevention research, the evidence-base is limited. What evidence does exist points clearly to the need for ED-based awareness of and intervention to reduce common patterns of firearm injury, such as suicide, community violence, and domestic violence. In this chapter, we present an overview of key activities that emergency providers can take to address this issue.

Firearm injuries are the second leading cause of child and adolescent death in the United States, with homicides currently responsible for 1915, or nearly 60%, of all firearm deaths occurring in the pediatric population. Rates of pediatric firearm homicide have increased over 20% in the past 4 years, and significant disparities persist with regard to age, sex, race/ethnicity, and urbanicity. In the present chapter, we review the current state of our knowledge about the epidemiology of firearm homicide and non-fatal firearm assaults, trends in such injuries over time, global comparisons, contextual factors associated with firearm homicides, and what is known about risk and protective factors associated with interpersonal firearm violence. Finally, we outline a pathway forward for the prevention of interpersonal firearm violence among children and adolescents.

Quantitative assessments of microbial activity in crustal fluids yield potential strategies to supplement recalcitrant DOC., Biogeochemical processes occurring in fluids that permeate oceanic crust make measurable contributions to the marine carbon cycle, but quantitative assessments of microbial impacts on this vast, subsurface carbon pool are lacking. We provide bulk and single-cell estimates of microbial biomass production from carbon and nitrogen substrates in cool, oxic basement fluids from the western flank of the Mid-Atlantic Ridge. The wide range in carbon and nitrogen incorporation rates indicates a microbial community well poised for dynamic conditions, potentially anabolizing carbon and nitrogen at rates ranging from those observed in subsurface sediments to those found in on-axis hydrothermal vent environments. Bicarbonate incorporation rates were highest where fluids are most isolated from recharging bottom seawater, suggesting that anabolism of inorganic carbon may be a potential strategy for supplementing the ancient and recalcitrant dissolved organic carbon that is prevalent in the globally distributed subseafloor crustal environment.

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

INTRODUCTION: Youth who carry firearms—and peers that surround them—are at increased risk for violent injuries. Because firearm carriage behaviors can change over time within an individual, it is important to identify individual and social-contextual determinants that explain this within-person variability in carriage. METHODS: The authors identified individual and social-contextual determinants of firearm carriage in the past 6 months using multilevel logistic models on five waves of panel data from the Flint Youth Injury Study (n=597; ages 14–24 years), collected in 2009–2011 and analyzed in 2019. RESULTS: Regarding within-person effects, when an individual had more positive peer affiliations compared with their average, their odds of carrying a firearm decreased (OR=0.88; 95% CI=0.81, 0.96). Conversely, an individual’s odds of carrying a firearm increased when they had more negative peer affiliations (OR=1.08, 95% CI=1.02, 1.14), experienced more victimization (OR=1.03, 95% CI=1.01, 1.05), perceived greater community violence (OR=1.12, 95% CI=1.05, 1.21), or exhibited greater retaliatory attitudes (OR=1.10, 95% CI=1.01, 1.19) than their average. CONCLUSIONS: Peer affiliations, victimization, community violence perceptions, and retaliatory attitudes explain within-person variability in firearm carriage. Strategies for reducing carriage among youth should consider individual- and environmental-level interventions to address these individual and social-contextual determinants.

Statement of Purpose Youth violence is a leading cause of morbidity and mortality. Adolescent primary care visits provide an opportunity for violence screening and delivery of interventions, which are not typically offered in this setting. Thus, we examined implementation of an evidenced-based behavioral intervention (SafeERteens) in primary care. Methods/Approach Adolescents (ages 14–18) reporting past year aggression on a screening survey were eligible. A quasi-experimental deign was used, enrolling a comparison sample (e.g., resource brochure) and an intervention sample, which consisted of clinic staff delivering a 30-minute Motivational Interviewing-based brief intervention, followed by automatic text message boosters over 8 weeks. Follow-up surveys were complete at 3-months. Results Overall, about half (50.0%; 56.6%) of youth screened positive, with 110 enrolled (n=49 comparison; n= 61 intervention). Intervention delivery characteristics varied by clinic, including completion (75.9%; 62.5%), modality (100% telehealth; 60% telehealth/40% in-person), and enrollment in text messages (81.8%; 55.0%). In analyses comparing relative changes over time (using an intent-to-treat approach), the intervention group showed significantly greater reductions in severe peer aggression (p Conclusions Findings support the feasibility and preliminary effectiveness of delivering violence interventions in primary care, with key lessons learned informing future translation of behavioral interventions into routine care in primary care. Significance/Contribution to Injury and Violence Prevention Primary care is a useful setting to identify adolescents involved with violence, and deliver interventions, which could reduce injury and improve health outcomes.