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Objectives To explore the association between return to work (RTW) and mental health outcomes in Black men in Philadelphia recovering from serious traumatic injuries. Methods We analyzed data from 498 Black men aged ≥ 18 years living in Philadelphia who were admitted to a Level I trauma center for injury between January 2013 and June 2017. We used multivariable logistic regression to estimate the association between pre-injury occupation, RTW and depression or PTSD 3 months after hospitalization. Results In adjusted analyses, men who had not RTW at follow-up had higher odds of poor mental health outcomes than men who had RTW (OR: 2.7, 95% CI: 1.8, 4.2). Additional significant factors included: younger age, lack of or public health insurance and higher lifetime experiences of racism. Conclusions The mental health recovery trajectory of injured Black men living in Philadelphia is associated with RTW and other factors that can influence financial stability and economic resources. Policy implications Programmatic strategies that seek to optimize recovery after injury in Black men should include consideration of key structural factors such as employment, financial stability, and the impact of racism-related exposures.

Objectives We analyze the degree to which community violence in Mexico, largely due to organized crime violence, affects health care service utilization. Methods This study exploits temporal and geographic variation in monthly county-level homicide rates, matching outpatient service utilization from individual longitudinal measures. Sensitivity analyses test for an age specific concentration of violence, respiratory conditions that are likely unrelated to violence, insurance status and health center availability per capita. We test for distributional responses to violence by urban and rural localities. Results The likelihood of service utilization increases by 5.2% with each additional homicide per 100,000. When we include self-reported health conditions in the model, our main coefficient remains significant at 4.5%. We find no added effect to our results from interaction terms for age specific concentration of violence, respiratory conditions, insurance status, or health center availability. A substantial increase of 11.7% in the likelihood of service utilization occurs in localities with > = 100,000 inhabitants, suggesting that service utilization is sensitive to the location of violence. Conclusions Results highlight the relationship between and increase in violence at the local level and an increase in health care service utilization. This study is among the first to examine this relationship empirically in Mexico. Future research is needed to shed more light on this relationship and its mechanisms.

Laws and policies are critical determinants of health and well-being. They can encourage positive behaviors and discourage harmful behaviors, and they can enhance or worsen health, health equity, health disparities, and health literacy. Recognizing their contribution to conditions in the environments in which people are born, live, learn, work, play, worship, and age, and people's experiences of these conditions, the US Department of Health and Human Services considered the roles of law and policy throughout its development of Healthy People 2030. Laws and policies often interrelate, but they have different purposes. A law is an established procedure, standard, or system of rules that members of a society must follow. A policy is a decision or set of decisions meant to address a long-term purpose or problem. Healthy People 2030 offers an opportunity for users in diverse sectors and at all levels to use laws and policies to support or inform the initiative's implementation, address health disparities and health inequities, and improve health and well-being in this decade. Introducing new laws and policies or rescinding existing ones to achieve Healthy People 2030 goals offers a chance to rigorously assess outcomes and weigh the balance of good outcomes against unintended consequences.

Firearm violence remains a critical public health challenge, disproportionately impacting some US regions. County-level variation may hold key insights into how firearm mortality rates vary across the US.To model county-level changes in firearm mortality rates (total, homicide, and suicide) from 1989 to 1993 vs 2015 to 2019 and identify and characterize hot spots showing unexpected changes over time.This is a cross-sectional study with 2 time points using a novel small area estimation method to analyze restricted access mortality microdata by cause of death and US county. The analysis included 3111 US counties from 49 states and the District of Columbia from January 1, 1989, to December 31, 2019. Bayesian spatial models were fitted to map geographical variation in changes in age-standardized firearm mortality rates (per 100 000 person-years) from 1989 to 1993 vs 2015 to 2019. County outliers (or hot spots) were defined as having observed rates that fell outside the 95% credible intervals of their expected posterior predictive distribution. These counties were characterized using visualization and descriptive statistics of their characteristics. Data were analyzed from June to December 2021.County of residence.Five-year age-standardized mortality rates by US county, age, and cause of death for 1989 to 1993 and 2015 to 2019.Between 1989 and 2019, 1 036 518 firearm deaths were recorded in counties across the US. Suicide was the most common cause of firearm mortality (589 285 deaths) followed by homicide (412 231 deaths). Age-standardized rates (deaths per 100 000 individuals) for firearm deaths and suicides increased from 1989 to 1993 vs 2015 to 2019 (mean [SD] change, 0.16 [8.78] for firearm deaths and 1.21 [6.91] for suicides), while firearm homicides decreased (mean [SD] change, -0.39 [3.96]). However, these national trends were not homogeneous across counties and often varied by geographical region. The West and Midwest showed the most pronounced increases in firearm suicide rates, whereas the Southeast showed localized increases in firearm homicide rates, despite the national decreasing trend. Critical hot spots were identified in urban counties of Alabama, and firearm homicide rates (per 100 000) in Baltimore City, Maryland, almost doubled from 29.71 to 47.43, and by 2015 to 2019 it accounted for 66.7% of all firearm homicide in Maryland. By contrast, District of Columbia showed promising improvements over time, decreasing from 56.5 firearm homicides per 100 000 in 1989 to 1993 to 14.45 in 2015 to 2019.There was substantial variation in rates and changes in firearm deaths among US counties. Geographical hot spots may be useful to inform targeted prevention efforts and local policy responses.

The aim of this review was to evaluate the current state of scientific knowledge describing the mental health of Black men who have experienced incarceration.This systematic mixed studies review employed a sequential explanatory design integrating quantitative and qualitative published research.PubMed, CINAHL, PsycINFO, Social Work and Criminal Justice databases were searched using search terms addressing core constructs of mental health, Black men, incarceration and re-entry, January 2010 through October 2021.Articles identified through a search protocol were screened for inclusion as: peer-reviewed original research, published in English and relevant to the mental health of formerly incarcerated Black men in the United States.Twenty-three articles met inclusion criteria. Quantitative findings demonstrated significant associations between incarceration history and poor mental health, including higher levels of psychological distress, increased severity of depressive and PTSD symptoms, and delayed mental health treatment. Discrimination, negative police encounters, solitary confinement and difficulty finding employment were associated with the relationship between incarceration and mental health outcomes. Four themes were identified from the qualitative synthesis: (1) Social Determinants of Mental Health (2) Pushing Through Emotional Despair (3) Challenges to Healthcare Engagement and (4) Gender, Race and Intersections between Social Identities.The United States has the highest rate of incarceration in the world and disproportionately incarcerates Black men. This review contextualizes the relationship between incarceration history and mental health in the lived experiences and perspectives of formerly incarcerated Black men. Findings indicate the need for interventions to support mental health needs and prevent downstream health consequences in this population.Mental health concerns are pervasive in formerly incarcerated Black men; to address key gaps in current scientific understandings future research should focus on how Black men navigate help-seeking experiences and use mental health services in the context of an incarceration history.

Background Black men are disproportionately impacted by injuries in the United States. This disparity is glaring given that injury is one of the top ten causes of death. Injured Black men from disadvantaged neighborhoods experience higher injury mortality, years of life-expectancy loss, and psychological symptoms that persist after initial wounds have been treated. These injured men are typically transported to a hospital where they are medically stabilized and soon after are returned to the community. Black men are less likely to be discharged to comprehensive rehabilitation facilities, magnifying disparities in recovery from injury. While much research has examined individual characteristics that predict poor recovery from injury, fewer studies have focused on social and physical features of the environment and how they may impact the recovery of injury survivors. Purpose The purpose of this study was to describe Black men's perceptions of how characteristics of their environment affect their recovery following serious injury. Methods This was a secondary analysis of an existing data set consisting of semi-structured, qualitative interviews of 43 injured Black men in a northeastern city. The interviews were conducted three months following discharge from a large urban trauma center, and were audiotaped, transcribed verbatim, and de-identified. Thematic analysis consistent with the qualitative paradigm was used to identify themes. Results Four themes were identified in injured men's narratives: challenges to recovery, feeling unsafe, efforts to increase safety, and resources for recovery. Conclusions Our findings emphasize the importance of the role of community resources that can support injured men's recovery within their neighborhoods. Additional resources should be directed to survivors who return to disadvantaged communities after injury in order to minimize adverse emotional experiences that detract from recovery.

Precision health can provide an avenue to bridge and integrate ways of knowing for research and practice. Nurse scientists have a long-standing interest in using multiple sources of information to address research questions of significance to the profession and discipline of nursing, which can lead to much needed contributions to precision health care. In this paper, nursing scientists discuss emerging research methods including omics, electronic sensors, and geospatial data, and mixed methods that further develop nursing science and contribute to precision health initiatives. The authors provide exemplars of the types of knowledge and ways of knowing that, using these and other advanced data and analytic strategies, may advance precision health within the context of nursing science.

INTRODUCTION: Urban black males are at disproportionately high risk of poor health outcomes, thus we need to measure neighborhood environments appropriately in order to understand aspects of neighborhoods that influence their mental and physical health. We explored associations between physical and mental health of injured, urban black men with objectively measured and perceived neighborhood characteristics. METHODS: In 2017–2018, we analyzed data from 486 black, adult males in Philadelphia admitted to a trauma center with injury between January 2013 and February 2017. Area-level measures of social, economic, and built environments were obtained from multiple sources. At enrollment, participants answered questions about neighborhood environment and self-reported physical and mental health 30 days before injury. We conducted factor analysis to identify neighborhood characteristics, then estimated odds of poor physical or mental health, accounting for spatial correlation of participants. RESULTS: Poor physical and mental health was reported by 12% and 22% of participants, respectively. In participants’ neighborhoods, 29% of adults lived in poverty. Individually, 73% of men reported abandoned buildings and 31% reported not feeling safe walking around their neighborhood. Physical health was associated with neighborhood poverty and disconnectedness. Mental health was associated with neighborhood economics and individual perceptions of social disorder and safety. Individual-level factors were not correlated with area-level factors. CONCLUSIONS: We found both area-level and individual-level measures were associated with health, perhaps operating through different mechanisms, but individual experiences may not be easily extrapolated from area-level data. By identifying important components of neighborhood environments, we may better understand how neighborhoods contribute to health in vulnerable populations.

ImportanceAttrition in cancer clinical trials (CCTs) can lead to systematic bias, underpowered analyses, and a loss of scientific knowledge to improve treatments. Little attention has focused on retention, especially the role of perceived benefits and burdens, after participants have experienced the trial.ObjectivesTo examine the association between patients’ perceived benefits and burdens of research participation and CCT retention.Design, Setting, and ParticipantsThis survey study was conducted at a National Cancer Institute–designated comprehensive cancer center in the Northeast region of the US. The sample included adult patients with a cancer diagnosis participating in cancer therapeutic trials. Data were collected from September 2015 to June 2019. Analysis of study data was ongoing since November 2019 through October 2022.ExposuresSelf-reported validated survey instrument with a list of 22 benefits and 23 burdens of research participation that can be rated by patients with a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).Main Outcomes and MeasuresA primary outcome was actual withdrawal from the CCT, and a composite outcome was composite withdrawal that included both actual withdrawal and thoughts of withdrawing. Bivariate and multivariable logistic regressions were used.ResultsAmong the 334 participants in the sample, the mean (SD) age was 61.9 (11.5) years and 174 women (52.1%) were included. Top-cited benefits included both aspirational and action-oriented goals, including helping others (94.2%), contributing to society (90.3%), being treated respectfully (86.2%), and hoping for a cure (86.0%). Worry over receiving a placebo (61.3%), rearranging one’s life (41.9%), and experiencing bothersome adverse effects (41.6%) were notable burdens. An increased burden score was associated with a higher probability of actual withdrawal (adjusted odds ratio [OR], 1.86; 95% CI, 1.1-3.17; P = .02) or composite withdrawal (adjusted OR, 3.44; 95% CI, 2.09-5.67; P P P = .03). The risk of withdrawal was even higher for the composite outcome (adjusted OR, 7.70; 95% CI, 2.76-21.48; P Conclusions and RelevanceThis survey study found that patients perceived important benefits from CCT participation, and this perception was associated with trial retention, even among those who also perceived substantial burdens. A broader dialogue among stakeholders can inform an ethical and patient-centric focus on benefits throughout the course of a CCT to increase retention.

Objective This study evaluated the association between pain outcomes and post-traumatic stress disorder (PTSD) symptom trajectories after combat-related injury, while adjusting for receipt of regional anesthesia (RA) soon after injury. Methods The PTSD symptom trajectories of N = 288 combat-injured service members were examined from within a month of injury up to two-years after. Linear mixed-effects models evaluated the association between PTSD symptom trajectories and average pain and pain interference outcomes while adjusting for receipt of RA during combat casualty care. Results Four PTSD trajectories were characterized: resilient, recovering, worsening, and chronic. Differential pain presentations were associated with PTSD symptom trajectories, even after adjusting for receipt of RA. Compared to those with a resilient PTSD symptom trajectory, individuals presenting with chronic PTSD trajectories were estimated to experience average pain scores 2.61 points higher (95% CI: 1.71, 3.14). Participants presenting with worsening (β = 1.42; 95% CI: 0.77, 1.78) and recovering PTSD trajectories (β = 0.65; 95% CI: 0.09, 1.08) were estimated to experience higher average pain scores than participants with resilient PTSD trajectories. Significant differences in pain interference scores were observed across PTSD trajectories. Receiving RA was associated with improved pain up to two years after injury (β = -0.31; 95% CI: -0.90, -0.04), however no statistically significant association was detected between RA and PTSD trajectories. Conclusions Chronic and worsening PTSD trajectories were associated with greater pain intensity and interference following combat injury even when accounting for receipt of early RA for pain management. These findings underscore the need to jointly assess pain and PTSD symptoms across the trauma care continuum.

As interest in nurse-led health and health care innovation grows, we must prepare nurses with the skills, knowledge, and experiences necessary to lead in these areas. In this article we describe how schools of nursing can integrate innovation in their mission, describe actionable steps to position nurses as leaders in this space, and provide a case study example of how to infuse innovation into a school of nursing. CLINICAL RELEVANCE: In order for nurses to lead in health and healthcare innovation, schools of nursing and nursing programs must think strategically about the knowledge and skills the next generation of nurses will need and then support those innovation needs at all levels of research, education, and practice.

Background: As COVID-19 forced in-person courses to transition online, an active learning course focused on design thinking in health and health care embraced the challenge. Lessons learned, mistakes made, and thoughts on the future of online education in nursing are discussed. Method: During the online transition, it was thought the flipped-classroom approach would transition well using the same design thinking methodology taught in the course. Because the course promoted rapid innovation and iteration, such a challenge served as a call to action, and the course became a valuable real-time case study. Results: Based on student surveys, the overall quality of the transitioned course increased slightly compared with the previous semester's in-person course, indicating schools of nursing can innovate both the way students are taught as well as what students are taught. Conclusion: Rather than mourn the loss of in-person learning, the newfound possibilities of virtual education should celebrated. [ J Nurs Educ . 2021;60(5):298–300.] .

Statement of purpose To appraise the ability of two short clinical screeners designed to predict future development of post-injury depression and PTSD in traumatically injured patients. Methods/Approach This study is part of a prospective longitudinal cohort study to improve the health of urban Black men after serious injury. The sample consisted of English-speaking, self-identified Black men at least 18 years old, residing in the Philadelphia metropolitan area, who were hospitalized for an acute traumatic injury. The two screeners used were the Penn Richmond Screener (PRS) and the Posttraumatic Adjustment Screen (PAS). Results A total of 623 participants completed baseline interviews. Over 80% completed the 3-month follow-up interview and had complete data for depression (n = 502) and PTSD (n = 501). Of these, 177 (35.3%) met criteria for depression and 145 (28.8%) for PTSD; 116 participants met criteria for both depression and PTSD (23.2%). Both screeners have similar positive predictive values (PPV) for depression. PAS performs slightly better in PPV for PTSD. Both screeners have high negative predictive values for PTSD and depression, so they will adequately identify individuals who will not develop symptoms. The area under the curve for PTSD and depression in both screeners is similar, so they similarly classify those with and without future risk of symptom development. Conclusion PRS and PAS, developed through different methods and with different populations, show comparable predictive ability within the study population. Thus, mental health outcomes can be predicted in various populations using screeners the clinician values for brevity over the similarity of patient population to the screener’s test population. Significance ACS-COT encourages screening all patients for depression and PTSD risk. Integrating a predictive screener prior to discharge is critical to identifying those at risk and targeting patients who would benefit from post-discharge concurrent screening.

Statement of purpose School violence is a major concern for the safety and wellbeing of school-age youth. In 2018, adolescent students reported 836,000 nonfatal victimizations at school, and 410,000 away from school. These experiences are disruptive to the educational environment and associated with negative mental health, school performance, and delinquency outcomes. The purpose of this study was to understand how students’ daily routines and social interactions over the school day influence risk of violence with the goal of informing intervention. Methods/Approach We conducted this qualitative work in the context of a large-scale, mixed-methods investigation of school violence in an urban setting. Semi-structured interviews (n=56) were conducted with 12–18 years old who lived/went to school in Philadelphia, PA, and were involved (victim/perpetrator) in a violent school-related assault in the six months prior to their interview. Interviews were recorded, transcribed and entered into NVivo 12 for coding and analysis. Using a modified grounded theory approach, we developed a codebook matching common themes identified in the interviews. Results Preliminary results suggest school-related violence is infrequently a random act; instead there was usually a precipitating event, and these incidents almost always involved people who knew each other. Important emerging themes included: opportunities to intervene; role of adults and peers in encouraging/discouraging violence; varied attitudes towards school supervision; role of social media; and presence of trauma and importance of emotion regulation. Social environment was considered in the context of the physical environment to enhance the meaning of place. Conclusion School violence occurs with some regularity, and violent acts or incidents are often the final culminating events, offering several areas of modifiable factors for intervention leading up to the incident. Significance Findings from this study lend important insights for how to reduce school violence and will inform training and policy recommendations at the local level which can also be adapted nationwide in similar settings.

Mexico’s violence related to organized crime activity has grown to epidemic levels in the last 12 years. We interviewed 22 Mexican health care providers from five states to examine how violence impacts health care services and health. We transcribed and analyzed semi-structured interviews using framework analysis. Our findings describe the ways in which community violence in Mexico permeates health care services, impacting health care providers, and the health of patients. We developed a model to reflect our main themes that illustrate how violence permeates health care services over geographic space and time. We identified three thematic categories: (a) the impact of violence on health care facilities and service provision, (b) the impact of violence on providers, and (c) the impact of violence on the health of the community. Our model articulates a dynamic process of the spread and permeation of violence. Prior literature focuses on the impact of violence as an occupational hazard and the effect of war or civil conflict on health care services. We extend this literature by documenting the impacts of widespread violence on Mexican health care services and providers. We discuss how violence impacts services, providers, and health in a country that is not officially at war. We compare our findings to previous literature on occupational violence in health professions and the impacts on health services in official war zones. Finally, we highlight the implications for health care practice and policy. We suggest that violence should be considered throughout the care continuum in Mexico and make the case for violence as a structural contributor to health and health disparities in Mexico. We suggest additional research on this under-investigated topic.

Background: The United States is experi­encing an opioid overdose crisis accounting for as many as 130 deaths per day. As a result, health care providers are increas­ingly aware that prescribed opioids can be misused and diverted. Prescription of pain medication, including opioids, can be in­fluenced by how health care providers per­ceive the trustworthiness of their patients. These perceptions hinge on a multiplicity of characteristics that can include a patient’s race, ethnicity, gender, age, and present­ing health condition or injury. The purpose of this study was to identify how trauma care providers evaluate and plan hospital discharge pain treatment for patients who survive serious injuries. Methods: Using a semi-structured guide from November 2018 to January 2019, we interviewed 12 providers (physicians, nurse practitioners, physician assistants) who pre­scribe discharge pain treatment for injured patients at a trauma center in Philadelphia, PA. We used thematic analysis to interpret these data. Results: Participants identified the impor­tance of determining “true” pain, which was the overarching theme that emerged in analysis. Subthemes included perceptions of the influence of reliable methods for pain assessment, the trustworthiness of their patient population, and the consequences of not getting it right. Conclusions: Trauma care providers de­scribed a range of factors, beyond patient-elicited pain reports, in order to interpret their patients’ analgesic needs. These included consideration of both the risks of under treatment and unnecessary suffering, and overtreatment and contribution to opi­oid overdoses. Ethn Dis. 2021;31(1):139- 148; doi:10.18865/ed.31.1.139

Privacy and confidentiality of personal medical information are cornerstones of ethical clinical care and ethical research. But real-world research has challenged traditional ways of thinking about privacy and confidentiality of information. In today's world of "big data" and learning health care systems, researchers and others are combining multiple sources of information to address complex problems. We present a case study that highlights the ethical concerns that arise when a patient who is employed by an academic medical center learns through a research invitational letter that her private information was accessed at this center without her consent. We discuss the ethical challenges of balancing patient privacy with advancing clinical research and ask, what level of privacy and confidentiality can and should patients expect from their clinician providers, fellow research colleagues, and institutions?

OBJECTIVES: This study clarifies three important issues regarding situational or opportunity theories of victimization: 1) whether engaging in risk activities triggers violent assault during specific, often fleeting moments, 2) how environmental settings along individuals’ daily paths affect their risk of violent assault, and 3) whether situational triggers have differential effects on violent assault during the day versus night. METHODS: Using an innovative GIS-assisted interview technique, 298 young male violent assault victims in Philadelphia, PA described their activity paths over the course of the day of being assaulted. Case-crossover analyses compared each subject’s exposure status at the time of assault with his own statuses earlier in the day (stratified by daytime and nighttime). RESULTS: Being at an outdoor/public space, conducting unstructured activities, and absence of guardians increase the likelihood of violent victimization at a fine spatial-temporal scale at both daytime and nighttime. Yet, the presence of friends and environmental characteristics have differential effects on violent victimization at daytime versus nighttime. Moreover, individual risk activities appeared to exhibit better predictive performance than did environmental characteristics in our space-time situational analyses. CONCLUSIONS: This study demonstrates the value of documenting how individuals navigate their daily activity space, and ultimately advances our understanding of youth violence from a real-time, real-life standpoint.

Nurses are well-positioned to be groundbreaking researchers, scientists, leaders, and innovators to improve the health and well-being of individuals, families, and communities. Nurse scientists are needed to contribute to scientific discoveries that inform effective strategies to improve patient care and outcomes and to inform future policies. Thoughtful consideration is required about the preparation of nurse scientists to ensure they are equipped with the knowledge and skill sets to meet the needs of society. Evolving health needs and priority areas of inquiry along with an ever-increasing array of sophisticated methodologies and centrality of interdisciplinary teams to solve complex problems should drive how we prepare PhD students. This paper reflects a panel and subsequent dialogue with nurse leaders at the PhD summit held at the University of Pennsylvania in October 2019. Three aspects of PhD education and the advancement of nursing science are discussed 1) examining important elements to support nurse scientist development; 2) identifying key gaps in science that the discipline needs to address in educating the next generation of nurse scientists; and 3) preparing nurse scientists for the competitive funding environment.

Black patients are less likely than white patients to receive pain treatment, especially opioids, for both acute and chronic pain. Black men are at higher risk than other populations of being "assumed criminal" regardless of any involvement in criminal activity. Additionally, certain injury and patient characteristics such as intentionality of injury and substance use history may lead providers to suspect criminal involvement and impact pain treatment decisions. The purpose of this study was to describe factors that predict receipt of opioid prescription at hospital discharge. We conducted a secondary analysis of data from a cohort of 623 seriously injured Black men treated at trauma centers in Philadelphia between 2013 and 2017. Regression models were used to examine relationships between discharge opioid prescriptions, injury intent, and substance use history. Controlling for age, injury severity, pain score, length of hospital stay (LOS), insurance type, and year of study, receipt of opioids was not impacted by injury intent. However, patients who self-reported substance overuse were less likely to receive opioids than those who did not. Patients with higher injury severity, pain scores, and longer LOS were more likely to receive opioids. Of patients who received opioids, patients with higher pain scores and longer LOS received higher dosages than those with lower scores and shorter LOS. While previous research highlights stigmatization experienced by intentionally injured patients, injury intent did not impact receipt of discharge opioid prescriptions in this study. Future research should continue to explore the effect of injury intent on patients' experiences in the healthcare system.

Purpose School violence, frequently resulting in serious injury, is a major public health concern, and can make students afraid to go school. Few studies investigate the myriad factors that contribute to school violence. We are conducting a mixed-methods study of school assaults, including violence that happen on the way to or from school. Approach In an urban environment, this NIJ-funded study of 12-18 year-olds involves using a map-based interview of the path of their activities up to the time of assault, with case-crossover analyses to identify situation-specific risk factors. Recruitment sites include a Level I trauma center, health clinics, and community centers. Results With a goal of 200, 45 participants have been enrolledto date: 85% African American, 4% Hispanic. Injuries sustained were blunt trauma (42%), concussion (23%), and fracture (4%). 50% of the incidents were described as random violence, 35% as non-gang fight, and 8% as gang fight. 38% occurred inside school, 27% on school grounds, and 4% off site. None had been carrying a weapon at the time of the injury. Only 18% reported they knew how to acquire a gun, and 43% reported they would tell a teacher if a student had a gun at school whereas 57% reported they would not do so. Importantly, 65% of incidents were reported to police and of those, 80% of participants felt the police were helpful. However 50% of respondents felt the conflict was not resolved. 60% had a teacher highly invested in them and 65% reported a teacher expects them to attend college. Thematic results thus far suggest students were vulnerable at moments when guardianship was absent, which varied from location to location during the school day. Conclusions and Significance Understanding the context of the timing and nature of school-based assaults can inform opportunities for place-based interventions.

Background Traumatic injury is not evenly distributed across race and class in America. Black men are marginalized in society, often live in disadvantaged neighborhoods, and are at higher risk for injury mortality and ongoing physical and psychological problems following injury, including post-traumatic stress disorder (PTSD) and depression. While much research has examined individual factors associated with increased post-injury psychological symptoms, the contribution of the social and physical environment has been relatively-understudied. Purpose The purpose was to examine the contribution of neighborhood characteristics to PTSD and depressive symptom severity in Black men following serious injury. Methods A secondary analysis of 451 seriously injured men living in Philadelphia were drawn from a prospective cohort study. Study participants were linked by a geographic information system (GIS) to characteristics in their neighborhood in order to spatially model the factors that contribute to increased psychological symptom severity at 3 months post-injury. Factor analysis identified underlying constructs of 32 neighborhood predictors, which were entered in a generalized estimating equation (GEE) regression analysis. Covariates included mechanism of injury, severity of injury, age, and health insurance. Results Neighborhood characteristics loaded onto 4 constructs: neighborhood disconnectedness; concentrated disadvantage; crime, violence, and vacancy; and race/ethnicity. Higher PTSD symptom severity was reported by 36.8% and associated with neighborhood crime, violence, and vacancy, and higher depressive symptom severity was reported by 30.4% and associated with neighborhood disconnectedness. Both PTSD and depressive symptoms were associated with intentional mechanisms of injury, such as gunshot wounds, stabbing, and assault; and with having Medicaid or no insurance. Higher severity of injury was associated with depressive symptoms. Conclusions Findings suggest that neighborhood characteristics such as neighborhood disconnectedness and crime, violence, and vacancy have measurable associations with psychological symptoms after injury. The evidence supports the need for interventions to improve post-injury mental health by modifying the urban environment.

Purpose The burden of injuries is disproportionately concentrated among Black men in the United States. Previous studies suggest that the mental health effects of trauma may vary by the intentionality of the injury (intentional vs. unintentional), yet little is known about this experience among Black men. We explored the emotional responses to traumatic injuries in the context of injury intentionality among Black men in an urban area. Methods We conducted semi-structured, qualitative interviews with 74 Black men who were traumatically injured. The interviews took place three months after discharge from the hospital and they were audiotaped, transcribed, and de-identified. We used systematic thematic analysis to identify themes about post-trauma emotional responses to intentional and unintentional injuries. Results The narratives of intentionally injured men revealed persistent exposure to neighborhood violence and their distrust of others including the people they knew and to whom they felt close. Survivors of unintentional injuries did not express a similar distrust of others. Our findings suggest that survivors of intentional injuries experience loss of social support following their injuries. Conclusions Emotional responses can differ by intentionality of traumatic injury among urban Black men. Intentional injuries may be a marker for chronic exposure to violence and limited social support for recovery. Additional resources should be targeted to survivors of intentional injury who return to disadvantaged communities after medical treatment to decrease risk of re-traumatization and adverse emotional responses.

Over 70,000 nonfatal firearm injuries occur in the US annually, frequently leaving victims injured with retained bullets. The long-term psychological risks associated with retained bullets remains unstudied. By serving as a constant reminder of injury, we hypothesized that the presence of retained bullets after firearm injury is associated with increased PTSD and depression symptom severity.We conducted a prospective cohort study (2013-2015) of Black male survivors of firearm injury at an urban Level I trauma center. Interviews, questionnaires and validated survey tools for PTSD (PCL-5) and depression (QIDS-SROf 139 participants, 101(73%) had retained bullets. The cohort was young (mean age 26 years), educated (82% high school or greater) yet unemployed (53%) and with multiple injuries (median [IQR] no. of GSWs 2 [1-3]). There was no difference in age, education, employment status, number of gunshot wounds, operative procedures, pain, hospital or ICU LOS between groups (p0.05). Patients with retained bullets less often rated their health as "very good" or "excellent" (10% vs 29%, p=0.046). Of those working prior to injury (n=47), 61% with retained bullets had not returned to work compared to 33% without retained bullets (p=0.027). No difference in PCL-5 scores [30.9 (SD 18.9) vs 27.9 (SD 18.6), p=0.470] was observed, but patients with retained bullets had greater mean QIDS-SRRetained bullets are associated with adverse psychological consequences after firearm injury. To improve recovery and to aid in clinical management decisions, clinicians should consider both the psychological and physical effects of retained bullets in survivors of firearm injury.

Objectives To review the public health approach to preventing and treating firearm violence. Data sources Peer-reviewed, published scholarship and federal data systems. Study selection English-language, indexed research articles on the epidemiology, risk, prevention, and consequences of firearm violence. Data extraction This narrative review includes findings related to the epidemiology and impact of firearm violence, focusing on short- and long-term outcomes. Evidence supporting interventions at the individual, agent, and environmental level to reduce firearm-related harm was examined. Data synthesis Firearm violence is a major public health challenge in the Unites States. The consequences of firearm violence reach beyond the nearly 40,000 firearm-related deaths and 90,000 firearm-related injuries each year. Firearm violence, including self-harm, assault, and unintentional injury, affects the health of individuals, families, communities, and health systems. Data sources remain inadequate, however, to fully capture these impacts. Treating firearm violence as a disease and taking a public health approach to prevention and treatment is key to reducing the harms of firearm violence. Using a public health framework not only recognizes the physical and mental consequences of firearm violence but also focuses our attention on underlying causes and on innovative, multi-level interventions to reduce the harms of firearm violence. Conclusions The public health approach positions clinicians to change the conversation from political diatribe of pro-gun and anti-gun to systematically reducing injury and death. To achieve comparable success, we must design, test, and implement effective interventions at the environmental, policy, technological, and individual levels to prevent firearm violence. We must collect robust data on firearm violence and its consequences. And we must reckon with the conditions of inequality and disadvantage that feed violence through all means.

Background Chronic diseases, such as opioid use disorder (OUD) require a multifaceted scientific approach to address their evolving complexity. The Council for the Advancement of Nursing Science's (Council) four nursing science priority areas (precision health; global health, determinants of health, and big data/data analytics) were established to provide a framework to address current complex health problems. Purpose To examine OUD research through the nursing science priority areas and evaluate the appropriateness of the priority areas as a framework for research on complex health conditions. Method OUD was used as an exemplar to explore the relevance of the nursing science priorities for future research. Findings Research in the four priority areas is advancing knowledge in OUD identification, prevention, and treatment. Intersection of OUD research population focus and methodological approach was identified among the priority areas. Discussion The Council priorities provide a relevant framework for nurse scientists to address complex health problems like OUD.

Background Traumatic injuries are a health event that can begin a trajectory towards chronic health and social challenges. Mobile technology-based prevention and treatment interventions have been used to monitor and transform outcomes across a myriad of health conditions, but their potential in long-term injury recovery is unexplored. The goal of this pilot study was to assess the acceptability and feasibility of mobile health monitoring for long-term outcomes in a population of trauma patients with known barriers to health and social care after injury. Methods We re-recruited 25 individuals, 12-36 months after acute hospitalization, from a recently concluded study of psychological outcomes in seriously injured Black men in Philadelphia, Pennsylvania. This mixed- methods pilot study was conducted in three phases: (I) qualitative interviews and development of a pilot monitoring platform; (II) a 3-month feasibility trial of mobile monitoring of patient-reported outcomes and biometric data using a wrist-worn commercial fitness monitor (n=18); (III) post-implementation qualitative interviews. Results Analysis of data from pre-implementation interviews indicated that the majority of participants used smartphones as a primary means of communicating with their social network and to access the internet. The 90-day pilot trial of mobile monitoring indicated participants' preference text-delivered communication and survey elicitation. Response rates for 12 automated surveys ranged from 84-92%. Twenty-four hours a day adherence to optional biometric monitoring was generally lower than 50% but ranged widely indicating both very low adherence and very high adherence. Four of 25 participants, 2 who had opted for Fitbit monitoring, were lost to follow-up at the end of the 90-day pilot trial. In post-implementation assessments, participants endorsed the acceptability of mobile monitoring highlighting the benefit of its convenience and flexibility over in-person outcome monitoring. Participants also perceived its potential benefit in long-term engagement with health and social services to assist with the challenges they faced when attempting to achieve physical, psychological, social, and financial recovery after hospitalization. These findings were reinforced through qualitative interviews which highlighted, in addition to acceptability, the perceived value of self-monitoring through the use of wearable devices to track health data like physical activity and sleep. Conclusions This study indicates the feasibility and acceptability of mobile health monitoring used to examine long-term injury sequalae. Future research may leverage this novel strategy, refining its application to address current limitations in the reliability and accuracy of commercially available wearable technology, relative costs and benefits of different mobile data collection strategies, integration within current clinical paradigms and generalizability across injured populations and socio-ecological environments.

IMPORTANCE: Physical injury is associated with postinjury mental health problems, which typically increase disability, cost, recidivism, and self-medication for symptoms. OBJECTIVE: To determine risk and protective factors across the life span that contribute to depression and posttraumatic stress symptom severity at 3 months after hospital discharge. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used a 3-month postdischarge follow-up of patients who had been treated at an urban, level 1 trauma center in the Northeastern United States. Men with injuries who were hospitalized, self-identified as black, were 18 years or older, and resided in the Philadelphia, Pennsylvania, region were eligible and consecutively enrolled. Those who were experiencing a cognitive dysfunction or psychotic disorder, hospitalized because of attempted suicide, or receiving current treatment for depression or posttraumatic stress disorder (PTSD) were excluded. Data were collected from January 2013 to October 2017. Data analysis took place from January 2018 to August 2018. EXPOSURES: A serious injury requiring hospitalization; adverse childhood experiences, childhood neighborhood disadvantage, and preinjury physical and mental health; and emotional resources, injury intent, and acute stress responses. MAIN OUTCOMES AND MEASURES: Depression and PTSD symptom severity were assessed with the Quick Inventory of Depressive Symptoms–Self-report and the PTSD Check List–5. The a priori hypothesis was that risk and protective factors are associated with depression and PTSD symptom severity. The analytic approach was structural equation modeling. RESULTS: A total of 623 black men were enrolled. Of these, 502 participants (80.6%) were retained at 3-month follow-up. Their mean (SD) age was 35.6 (14.9) years; 346 (55.5%) had experienced intentional injuries, and the median (range) Injury Severity Score was 9 (1-45). Of the 500 participants with complete primary outcome data, 225 (45.0%) met the cut point criteria for mental health diagnoses at 3 months. For both mental health outcomes, the models fit the data well (depression: root mean square error of approximation [RMSEA], 0.044; comparative fit index [CFI], 0.93; PTSD: RMSEA = 0.045; CFI = 0.93), and all hypothesized paths were significant and in the hypothesized direction. Outcomes were associated with poor preinjury health (standardized weights: depression, 0.28; P

Many Black men suffer symptoms of traumatic stress in the aftermath of traumatic injury, and they also often carry social concerns, including experiences of discrimination and stigma, and a lack of financial resources. The objective of the present study was to understand how traumatic symptoms and social factors combine in complex ways toward the outcome of psychological help-seeking. We analyzed qualitative and quantitative data from 32 injured Black men admitted to a Level 1 trauma center. Qualitative interviews explored their attitudes toward seeking professional psychological help. We analyzed quantitative data, collected using validated instruments, on posttraumatic stress and depression symptoms, financial worry, and discrimination/stigma. Fuzzy set qualitative comparative analysis (fsQCA) was conducted by calibrating each condition to fuzzy set membership scores based on our knowledge of the causal conditions and the cases. We then constructed truth tables for QCA analysis using fsQCA software. Three causal pathways for psychological help-seeking were identified: Two pathways showed that severe trauma symptoms in the absence of financial worry were sufficient for seeking help, whereas the third showed that financial worry and discrimination in the absence of trauma symptoms were sufficient for help-seeking. We identified two causal pathways for negated help-seeking, in which low posttraumatic symptom severity and low levels of discrimination or financial worry were sufficient for not seeking psychological help. The QCA analysis revealed multiple pathways for psychological help-seeking among Black men who suffer trauma. These findings highlight the need for further research to understand complex pathways toward psychological help-seeking in this population.

Importance Cancer clinical trials (CCTs) provide patients an opportunity to receive experimental drugs, tests, and/or procedures that can lead to remission. For some, a CCT may seem like their only option. Little is known about experiences of patient-participants who withdraw or are withdrawn from CCTs. Objective To examine patient-participants' experiences during withdrawal from CCTs. Design, setting, and participants This qualitative, descriptive study used a semistructured interview designed specifically for it, with open-ended and probing questions. The study took place at a National Cancer Institute-designated comprehensive cancer center affiliated with the University of Pennsylvania. The need for a sample of 20 interviewees was determined by code and meaning saturation (ie, no new themes revealed and identified themes fully elaborated). Interviews were transcribed verbatim and analyzed with a qualitative software program. Data coded with the software were refined into categories reflecting broad themes. A criterion-based sampling approach was used to select a subset of adult patients with cancer who were former CCT participants and who agreed on exit from those CCTs to a later interview about withdrawal experiences. They were contacted one by one by telephone from September 2015 through June 2019 until 20 agreed. Data analysis was completed in October 2020. Main outcomes and measures Themes characterizing patient-participants' perceptions of their withdrawal experiences. Results Respondents' mean (SD) age was 64.42 (8.49) years; 12 (63.2%) were men. Most respondents were White (18 respondents [94.7%]) and college educated (11 respondents [55.0%]). Cancer stage data were available for 17 participants, 11 of whom (64.7%) had stage IV cancer at CCT enrollment. Thirteen respondents reported withdrawal as a result of disease progression, and 5 withdrew because of adverse effects. Other reasons for withdrawal included acute illness and participant uncertainty about the reason. Analysis of interview data yielded 5 themes: posttrial prognostic awareness, goals of care discussions, emotional coping, burden of adverse effects, and professional trust and support. Subthemes included regrets or hindsight, urgency to start next treatment, and weighing benefits and burdens of treatment. Limited discussions about patient-participants' immediate posttrial care needs left many feeling that there was no clear path forward. Conclusions and relevance Patient-participants transitioning from a CCT described feeling intense symptoms and emotions and awareness that their life span was short and options seemed to be limited. Communication that includes attention to posttrial needs is needed throughout the CCT to help patient-participants navigate posttrial steps. Research should focus on components of responsible and ethical CCT transitions, including types and timing of discussions and who should begin these discussions with patient-participants and their families.

In rapidly developing economies, like urban India, where road traffic injury rates are among the world’s highest, the corporate workplace offers a non-traditional venue for road safety interventions. In partnership with a major multinational corporation with a large Indian workforce, this study aimed to elicit local employee perspectives on road safety to inform a global corporate health platform. The safety attitudes and behaviors of 75 employees were collected through self-report survey and focus groups in the multinational corporation offices in Bangalore and Pune. Analysis of these data uncovered incongruity between employee knowledge of safety strategies and their enacted safety behaviors and identified local preference for interventions and policy-level actions. The methods modeled by this study offer a straightforward approach for eliciting employee perspective for local road safety interventions that fit within a global strategy to improve employee health. Study findings suggest that multinational corporations can employ a range of strategies to improve the road traffic safety of their employees in settings like urban India including: implementing corporate traffic safety policy, making local infrastructure changes to improve road and traffic conditions, advocating for road safety with government partners and providing employees with education and access to safety equipment and safe transportation options.

The mental health consequences of injuries can interfere with recovery to pre-injury levels of function and long term wellbeing.The purpose of this study was to explore the relationship between psychological symptoms after minor injury and long-term functional recovery and disability.This exploratory study uses secondary data derived from a longitudinal cohort study of psychological outcomes after minor injury.Participants were recruited from the Emergency Department of an urban hospital in the United States.A cohort of 275 patients was randomly selected from 1100 consecutive emergency department admissions for minor injury. Potential participants were identified as having sustained minor injury by the combination of three standard criteria including: presentation to the emergency department for medical care within 24h of a physical injury, evidence of anatomical injury defined as minor by an injury severity score between 2 and 8 and normal physiology as defined by a triage-Revised Trauma Score of 12. Patients with central nervous system injuries, injury requiring medical care in the past 2 years and/or resulting from domestic violence, and those diagnosed with major depression or psychotic disorders were excluded.Psychological symptom severity was assessed within 2 weeks of injury, and outcome measures for functional limitations and disability were collected at 3, 6 and 12 months. A quasi-least squares approach was used to examine the relationship between psychological symptom scores at intake and work performance and requirement for bed rest in the year after injury.Adjusting for demographic and injury covariates, depression symptoms at the time of injury predicted (p≤0.05) both poorer work performance and increased number of days in bed due to health in the year after injury. Anxiety symptoms predicted (p≤0.05) bed days at 3, 6, and 12 months and work performance at 3 months.Depression and anxiety soon after minor injury may help predict important markers of long-term recovery. With further research, simple assessment tools for psychological symptoms may be useful to screen for patients who are at higher risk for poor long-term recoveries and who may benefit from targeted interventions.

AIMS: This study estimated, with high spatial and temporal specificity, individuals' risk of being assaulted relative to their momentary proximity to alcohol outlets during daily activities. DESIGN: Case-control study. SETTING: Philadelphia, Pennsylvania, USA. PARTICIPANTS: Cases were 194 non-gun assault victims and 135 gun assault victims aged between 10 and 24 years. Age-matched controls (n = 274) were selected using random-digit dialing. MEASUREMENTS: Participants described minute-by-minute movements (i.e. activity paths) over the course of the day of the assault (cases) or a recent randomly selected day within three days of interview (controls). The dependent measure was being an assault case compared with a non-assault control. The main independent measures were participants' momentary proximity to alcohol outlets. The units of analysis were 10-minute segments. FINDINGS: Proximity to bars and restaurants was associated with decreased odds of non-gun assault before 1 pm (e.g. 7 am to 9:59 pm: OR = 0.78; 95% CI: 0.64, 0.94; p = 0.008), and increased odds after 7 pm (e.g. 1 am to 3:59 am: OR = 1.96; 95% CI: 1.24, 3.09; p = 0.004). Proximity to beer stores was associated with increased odds before 1 pm (e.g. 7 am to 9:59 am: OR = 2.34; 95% CI: 1.58, 3.46; p = CONCLUSIONS: Individuals in areas with greater densities of bars and restaurants and beer stores appear to be increased risk for non-gun assault at times when these outlets are likely to be most heavily patronized.This article is protected by copyright. All rights reserved. Language: en

Purpose To investigate the impact on health related quality of life (HRQL) during the first year after minor extremity injury and to determine whether there is a difference in recovery patterns and return to work between upper extremity injuries (UEI) and lower extremity injuries (LEI). Method A total of 181 adults’ age 18 years or older randomly selected from patients admitted to an emergency department with minor injuries were studied. HRQL was measured using the Functional Status Questionnaire (FSQ) at 1–2 weeks, 3, 6, and 12-months post-injury. Pre-injury FSQ scores were measured retrospectively at admission. A quasi-least square (QLS) model was constructed to examine differences of FSQ scores at each measuring point for UEI and LEI. Results Fractures of the knee/lower leg (25%) were the most frequently injured body area. Slips or falls (57%) and traffic-related events (22%) were the most common injury causes. The mean ISS was 4.2 (SD 0.86). Both groups had significant declines in the FSQ scores physical and social functioning at 1–2 weeks after injury. Patients with UEI made larger improvements in the first 3 months post-injury versus patients with LEI whose improvements extended over the first 6 months. None of the groups reached the pre-injury FSQ scores during the first post-injury year except in the subscale work performance where UEI exceeded the pre-injury scores. At 12 months post-injury, significant lower FSQ scores remained in the LEI group compared to the UEI group in intermediate activities of daily living (p = 0.036, d 0.4) and work performance (p = 0.004, d 0.7). The return to work at 3 months and 12 months were 76% and 88% for UEI and 58% and 77% for LEI. No significant differences were found between groups in the FSQ scale mental health and social interaction. Conclusions LEI had the highest impact on HRQL and return to work during the first year which exceeded the consequences of UEI. These findings contribute to the information about the consequences of injury in order to give sufficient prognostic information to patients and different stakeholders. Future investigations should aim to investigate specific minor extremity injuries and identify factors that facilitate recovery and return to work.

To explore the factors that influence provider pain treatment decision-making and the receipt of pain management by injured Black patients in the United States.We completed a systematic mixed studies review using a results-based convergent synthesis design.PubMed, SCOPUS and CINAHL were searched for articles published between 2007-2017 using the search terms 'African American', 'Black American', 'race', 'pain treatment', 'pain management' and 'analgesia'. Twenty studies were included in this review.A search of databases and hand-searching identified peer-reviewed published papers. The Mixed Method Appraisal Tool was used to appraise the studies.The results indicate that healthcare provider characteristics, racial myths about pain sensitization and assumed criminality all impact provider treatment decision-making and the receipt of pain treatment by injured Black patients.This review addresses racial disparities in pain management by focusing on the factors that impact the receipt of pain treatment by injured Black patients. The findings will have an impact on providers who prescribe pain treatment and on the patients they treat. These findings suggest that assumed criminality of certain patients can negatively impact care, which is a type of bias not frequently explored or discussed in health disparities research. This review will help inform further research in healthcare disparities and prompt providers to examine their assumptions about the patients for whom they care.These results provide important areas for further study, including how assumed criminality of certain patients can have a negative impact on care.目的: 在于探讨影响医疗保健提供者疼痛治疗决策和美国黑人受伤患者接受疼痛管理的因素。 设计: 我们通过使用基于结果的汇聚式合成设计完成了系统性混合研究综述。 资料来源: 通过搜索‘非裔美国人’、‘美国黑人’、‘种族’、‘ 疼痛治疗’、‘疼痛管理’和‘镇痛’之类的术语,在PubMed、SCOPUS 和CINAHL 搜索了在2007-2017年间发表的相关文章。这篇综述纳入了20项研究。 综述方法: 对数据库进行了搜索,并手工搜索了经同行评审的出版论文。采用了混合方法评价工具(Mixed Method Appraisal Tool,MMAT)对各项研究进行评价。 结果: 研究结果表明,医疗服务提供者的特征、关于痛觉敏化的种族神话和假定犯罪行为都会影响到医疗服务提供者的治疗决策和黑人受伤患者接受疼痛治疗的情况。 影响: 这篇综述通过关注影响黑人受伤患者接受疼痛治疗的因素来处理疼痛管理中的种族差异。这些调查结果既对开疼痛治疗处方的医疗服务提供者有影响,也对他们救治的患者有影响。这些调查结果表明,某些患者存在犯罪行为这一假定会对护理产生负面影响,这是一种在健康差异研究中不常探索或讨论的偏见。这一综述将有助于进一步研究医疗保健方面的差异,并促使医疗服务提供者审视他们对所护理患者的假定。 结论: 这些结果为今后研究提供了重要领域,包括某些患者存在犯罪行为这一假定是如何对护理产生负面影响的。.

Purpose This purpose of this article is to frame firearm violence as a health and public health problem, to illustrate the magnitude of the problem, to examine factors that increase the risk to be injured by a firearm, or conversely, that confer protection, and to identify relevant priority areas for nursing science. Organizing construct Firearm violence results in physical and psychological injuries and is a global health priority. Firearm violence is categorized as intentional (interpersonal and self-inflicted) and unintentional (interpersonal and self-inflicted) and accounts for an estimated 196,000 to 220,000 nonconflict deaths annually. Methods We reviewed the theoretical and scientific literature to analyze the magnitude and geographic distribution of firearm violence, the factors associated with firearm injury, the consequences of firearm violence, and areas where nursing science can make an impact on prevention, outcomes, and recovery. Findings Firearm violence is a significant public health problem that affects the health of individuals, families, and communities. The burdens and contributors to firearm violence vary worldwide, making it important to understand the local context of this global phenomenon. Relevant areas of inquiry span primary prevention focusing on individual and environmental risk factors; and focus on managing the physical and psychological consequences postinjury; and mitigating long-term consequences of firearm violence. Conclusions Reducing the global burden of firearm violence and improving the health and safety of individuals, families, and communities provide compelling reasons to integrate this area into nursing science. Clinical relevance The goals of nursing are to keep people healthy and safe and to help return those injured to their optimal levels of health and well-being. Understanding the factors that come together to injure people with a firearm in various physical, social, economic, and cultural environments positions nurses to both extend the dialogue beyond pro-gun versus anti-gun and to design and carry out rigorous studies to reduce firearm violence.

Strengths-based strategies to reduce youth violence in low-resource urban communities are urgently needed. Supportive adolescent-adult relationships may confer protection, but studies have been limited by self-reported composite outcomes. We conducted a population-based case-control study among 10- to 24-year-old males in low-resource neighborhoods to examine associations between supportive adult connection and severe assault injury. Cases were victims of gunshot assault injury (n = 143) and non-gun assault injury (n = 206) from two level I trauma centers. Age- and race-matched controls (n = 283) were recruited using random digit dial from the same catchment. Adolescent-adult connections were defined by: (1) brief survey questions and (2) detailed family genograms. Analysis used conditional logistic regression. There were no significant associations between positive adult connection, as defined by brief survey questions, and either gunshot or non-gun assault injury among adolescents with high prior violence involvement (GSW OR = 2.46, 95% CI 0.81–7.49; non-gun OR = 1.59, 95% CI 0.54–4.67) or low prior violence involvement (GSW OR = 0.92, 95% CI 0.34–2.44; non-gun OR = 1.96, 95% CI 0.73–5.28). In contrast, among adolescents with high levels of prior violence involvement, reporting at least one supportive adult family member in the family genogram was associated with higher odds of gunshot assault injury (OR = 4.01, 95% CI 1.36–11.80) and non-gun assault injury (OR = 4.22, 95% CI 1.48–12.04). We were thus unable to demonstrate that positive adult connections protected adolescent males from severe assault injury in this highly under-resourced environment. However, at the time of injury, assault-injured adolescents, particularly those with high prior violence involvement, reported high levels of family support. The post-injury period may provide opportunities to intervene to enhance and leverage family connections to explore how to better safeguard adolescents. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11524-018-0260-8) contains supplementary material, which is available to authorized users.