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BackgroundIn 2022, a nationally representative longitudinal survey in the USA found concerningly high prevalences of support for and personal willingness to engage in political violence, but those prevalences decreased in 2023. This study examines changes in those prevalences from 2023 to 2024, an election year in the USA.MethodsParticipants were members of Ipsos KnowledgePanel. Wave 3 of the survey was conducted May 23-June 14, 2024; invitations to participate were sent to all respondents to prior waves who remained in KnowledgePanel. Outcome measures concern justification for the use of violence to advance any of 17 specified political objectives, personal willingness to engage in political violence at 4 levels of severity and against 9 target populations, and expectation of firearm use in political violence. Outcomes are expressed as weighted proportions. Year-to-year change is based on the means of aggregated individual change scores, which have a potential range from 0 (no change) to ± 2.ResultsThe 2024 completion rates were 88.4% (8896 respondents/10,064 invitees) overall, 91.6% (8185 respondents/8932 invitees) for invitees in 2024 who had responded in 2023, and 62.8% (711 respondents/1132 invitees) for invitees in 2024 who had responded in 2022 but not in 2023. After weighting, 50.9% (95% confidence interval (CI) 49.5%, 52.3%) were female; weighted mean (SD) age was 48.5 (24.9) years. From 2023 to 2024, the prevalence of the view that violence was usually or always justified to advance at least 1 political objective did not change (2024: 26.2%, 95% CI 25.0%, 27.5%; 2023: 25.3%, 95% CI 24.1%, 26.5%). There were no changes from 2023 to 2024 in willingness to damage property, threaten a person, injure a person, or kill a person in an act of political violence, and no changes in expectations of firearm use in situations where respondents considered political violence justifiable. Changes on other measures were infrequent (17 of 58 comparisons in the main analysis) and small where they occurred (with 2 exceptions, change

BACKGROUND: Surveys have found concerningly high levels of agreement that the United States will experience civil war soon. This study assesses variation in expectation of and perceived need for civil war with respondent sociopolitical characteristics, beliefs, firearm ownership, and willingness to engage in political violence. METHODS: Findings are from Wave 2 of a nationally representative annual longitudinal survey of members of the Ipsos KnowledgePanel, conducted May 18-June 8, 2023. All respondents to 2022s Wave 1 who remained in KnowledgePanel were invited to participate. Outcomes are expressed as weighted proportions and adjusted prevalence differences, with p-values adjusted for the false discovery rate and reported as q-values. RESULTS: The completion rate was 84.2%; there were 9385 respondents. After weighting, half the sample was female (50.7%, 95% CI 49.4%, 52.1%); the weighted mean (± standard deviation) age was 48.5 (25.9) years. Approximately 1 respondent in 20 (5.7%, 95% CI 5.1%, 6.4%) agreed strongly or very strongly that in the next few years, there will be civil war in the United States. About 1 in 25 (3.8%, 95% CI 3.2%, 4.4%), and nearly 40% (38.4%, 95% CI 32.3%, 44.5%) of those who strongly or very strongly agreed that civil war was coming, also agreed strongly or very strongly that the United States needs a civil war to set things right. Expectation of and perceived need for civil war were higher among subsets of respondents who in Wave 1 were more willing than others to commit political violence, including MAGA Republicans, persons in strong agreement with racist beliefs or statements of the potential need for violence to effect social change, persons who strongly approved of specified extreme right-wing political organizations and movements, firearm owners who purchased firearms in 2020 or later, and firearm owners who carried firearms in public all or nearly all the time. CONCLUSIONS: In 2023, the expectation that civil war was likely and the belief that it was needed were uncommon but were higher among subsets of the population that had previously been associated with greater willingness to commit political violence. These findings can help guide prevention efforts.

BACKGROUND: A 2022 survey in the USA found concerningly high prevalences of support for and personal willingness to engage in political violence, of beliefs associated with such violence, and of belief that civil war was likely in the near future. It is important to determine the durability of those findings. METHODS: Wave 2 of a nationally representative cohort survey was conducted May 18-June 8, 2023; the sample comprised all respondents to 2022s Wave 1. Outcomes are expressed as weighted proportions; changes from 2022 to 2023 are for respondents who participated in both surveys, based on aggregated individual change scores. RESULTS: The completion rate was 84.2%; there were 9385 respondents. After weighting, 50.7% (95% confidence interval (CI) 49.4%, 52.1%) were female; weighted mean (SD) age was 48.5 (25.9) years. About 1 in 20 respondents (5.7%, 95% CI 5.1%, 6.4%) agreed strongly/very strongly that in the next few years, there will be civil war in the United States, a 7.7% decrease. In 2023, fewer respondents considered violence to be usually/always justified to advance at least 1 of 17 specific political objectives [25.3% (95% CI 24.7%, 26.5%), a 6.8% decrease]. However, more respondents thought it very/extremely likely that within the next few years, in a situation where they consider political violence justified, I will be armed with a gun [9.0% (95% CI 8.3%, 9.8%), a 2.2% increase] and I will shoot someone with a gun [1.8% (95% CI 1.4%, 2.2%), a 0.6% increase]. Among respondents who considered violence usually/always justified to advance at least 1 political objective, about 1 in 20 also thought it very/extremely likely that they would threaten someone with a gun (5.4%, 95% CI 4.0%, 7.0%) or shoot someone (5.7%, 95% CI 4.3%, 7.1%) to advance such an objective. CONCLUSIONS: In this cohort, support for political violence declined from 2022 to 2023, but predictions of firearm use in political violence increased. These findings can help guide prevention efforts, which are urgently needed.

In 2020, firearm injuries became the leading cause of death in children and adolescents and have continued to increase despite injury prevention strategies. The information obtained about these injuries is often limited to the demographic and clinical data required for trauma registries, which often lack granularity regarding the circumstances leading to the use of a firearm. The purpose of this study is to analyze admissions for firearm injuries according to intention and social vulnerability to enable the creation of targeted prevention strategies. This is a retrospective cohort study using trauma registry data from a single institution from 2012 to 2022. Patients were stratified by a mechanism into unintentional, intentional, and self-inflicted firearm injuries based on chart review. Demographics were compared between groups and the overall trauma population. Social Vulnerability Index data were obtained from the Centers for Disease Control and Prevention registry. Of the 13,197 trauma patients admitted from January 2012 to December 2022, 153 were related to firearm injuries (1.2%). Relative to the overall trauma population, patients with firearm injuries were predominantly older (9.7 versus 7.4 y, P < 0.001), male (74% versus 61%, P < 0.001), Black (43% versus 17%, P < 0.001), and insured via Medicaid or another government subsidized program (62% versus 48%, P < 0.001). Injuries were classified as intentional (53%), unintentional (44%), and self-harm (1%). Unintentional injuries more frequently resulted in death (17.6% versus 8.6%), although this difference was not enough to reach the statistical significance. The proportion of intentional injuries increased significantly in the 2020-2022 period relative to previous years (P = 0.032). Vulnerable populations have experienced a disproportionate increase in firearm violence starting in 2020. Unintentional injuries are a significant source of mortality in the pediatric population and represent a vital target for future injury prevention strategies. [ABSTRACT FROM AUTHOR]

Abstract Background In 2022, a nationally representative longitudinal survey in the USA found concerningly high prevalences of support for and personal willingness to engage in political violence, but those prevalences decreased in 2023. This study examines changes in those prevalences from 2023 to 2024, an election year in the USA. Methods Participants were members of Ipsos KnowledgePanel. Wave 3 of the survey was conducted May 23-June 14, 2024; invitations to participate were sent to all respondents to prior waves who remained in KnowledgePanel. Outcome measures concern justification for the use of violence to advance any of 17 specified political objectives, personal willingness to engage in political violence at 4 levels of severity and against 9 target populations, and expectation of firearm use in political violence. Outcomes are expressed as weighted proportions. Year-to-year change is based on the means of aggregated individual change scores, which have a potential range from 0 (no change) to ± 2. Results The 2024 completion rates were 88.4% (8896 respondents/10,064 invitees) overall, 91.6% (8185 respondents/8932 invitees) for invitees in 2024 who had responded in 2023, and 62.8% (711 respondents/1132 invitees) for invitees in 2024 who had responded in 2022 but not in 2023. After weighting, 50.9% (95% confidence interval (CI) 49.5%, 52.3%) were female; weighted mean (SD) age was 48.5 (24.9) years. From 2023 to 2024, the prevalence of the view that violence was usually or always justified to advance at least 1 political objective did not change (2024: 26.2%, 95% CI 25.0%, 27.5%; 2023: 25.3%, 95% CI 24.1%, 26.5%). There were no changes from 2023 to 2024 in willingness to damage property, threaten a person, injure a person, or kill a person in an act of political violence, and no changes in expectations of firearm use in situations where respondents considered political violence justifiable. Changes on other measures were infrequent (17 of 58 comparisons in the main analysis) and small where they occurred (with 2 exceptions, change

Abstract Background Firearm injuries are the leading cause of death for U.S. adolescents. Given the prevalence of firearm ownership in the U.S., particularly among parental figures in homes with children and teens, and the relationship between firearm access and injury outcomes, it is vital to shed light on potential parental motivations for keeping firearms in their homes. The purpose of this analysis was to examine whether exposure to community violence is associated with parental firearm ownership. Methods Data from the Firearm Safety Among Children and Teens Consortium’s National Survey (6/24/2020-7/24/2020) was examined. The survey sample comprised parents/caregivers of high-school-age teens (age 14–18). The survey examined various measures, including firearm ownership, storage, community violence exposure, and sociodemographic characteristics. Stepwise logistic regression was used to examine the association between community violence exposure and parental firearm ownership. Results The study included 2,924 participants, with 45.1% identifying as male, 12.9% identifying as Hispanic, and 25.3% identifying as non-White. Among these participants, 43.1% reported firearm ownership, and 49.9% reported exposure to community violence. Regression models demonstrate that community violence exposure is associated with an increased likelihood of firearm ownership among parents/caregivers of high-school age teens (OR = 1.08, p

In 2013, two well-known place-based gun violence reduction strategies were implemented in different neighborhoods in Philadelphia, Pennsylvania. Separate evaluations showed each strategy was associated with significant reductions in fatal and nonfatal shootings compared to statistically-matched areas. The current study assessed whether the interventions had spillover benefits for shooting investigations. We hypothesized that the intervention-driven reductions in fatal and non-fatal shooting caseloads and new dedicated investigatory resources would result in increased clearances for shootings committed in the target areas. Contrary to hypothesized benefits, the results of regression models showed that there were no significant increases in clearance rates compared to matched areas or the city. In the spite of the null findings, given extensive studies showing that lower caseloads and focused investigative resources could improve clearances, we recommend future evaluation research on place-based gun violence reduction strategies that include components to assess potential intervention benefits beyond crime reduction alone. [ABSTRACT FROM AUTHOR]

Background: Firearm injuries are the leading cause of death for U.S. adolescents. Given the prevalence of firearm ownership in the U.S., particularly among parental figures in homes with children and teens, and the relationship between firearm access and injury outcomes, it is vital to shed light on potential parental motivations for keeping firearms in their homes. The purpose of this analysis was to examine whether exposure to community violence is associated with parental firearm ownership. Methods: Data from the Firearm Safety Among Children and Teens Consortium's National Survey (6/24/2020-7/24/2020) was examined. The survey sample comprised parents/caregivers of high-school-age teens (age 14–18). The survey examined various measures, including firearm ownership, storage, community violence exposure, and sociodemographic characteristics. Stepwise logistic regression was used to examine the association between community violence exposure and parental firearm ownership. Results: The study included 2,924 participants, with 45.1% identifying as male, 12.9% identifying as Hispanic, and 25.3% identifying as non-White. Among these participants, 43.1% reported firearm ownership, and 49.9% reported exposure to community violence. Regression models demonstrate that community violence exposure is associated with an increased likelihood of firearm ownership among parents/caregivers of high-school age teens (OR = 1.08, p < 0.05). Other significant predictors of firearm ownership among parents/caregivers included parent/caregiver age (OR = 0.99, p < 0.01), marital status (OR = 1.29, p < 0.05), and educational attainment (OR = 0.60, p < 0.001). Conclusions: The findings supported the hypothesis that community violence exposure was associated with an increased likelihood of parental firearm ownership, even after adjusting for potential confounders. These findings contribute to the existing literature by shedding light on the possible contributing factors for firearm ownership among parents/caregivers of teens. Public health interventions focused on raising awareness about the risks of firearm access in households with youths, providing counseling on locked storage practices, and offering resources for accessing secure firearm storage options, such as rapid access storage, may contribute to reducing firearm access among youth. Additionally, community-based initiatives focused on violence prevention and addressing the root causes of community violence can help create safer environments, thereby reducing the perceived need for accessible firearms in the home by parents and caregivers. [ABSTRACT FROM AUTHOR]

Gun violence against children in the United States (U.S.) is a public health crisis which violates the human rights of its victims, resulting in lasting morbidity and death. Firearm-related injury is the leading cause of death for children under eighteen years old in the U.S. We use the United [End Page 712] Nations (UN) Universal Declaration of Human Rights, UN Convention on the Rights of the Child, and UN Sustainable Development Goals to analyze gun violence against children in the U.S. from a human rights perspective. We recommend to 1) ratify the UN Convention on the Rights of the Child, establishing a framework for comprehensive gun law reform, 2) partner with the UN Special Representative for the Secretary-General on Violence Against Children to draft policy, 3) increase gun violence research funding, and 4) implement evidence-based community violence prevention programs. [ABSTRACT FROM AUTHOR]

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

Firearm violence is a persistent public health crisis in the United States, with over 100,000 individuals being shot every year. This violence not only affects those directly injured but also thousands of youth who are exposed to indirect forms of firearm violence, such as witnessing gunfire or losing a family member to gun violence. Firearms are the leading cause of death among children and teens in the U.S., with youth of color disproportionately affected. Additionally, there has been an increase in adverse childhood experiences (ACEs) in the U.S., which further exacerbates the negative outcomes for children. This special issue of Youth & Society presents new research on the impacts of firearm violence on youth, including disparities, prevention efforts, and interventions. The findings highlight the need for preventive efforts that account for racial and ethnic groups, screening for suicide risk among younger adolescents, and addressing systemic factors that drive firearm violence outcomes. The research also explores the associations between firearm-related beliefs and perceived ease of firearm access with firearm exposure and police violence exposure. The studies provide insights into specific interventions and challenge presumptions about youth and their perceptions of safety. The research also identifies protective factors and pathways for mental health support and interventions for adolescents exposed to firearm violence. The implementation of firearm purchaser licensing laws has been found to be associated with lower rates of violence. Overall, this body of research contributes to the growing field of firearm violence prevention and offers opportunities for effective solutions to address this public health crisis. The impacts of firearm violence on youth are extensive and lifelong, [Extracted from the article]

Objective Firearm injury research necessitates using data from often-exploited vulnerable populations of Black and Brown Americans. In order to reduce bias against protected attributes, this study provides a theoretical framework for establishing trust and transparency in the use of AI with the general population. Methods We propose a Model Facts template that is easily extendable and decomposes accuracy and demographics into standardized and minimally complex values. This framework allows general users to assess the validity and biases of a model without diving into technical model documentation. Examples We apply the Model Facts template on 2 previously published models, a violence risk identification model and a suicide risk prediction model. We demonstrate the ease of accessing the appropriate information when the data are structured appropriately. Discussion The Model Facts template is limited in its current form to human based data and biases. Like nutrition facts, it will require educational programs for users to grasp its full utility. Human computer interaction experiments should be conducted to ensure model information is communicated accurately and in a manner that improves user decisions. Conclusion The Model Facts label is the first framework dedicated to establishing trust with end users and general population consumers. Implementation of Model Facts into firearm injury research will provide public health practitioners and those impacted by firearm injury greater faith in the tools the research provides. [ABSTRACT FROM AUTHOR]

Gun violence, often characterized as a singular issue, is not one cohesive problem. Instead, it takes many forms resulting from the complex interplay of multiple factors. Outcomes of gun violence also vary significantly. They may be (a) physically non-injurious (a gun is brandished), (b) injurious but non-lethal, or (c) lethal. To understand and address gun violence effectively, it is essential to consider various risk factors for both non-lethal and lethal gun violence victimization, using a comprehensive, comparative framework. We present a novel comparative framework for better understanding gun violence, and for developing policy responses to this violence. We disaggregate gun violence into its various forms and propose a conceptualization of risk factors in discrete categories, each with important implications for policy intervention. While we emphasize the value of this framework for understanding and combatting interpersonal gun violence in America, the research and policy approaches discussed here should be equally applicable to other international contexts with gun violence as a serious public health issue as well. [ABSTRACT FROM AUTHOR]

Black men in the United States face disproportionately high rates of firearm violence, leading to death and disability more often than males of other racial/ethnic groups. Managing life after such injuries involves significant challenges in daily activities, employment, and pain management. Despite the critical impacts of firearm-related disabilities on Black men, their experiences remain largely unexplored by disability scholars, public health researchers, and practitioners. This oversight is alarming, as Black men with firearm-acquired disabilities encounter considerable structural barriers to achieving health and social objectives. Our team focuses on: (a) the experiences of Black men with firearm-acquired disabilities, (b) the lack of literature on their lived realities, and (c) new pathways for disability and public health research. Recognizing and addressing the invisibility of violently injured Black men in research is crucial for advancing equity, social justice, and representation across society. We argue that disability justice is a vital starting point for acknowledging the social experiences of gunshot wound survivors. More research is needed to understand the experiences of these young Black men who have been largely ignored in public health and disability narratives. It is essential for clinicians and policymakers to grasp how this neglect affects conventional views on health, accessibility, and well-being, underscoring the need for a more inclusive and equitable approach. [ABSTRACT FROM AUTHOR]

BACKGROUND: Current conditions in the USA suggest an increasing risk for political violence. Little is known about the prevalence of beliefs that might lead to political violence, about support for and personal willingness to engage in political violence, and about how those measures vary with individual characteristics, lethality of violence, political objectives that violence might advance, or specific populations as targets. METHODS: This cross-sectional US nationally representative survey was conducted on May 13 to June 2, 2022, of adult members of the Ipsos KnowledgePanel. Outcomes are weighted, population-representative proportions of respondents endorsing selected beliefs about American democracy and society and violence to advance political objectives. RESULTS: The analytic sample included 8620 respondents; 50.5% (95% confidence interval (CI) 49.3%, 51.7%) were female; and weighted mean (± standard deviation) age was 48.4 (± 18.0) years. Nearly 1 in 5 (18.9%, 95% CI 18.0%, 19.9%) agreed strongly or very strongly that having a strong leader for America is more important than having a democracy; 16.2% (95% CI 15.3%, 17.1%) agreed strongly or very strongly that in America, native-born white people are being replaced by immigrants, and 13.7% (95% CI 12.9%, 14.6%) agreed strongly or very strongly that in the next few years, there will be civil war in the United States. One-third of respondents (32.8%, 95% CI 31.7%, 33.9%) considered violence to be usually or always justified to advance at least 1 of 17 specific political objectives. Among all respondents, 7.7% (95% CI 7.0%, 8.4%) thought it very or extremely likely that within the next few years, in a situation where they believe political violence is justified, I will be armed with a gun; 1.1% (95% CI 0.9%, 1.4%) thought it very or extremely likely that I will shoot someone with a gun. Support for political violence and for the use of firearms in such violence frequently declined with increasing age, education, and income. CONCLUSIONS: Small but concerning proportions of the population consider violence, including lethal violence, to be usually or always justified to advance political objectives. Prevention efforts should proceed urgently based on the best evidence available.

Objective: Concurrent with a substantial surge in gun purchases among Americans during COVID-19, there was an escalation of racism and hate crimes in the United States. Despite this disturbing trend, little is known about whether and the extent to which racism experience is linked to gun purchase during the pandemic. This study aims to examine the association between experience of racial discrimination and gun purchase among Americans during COVID-19. Methods: Based on data from the Health, Ethnicity, and Pandemic Survey (n = 2,584), a national survey conducted in the U.S. in October 2020, chi-square tests and logistic regressions were estimated to examine the association between racism experience and gun purchase during COVID-19 with and without controlling for selected covariates. Results: About 6.9 % of the sample reported gun purchases during COVID-19. Among respondents who reported experience of racism, 18.3 % purchased a gun as compared to 5.8 % among those who did not report experience of racism. Relative to respondents with no experience of racism, the odds of gun purchase for those who reported racism experience became 257 % as much (AOR = 2.57, 95 % CI: 1.63, 4.04) after controlling for other covariates in the analysis. Non-Hispanic Blacks were more likely to report gun purchases than non-Hispanic Whites (AOR = 1.80, 95 % CI: 1.04, 3.10). Conclusions: Americans who reported experience of racism during COVID-19 were far more likely to purchase a gun than those otherwise. These findings elevate the need for addressing racism as an important risk factor of firearm violence.

BackgroundLiving near an incident of firearm violence can negatively impact youth, regardless of whether the violence is experienced firsthand. Inequities in household and neighborhood resources may affect the prevalence and consequences of exposure across racial/ethnic groups.FindingsUsing data from the Future of Families and Child Wellbeing Study and the Gun Violence Archive, we estimate that approximately 1 in 4 adolescents in large US cities lived within 800 m (0.5 miles) of a past-year firearm homicide during 2014-17. Exposure risk decreased as household income and neighborhood collective efficacy increased, though stark racial/ethnic inequities remained. Across racial/ethnic groups, adolescents in poor households in moderate or high collective efficacy neighborhoods had a similar risk of past-year firearm homicide exposure as middle-to-high income adolescents in low collective efficacy neighborhoods.ConclusionsEmpowering communities to build and leverage social ties may be as impactful for reducing firearm violence exposure as income supports. Comprehensive violence prevention efforts should include systems-level strategies that jointly strengthen family and community resources.

Abstract Background Surveys have found concerningly high levels of agreement that the United States will experience civil war soon. This study assesses variation in expectation of and perceived need for civil war with respondent sociopolitical characteristics, beliefs, firearm ownership, and willingness to engage in political violence. Methods Findings are from Wave 2 of a nationally representative annual longitudinal survey of members of the Ipsos KnowledgePanel, conducted May 18–June 8, 2023. All respondents to 2022’s Wave 1 who remained in KnowledgePanel were invited to participate. Outcomes are expressed as weighted proportions and adjusted prevalence differences, with p-values adjusted for the false discovery rate and reported as q-values. Results The completion rate was 84.2%; there were 9385 respondents. After weighting, half the sample was female (50.7%, 95% CI 49.4%, 52.1%); the weighted mean (± standard deviation) age was 48.5 (25.9) years. Approximately 1 respondent in 20 (5.7%, 95% CI 5.1%, 6.4%) agreed strongly or very strongly that “in the next few years, there will be civil war in the United States.” About 1 in 25 (3.8%, 95% CI 3.2%, 4.4%), and nearly 40% (38.4%, 95% CI 32.3%, 44.5%) of those who strongly or very strongly agreed that civil war was coming, also agreed strongly or very strongly that “the United States needs a civil war to set things right.” Expectation of and perceived need for civil war were higher among subsets of respondents who in Wave 1 were more willing than others to commit political violence, including MAGA Republicans, persons in strong agreement with racist beliefs or statements of the potential need for violence to effect social change, persons who strongly approved of specified extreme right-wing political organizations and movements, firearm owners who purchased firearms in 2020 or later, and firearm owners who carried firearms in public all or nearly all the time. Conclusions In 2023, the expectation that civil war was likely and the belief that it was needed were uncommon but were higher among subsets of the population that had previously been associated with greater willingness to commit political violence. These findings can help guide prevention efforts.

Abstract In this article, we investigate situations involving firearm violence in Sweden. The spatiotemporal distribution of records is assessed in different contexts across the country and linked to land use, demographic, and socio-economic characteristics by area and by street segment. The findings emphasize the prevalence of evening shootings, particularly in economically disadvantaged areas where young people congregate in public places often in residential areas, in parks, in playgrounds, and in transit areas. Although two-thirds of shootings took place in larger urban municipalities, our study sheds light on the non-uniform distribution of gun violence along the rural–urban continuum. We conclude by offering suggestions for future research and practical interventions to address this pressing issue that negatively affects people and communities.

Abstract Background Globally, Mexico is one of six countries with the highest level of firearm mortality. While previous studies have examined firearm mortality in Mexico before 2015, increases in violence since then highlight the need for an updated analysis. In this study, we examined changes in firearm-related deaths in Mexico from 2015 to 2022 and described these deaths by key demographic groups, incident location, and state of occurrence. Data came from Mexico’s Instituto Nacional de Estadistica y Geografia (INEGI), a federal agency that collects and reports national population data. We used descriptive statistics to analyze rates, proportions, and percentage changes in firearm mortality, and we displayed temporal trends using time plots and special trends using maps. Results Firearm deaths increased in Mexico from 2015 to 2018 but slightly decreased from 2018 to 2022. Homicides presented the highest increase and the highest proportion of firearm-related deaths from 2015 to 2022. Victims were primarily males but rates among women increased at a higher proportion (99.5% vs 53.5%). One third of victims were 20–29y but rates among children and adolescents (10–9y) increased at a higher proportion. Most firearm-related deaths occurred in streets or public spaces but the percentage of incidents occurring in households have increased. State-level rates and percentage changes varied significantly. States with higher rates of firearm mortality coincide with those involving conflict among organized criminal organizations. Conclusion Firearm mortality in Mexico is a major public health burden. The epidemiology of firearm-related deaths in Mexico varies by intent, demographics, location, and states. To mitigate this challenge, multiple solutions are required.

IntroductionPast research has demonstrated a "reopening phenomenon" of increased firearm violence associated with the initial lifting of coronavirus disease 2019 (COVID-19) pandemic-related restrictions after the first wave. Now, with widespread societal reemergence from stay-at-home measures, we hypothesize another spike in firearm violence in the United States (US). Thus, the purpose of this study was to evaluate the trends in firearm violence before and after extensive community reopenings during the COVID-19 pandemic.MethodsThe Gun Violence Archive was utilized to collect data on daily firearm violence incidents, injuries, and deaths as well as on types of firearm violence. Mann-Whitney U-tests were performed for trends and types of firearm violence "before" (12/14/20-4/9/21) versus "after" (4/10/21-7/31/21) widespread societal reopening in the US. Additional analyses also sought to compare the after reopening time-period to historical data (2017-2020) of similar calendar dates, to better control for possible annual/seasonal variation.ResultsMedian daily firearm violence incidents (153 versus 176, P

Despite promising results from individual-level studies, state-level studies of the effectiveness of comprehensive background-check (CBC) policies in reducing firearm fatalities have yielded null results in multiple states. These prior studies focused on CBC laws adopted in the 1990s, when record keeping was far less complete. We estimated the effect of the implementation of CBC policies on state-level firearm homicide and suicide rates in states implementing CBC policies from 2013 to 2015 (Colorado, Delaware, Oregon, and Washington). We compared age-adjusted firearm homicide and suicide rates, measured annually from 15 years prior to policy implementation until 2019, in each treated state to rates in control groups constructed using the synthetic control group method. Differences in firearm homicide rates for Colorado, Oregon, and Washington post treatment were all small (0.09 to 0.18 per 100,000 residents per year) and not well distinguished from natural variation. Oregon had on average 0.80 per 100,000 fewer firearm suicides per year than did synthetic Oregon post treatment. However, these results were inconsistent across modeling approaches and not well distinguished from natural variation. Our models produced poor fit for Delaware. Coupled with previous null results from Indiana, California, Maryland, Pennsylvania, and Tennessee, the present results suggest that extending background check requirements to private transfers alone and implementing these policies as is currently done is not sufficient to achieve significant state-level reductions in firearm fatalities.

Firearms are used in around 25% of homicides in Europe. More so than other weapons commonly used in violent encounters, firearms have the ability to inflict lethal injuries. Yet, theoretical approaches to understanding the impact of firearms on the prevalence, lethality, and nature of violent encounters are scarce and have been developed almost exclusively within and for the context of the United States, where the levels of firearm violence and firearm availability are much higher than in Europe, limiting their applicability to the European context. To address this issue, European empirical data are reviewed in this paper to critically assess the few existing theoretical approaches focusing on the use of firearms in lethal and non-lethal violence. Based on the obtained findings, future directions for empirical research, as well as suggestions for new conceptualizations of firearm violence in Europe are presented. [ABSTRACT FROM AUTHOR]

Background: Globally, Mexico is one of six countries with the highest level of firearm mortality. While previous studies have examined firearm mortality in Mexico before 2015, increases in violence since then highlight the need for an updated analysis. In this study, we examined changes in firearm-related deaths in Mexico from 2015 to 2022 and described these deaths by key demographic groups, incident location, and state of occurrence. Data came from Mexico's Instituto Nacional de Estadistica y Geografia (INEGI), a federal agency that collects and reports national population data. We used descriptive statistics to analyze rates, proportions, and percentage changes in firearm mortality, and we displayed temporal trends using time plots and special trends using maps. Results: Firearm deaths increased in Mexico from 2015 to 2018 but slightly decreased from 2018 to 2022. Homicides presented the highest increase and the highest proportion of firearm-related deaths from 2015 to 2022. Victims were primarily males but rates among women increased at a higher proportion (99.5% vs 53.5%). One third of victims were 20–29y but rates among children and adolescents (10–9y) increased at a higher proportion. Most firearm-related deaths occurred in streets or public spaces but the percentage of incidents occurring in households have increased. State-level rates and percentage changes varied significantly. States with higher rates of firearm mortality coincide with those involving conflict among organized criminal organizations. Conclusion: Firearm mortality in Mexico is a major public health burden. The epidemiology of firearm-related deaths in Mexico varies by intent, demographics, location, and states. To mitigate this challenge, multiple solutions are required. [ABSTRACT FROM AUTHOR]

In this article, we investigate situations involving firearm violence in Sweden. The spatiotemporal distribution of records is assessed in different contexts across the country and linked to land use, demographic, and socio-economic characteristics by area and by street segment. The findings emphasize the prevalence of evening shootings, particularly in economically disadvantaged areas where young people congregate in public places often in residential areas, in parks, in playgrounds, and in transit areas. Although two-thirds of shootings took place in larger urban municipalities, our study sheds light on the non-uniform distribution of gun violence along the rural–urban continuum. We conclude by offering suggestions for future research and practical interventions to address this pressing issue that negatively affects people and communities. [ABSTRACT FROM AUTHOR]

This study investigates the relationship between firearm violence exposure and functional health among Black adults in the United States (US). We examined associations between different forms of firearm violence exposure (direct, indirect, and community) and functional health with particular attention to differences across sex groups. We used survey data from a nationally representative sample of 3015 Black adult Americans to analyze associations between types of firearm violence exposure and four aspects of functional disability including: the ability to concentrate, walk/use stairs, dress/bathe, and run errands among males and females. The findings indicate notable disparities in exposure and health outcomes based on the exposure type and cumulative exposure to violence. Among males, functional disability was associated most closely with community violence exposure, while direct threats of firearm violence were most consequential for functional health among females. High cumulative exposure to firearm violence was linked to significant risks to functional health, particularly among females. The results shed light on sex differences in the repercussions of firearm violence exposure and emphasize its implications for daily functioning and health. This study contributes to the understanding of the multifaceted impacts of firearm violence on functional well-being and highlights the need for inclusive and culturally sensitive healing approaches based in community settings. There is a critical need for heightened awareness and strategies to enhance the well-being of those disproportionately affected by firearm violence in the US. [ABSTRACT FROM AUTHOR]

Self-appraisal after a life-altering event is a critical process for individuals, often comprised by assigned labels that may not align with an individuals' perceptions of themselves or of their situation. Existing research within this victim-survivor dichotomy largely rests in the interpersonal violence space, with a victim assuming legal recourse and wrongdoing, and a survivor associating with positive personal characteristics like grit and resilience. Much existing literature on self-appraisal after interpersonal injury is heavily concentrated within the sexual violence literature, and this study applies these concepts to a sample of Black men injured by firearms. Ten Black men enrolled in a hospital-based violence intervention program (HVIP) were interviewed to understand how they label their experience of firearm injury, and if their perceptions aligned with common labels seen among other populations and/or in other areas of study (e.g., cancer, domestic violence). Each participant assigned themselves their own label, with three labels emerging: survivor, victim and survivor, and neither victim nor survivor. The results illustrate the nuance of experiences beyond the victim-survivor dichotomy, and how labels and personal identities may shift following injury into new terms and considerations of resilience and trauma processing. More research is warranted to understand the factors that shape self-labeling within this population, including influences of masculine norms, racialized stereotypes, community context, and availability of services. Findings support public awareness campaigns to reframe surviving violence as a strength, and for community partners and practitioners to increase access to culturally competent and trauma-informed mental healthcare. [ABSTRACT FROM AUTHOR]

Summary: Background: Most Americans believe that gun-free zones make locations more vulnerable to violent crimes, particularly active shootings. However, there is no empirical evidence regarding the impact of gun-free zones on protecting locations from violence. The objective of this study was to estimate the association between gun-free zones and active shootings. Methods: We used a pair-matched case-control study where cases were all US establishments where active shootings occurred between 2014 and 2020, and controls were randomly selected US establishments where active shootings could have but did not occur, pair-matched by establishment type, year, and county. Gun-free status of included establishments was determined via local laws, company policy, news reporting, Google Maps and posted signage, and calling establishments. Findings: Of 150 active shooting cases, 72 (48.0%) were determined to have occurred in a gun-free zone. Of 150 controls where no active shooting occurred, 92 (61.3%) were determined to be gun-free. After accounting for matched pairs, the conditional odds of an active shooting in gun-free establishments were 0.38 times those in non-gun-free establishments, with a 95% confidence interval of 0.19–0.73 (p-value = 0.0038). Several robustness analyses affirmed these findings. Interpretation: It is unlikely that gun-free zones attract active shooters; gun-free zones may be protective against active shootings. This study challenges the proposition of repealing gun-free zones based on safety concerns. Funding: This work was funded in part by the National Collaborative on Gun Violence Research and the Arnold Foundation.

Introduction: The epidemic of gun violence in the United States (US) is exacerbated by frequent mass shootings. In 2021, there were 698 mass shootings in the US, resulting in 705 deaths and 2,830 injuries. This is a companion paper to a publication in JAMA Network Open, in which the nonfatal outcomes of victims of mass shootings have been only partially described.Methods: We gathered clinical and logistic information from 31 hospitals in the US about 403 survivors of 13 mass shootings, each event involving greater than 10 injuries, from 2012-19. Local champions in emergency medicine and trauma surgery provided clinical data from electronic health records within 24 hours of a mass shooting. We organized descriptive statistics of individual-level diagnoses recorded in medical records using International Classification of Diseases codes, according to the Barell Injury Diagnosis Matrix (BIDM), a standardized tool that classifies 12 types of injuries within 36 body regions.Results: Of the 403 patients who were evaluated at a hospital, 364 sustained physical injuries—252 by gunshot wound (GSW) and 112 by non-ballistic trauma—and 39 were uninjured. Fifty patients had 75 psychiatric diagnoses. Nearly 10% of victims came to the hospital for symptoms triggered by, but not directly related to, the shooting, or for exacerbations of underlying conditions. There were 362 gunshot wounds recorded in the Barell Matrix (1.44 per patient). The Emergency Severity Index (ESI) distribution was skewed toward higher acuity than typical for an emergency department (ED), with 15.1% ESI 1 and 17.6% ESI 2 patients. Semi-automatic firearms were used in 100% of these civilian public mass shootings, with 50 total weapons for 13 shootings (Route 91 Harvest Festival, Las Vegas. 24).  Assailant motivations were reported to be associated with hate crimes in 23.1%.Conclusion: Survivors of mass shootings have substantial morbidity and characteristic injury distribution, but 37% of victims had no GSW. Law enforcement, emergency medical systems, and hospital and ED disaster planners can use this information for injury mitigation and public policy planning. The BIDM is useful to organize data regarding gun violence injuries. We call for additional research funding to prevent and mitigate interpersonal firearm injuries, and for the National Violent Death Reporting System to expand tracking of injuries, their sequelae, complications, and societal costs.

The burden of firearm homicide in the United States is not evenly distributed across the population; rather, it disproportionately affects youth in disadvantaged and marginalized communities. Research is limited relevant to the impacts of exposure to firearm violence that occurs near where youth live or attend school - spatially proximate firearm violence - on youths mental health and whether those impacts vary by characteristics that shape youths risk for experiencing that exposure in the first place. Using a dataset linking the Fragile Families and Child Wellbeing Study with the Gun Violence Archive (N = 3086), we employed propensity score matching and multilevel stratification to examine average and heterogeneous associations between spatially proximate firearm homicide exposure and anxiety and depression among all youth and then separately for boys and girls. We found a statistically significant average association between firearm homicide exposure and symptoms of depression among youth. Furthermore, heterogeneous effects analyses yielded evidence that the average association is driven by youth, and particularly boys, who are the most disadvantaged and have the highest risk of firearm homicide exposure. The results of this study suggest that the accumulation of stressors associated with structural disadvantage and neighborhood disorder, coupled with exposure to spatially proximate and deadly firearm violence, may make boys and young men, particularly Black boys and young men, uniquely vulnerable to the mental health impacts of such exposure. Ancillary analyses of potential effect moderators suggest possible future areas of investigation.

Abstract Background Firearm violence is an intensifying public health problem in the United States. News reports shape the way the public and policy makers understand and respond to health threats, including firearm violence. To better understand how firearm violence is communicated to the public, we aimed to determine the extent to which firearm violence is framed as a public health problem on television news and to measure harmful news content as identified by firearm-injured people. Methods This is a quantitative content analysis of Philadelphia local television news stories about firearm violence using a database of 7,497 clips. We compiled a stratified sample of clips aired on two randomly selected days/month from January-June 2021 from the database (n = 192 clips). We created a codebook to measure public health frame elements and to assign a harmful content score for each story and then coded the clips. Characteristics of stories containing episodic frames that focus on single shooting events were compared to clips with thematic frames that include broader social context for violence. Results Most clips employed episodic frames (79.2%), presented law enforcement officials as primary narrators (50.5%), and included police imagery (79.2%). A total of 433 firearm-injured people were mentioned, with a mean of 2.8 individuals shot included in each story. Most of the firearm-injured people featured in the clips (67.4%) had no personal information presented apart from age and/or gender. The majority of clips (84.4%) contained at least one harmful content element. The mean harmful content score/clip was 2.6. Public health frame elements, including epidemiologic context, root causes, public health narrators and visuals, and solutions were missing from most clips. Thematic stories contained significantly more public health frame elements and less harmful content compared to episodic stories. Conclusions Local television news produces limited public health coverage of firearm violence, and harmful content is common. This reporting likely compounds trauma experienced by firearm-injured people and could impede support for effective public health responses to firearm violence. Journalists should work to minimize harmful news content and adopt a public health approach to reporting on firearm violence.

Abstract Background A 2022 survey in the USA found concerningly high prevalences of support for and personal willingness to engage in political violence, of beliefs associated with such violence, and of belief that civil war was likely in the near future. It is important to determine the durability of those findings. Methods Wave 2 of a nationally representative cohort survey was conducted May 18-June 8, 2023; the sample comprised all respondents to 2022’s Wave 1. Outcomes are expressed as weighted proportions; changes from 2022 to 2023 are for respondents who participated in both surveys, based on aggregated individual change scores. Results The completion rate was 84.2%; there were 9385 respondents. After weighting, 50.7% (95% confidence interval (CI) 49.4%, 52.1%) were female; weighted mean (SD) age was 48.5 (25.9) years. About 1 in 20 respondents (5.7%, 95% CI 5.1%, 6.4%) agreed strongly/very strongly that “in the next few years, there will be civil war in the United States,” a 7.7% decrease. In 2023, fewer respondents considered violence to be usually/always justified to advance at least 1 of 17 specific political objectives [25.3% (95% CI 24.7%, 26.5%), a 6.8% decrease]. However, more respondents thought it very/extremely likely that within the next few years, in a situation where they consider political violence justified, “I will be armed with a gun” [9.0% (95% CI 8.3%, 9.8%), a 2.2% increase] and “I will shoot someone with a gun” [1.8% (95% CI 1.4%, 2.2%), a 0.6% increase]. Among respondents who considered violence usually/always justified to advance at least 1 political objective, about 1 in 20 also thought it very/extremely likely that they would threaten someone with a gun (5.4%, 95% CI 4.0%, 7.0%) or shoot someone (5.7%, 95% CI 4.3%, 7.1%) to advance such an objective. Conclusions In this cohort, support for political violence declined from 2022 to 2023, but predictions of firearm use in political violence increased. These findings can help guide prevention efforts, which are urgently needed.

Background: Firearm violence is an American public health crisis that negatively impacts children and disproportionately affects Black youth. Few firearm injury prevention programs have been described in pre-adolescent children. The Future Healers Program is a novel collaboration constructed via partnership between the medical school, trauma center, academic surgery department, and local non-profit community organization. Our study sought to evaluate if (1) partnering with community organizations facilitated recruitment of children with prior exposure to firearm violence and (2) the health care community was a potential trusted partner appropriate for program delivery. Methods: Children aged 4-13 were recruited to join the program via news outlets and social media and in partnership with a local non-profit organization. Of the children and parents participating in the program, 48% (44/92) and 59% (38/64), respectively, completed an IRB-approved survey study. Pearson's chi-square, percentages, and 95% confidence intervals evaluated differences between children and caregivers on sociodemographic characteristics, firearm exposure (FE), firearm violence exposure (FVE), and perception of health care. Participant's residence was geocoded in relationship to incidents of firearm injury (2008-2021) in the same region. Results: Caregivers (95%) and children (84%) reported substantial exposure to firearm violence and resided in areas with frequent firearm injury incidents. Notably, 82% of caregivers and 66% of children reported having a family member injured by gunfire. A high percentage of caregivers (79%) and children (91%) self-reported trust in the health care system. Conclusion: Partnerships between community organizations and health care systems can develop prevention programs that effectively recruit and engage pre-adolescent children impacted by firearm violence. [ABSTRACT FROM AUTHOR]

Many trauma centers use the first firearm injury admission as a reachable moment to mitigate reinjury. Understanding repeat firearm violence can be difficult in metropolitan areas with multiple trauma centers and laws that prohibit sharing private health information across health systems. We hypothesized that risk factors for repeat firearm violence could be better understood using pooled data from two major metropolitan trauma centers. Two level I trauma center registries were queried (2007-2017) for firearm injury admissions using International Classification of Diseases, Ninth and Tenth Revision (ICD9/10) Ecodes. A pseudo encryption tool allowed sharing of deidentified firearm injury and repeat firearm injury data without disclosing private health information. Factors associated with firearm reinjury admissions including, age, sex, race, payor, injury severity, intent, and discharge, were assessed by multivariable logistic regression. We identified 2145 patients with firearm injury admissions, 89 of whom had a subsequent repeat firearm injury admission. Majority of repeat firearm admissions were assaulted (91%), male (97.8%), and non-Hispanic Black (86.5%). 31.5% of repeat firearm injury admissions were admitted to a different trauma center from their initial admission. Independent predictors of repeat firearm injuries were age (adjusted odds ratio [aOR] 0.94, P < 0.001), male sex (aOR 6.18, P = 0.013), non-Hispanic Black race (aOR 5.14, P = 0.007), or discharge against medical advice (aOR 6.64, P=<0.001). Nearly a third of repeat firearm injury admissions would have been missed in the current study without pooled metropolitan trauma center data. The incidence of repeat firearm violence is increasing and those at the highest risk for reinjury need to be targeted for mitigating interventions. [ABSTRACT FROM AUTHOR]

We have a firearm public health crisis in the United States, with firearm injuries being the leading cause of death in children. The state of pediatric firearm violence will be summarized through a synopsis of an expert panel of pediatric-focused advanced practice registered nurses. A review of related statistics, policy initiatives, programs, screening tools, and resources to support providers to intervene with patients, parents, and caregivers is summarized. Strategies to identify and intervene with all youth and families are described. All pediatric providers must take action against pediatric firearm violence and work to develop care strategies and health policy changes to combat this growing epidemic. [ABSTRACT FROM AUTHOR]

Social workers often work with clients who are at elevated risk for firearm victimization or perpetration due to their personal risk factors. But are they talking to their clients about firearms? Research on social workers' firearm assessment or discussions with clients about safe storage is scarce. This study sought to better understand social workers' and students' firearms training, beliefs, general knowledge, and application to practice. An anonymous, online, quantitative survey was completed by 139 social workers and students. Most social work practitioners and students had zero hours of training regarding firearms in their social work programs, their internship, and/or from continuing education units (CEUs). Those that had training asked clients about firearms. Besides asking suicidal and aggressive clients, most social workers were not routinely asking other high-risk clients about their access to firearms or their storage practices. Over half of the participants said they would be interested in future training. Social workers have unique skills and key connections with high-risk clients who are vulnerable to firearm-related risks. They have the potential to prevent gun violence, but only if they receive thorough, effective training on firearms assessment and safe storage practices. [ABSTRACT FROM AUTHOR]

Background: Gun violence is a global public health concern that has significant implications for mental health. This systematic review aims to synthesize the existing literature on the mental health consequences of interpersonal gun violence. Methods: A comprehensive search was conducted across PubMed, PsycInfo, and Web of Science databases to identify relevant studies published up to December 15, 2023. Studies were included if they documented the mental health impact of interpersonal gun violence. The data extraction process included information on study design, population characteristics, exposure to gun violence, mental health indicators, and measurement instruments. Results: A total of 58 studies were included in the review. The studies varied in design, population, and mental health indicators assessed. We found that exposure to interpersonal gun violence was significantly associated with increased reports of post-traumatic stress disorder, depressive symptoms, and substance use. We also found that interpersonal gun violence exposure was associated with increased disruptive behaviors and the likelihood of gun carrying especially among adolescents. Further, those closer to the interpersonal gun violence consistently reported more adverse mental health consequences than persons less centrally involved. The review also highlighted limitations in the current literature, including a narrow focus on certain mental health indicators and a paucity of studies from countries other than the US. Conclusion: The consequences of interpersonal gun violence extend beyond immediate physical injury to include enduring mental health impacts. This review also highlights the need for further research to better understand the impact of gun violence on mental health.

Objective: To better understand how community firearm violence (CFV) is communicated to the public, we aimed to identify systematic differences between the characteristics of shooting victims and events covered on television news and all shootings in Philadelphia, PA, a city with escalating CFV incidence. Methods: We compiled a stratified sample of local television news clips covering shootings that occurred in Philadelphia aired on two randomly selected days per month from January-June 2021 (n = 154 clips). We coded the clips to determine demographic and geographic information about the shooting victims and events and then matched coded shootings with corresponding shootings in the Philadelphia police database. We compared characteristics of shooting victims and shooting event locations depicted in television clips (n = 62) with overall characteristics of shootings in Philadelphia during the study period (n = 1082). Results: Compared to all individuals shot, victims whose shootings were covered on local television news more likely to be children and more likely to be shot in a mass shooting. The average median household income of shooting locations featured on television was significantly higher than the median household income across all shooting locations ($60,302 for television shootings vs. $41,233 for all shootings; p = 0.002). Shootings featured on television occurred in areas with lower rates of income inequality and racialized economic segregation compared to all shooting locations. Conclusions: Television news outlets in Philadelphia systematically over-reported shootings of children, mass shootings, and shootings that occurred in neighborhoods with higher median household income, less socioeconomic inequality, and lower rates of racialized economic segregation.

IntroductionFirearms and motor vehicle collisions (MVC) are leading causes of mortality in children. We hypothesized that firearm injuries would have a higher mortality than MVCs in children and a higher level of resource utilization METHODS: Trauma patients

Thousands of buildings in Cleveland, Ohio were demolished or rehabilitated since the Great Recession in the 2000s. Recent evidence suggests removing vacant and decaying buildings reduces violent and firearm-involved crime. This study examines the dose-response relationship between demolitions, rehabilitations, and crime. We use Bayesian spatiotemporal models to estimate the association of interest for five types of crime outcomes: violent crimes, violent crimes involving a firearm, drug crimes, and crimes often associated with building vacancy. We estimate associations in quarterly time periods from 2012 through 2017 in 569 hexagons approximately the size of a neighborhood (2000 feet, approximately 610 m, in diameter), stratified by vacancy level. Across vacancy levels, the majority of our models do not identify statistically significant associations between demolition and rehabilitation dose and crime incidence. However, in some cases, we identify positive associations between demolition and crime. These associations generally appeared at higher levels of demolition (2 or 3 or more demolitions) in areas characterized by medium to high levels of vacancy. We also find that the presence of a property rehabilitation is associated with an increase in drug crimes in areas with medium levels of vacancy.

BackgroundFirearm injury and death are significant public health problems in the U.S. and physicians are uniquely situated to help prevent them. However, there is little formal training in medical education on identifying risk for firearm injury and discussing safe firearm practices with patients. This study assesses prior education, barriers to counseling, and needs for improved training on firearm safety counseling in medical education to inform the development of future education on clinical strategies for firearm injury prevention.MethodA 2018 survey administered to 218 residents and fellows at a large, academic medical center asked about medical training on firearm injury prevention, frequency of asking patients about firearm access, and perceived barriers.ResultsThe most common barriers cited were not knowing what to do with patients' answers about access to firearms (72.1%), not having enough time (66.2%), not feeling comfortable identifying patients at-risk for firearm injury (49.2%), and not knowing how to ask patients about firearm access (48.6%). Prior education on firearm injury prevention was more strongly associated with asking than was personal exposure to firearms: 51.5% of respondents who had prior medical education reported asking compared with who had not received such education (31.8%, p=0.004). More than 90% of respondents were interested in further education about interventions, what questions to ask, and legal mechanisms to separate dangerous people from their firearms.ConclusionsEducation on assessing risk for firearm-related harm and, when indicated, counseling on safe firearm practices may increase the likelihood clinicians practice this behavior, though additional barriers exist.

BackgroundThis study aimed to evaluate the patterns of firearm violence against children before and after the COVID-19 pandemic, as well as the patterns of specific types of firearm violence against children over time (2016-2020).MethodsRetrospective firearm violence data were obtained from the Gun Violence Archive. The rate of firearm violence was weighted per 100,000 children. A scatterplot was created to depict the rate of total annual child-involved shooting incidents over time; with a linear trendline fit to 2016 to 2019 data to show projected versus actual 2020 firearm violence. All 50 states were categorized into either "strong gun law" (n = 25) or "weak gun law" (n = 25) cohorts. Multivariate linear regressions were performed for number of child-involved shootings over time.ResultsThere were a total of 1,076 child-involved shootings in 2020, 811 in 2019, and 803 in 2018. The median total child-involved shooting incidents per month per 100,000 children increased from 2018 to 2020 (0.095 vs. 0.124, p = 0.003) and from 2019 to 2020 (0.097 vs. 0.124, p = 0.010). Child killed by adult incidents also increased in 2020 compared with 2018 (p = 0.024) and 2019 (p = 0.049). The scatterplot demonstrates that total child-involved shootings in addition to both fatal and nonfatal firearm violence incidents exceeded the projected number of incidents extrapolated from 2016 to 2019 data. Multivariate linear regression demonstrated that, compared with weak gun law states, strong gun law states were associated with decreased monthly total child-involved shooting incidents between 2018 and 2020 (p < 0.001), as well as between 2019 and 2020 (p < 0.001).ConclusionChild-involved shooting incidents increased significantly in 2020 surrounding the COVID-19 pandemic. Given that gun law strength was associated with a decreased rate of monthly child-involved firearm violence, public health and legislative efforts should be made to protect this vulnerable population from exposure to firearms.Level of evidenceEpidemiological, level III.

Recent studies have demonstrated a significant change in the epidemiology of injury fatalities in children, most notably a marked increase in firearm-related deaths. Few studies have specifically addressed pediatric TBI-related mortality trends. Studying these trends is important for both clinical preparedness and public health interventions. The purpose of this study therefore is to examine recent trends in mechanisms, intents, and rates of pediatric TBI fatalities. Data regarding fatalities from TBI for children

Abstract Background Current conditions in the USA suggest an increasing risk for political violence. Little is known about the prevalence of beliefs that might lead to political violence, about support for and personal willingness to engage in political violence, and about how those measures vary with individual characteristics, lethality of violence, political objectives that violence might advance, or specific populations as targets. Methods This cross-sectional US nationally representative survey was conducted on May 13 to June 2, 2022, of adult members of the Ipsos KnowledgePanel. Outcomes are weighted, population-representative proportions of respondents endorsing selected beliefs about American democracy and society and violence to advance political objectives. Results The analytic sample included 8620 respondents; 50.5% (95% confidence interval (CI) 49.3%, 51.7%) were female; and weighted mean (± standard deviation) age was 48.4 (± 18.0) years. Nearly 1 in 5 (18.9%, 95% CI 18.0%, 19.9%) agreed strongly or very strongly that “having a strong leader for America is more important than having a democracy”; 16.2% (95% CI 15.3%, 17.1%) agreed strongly or very strongly that “in America, native-born white people are being replaced by immigrants,” and 13.7% (95% CI 12.9%, 14.6%) agreed strongly or very strongly that “in the next few years, there will be civil war in the United States.” One-third of respondents (32.8%, 95% CI 31.7%, 33.9%) considered violence to be usually or always justified to advance at least 1 of 17 specific political objectives. Among all respondents, 7.7% (95% CI 7.0%, 8.4%) thought it very or extremely likely that within the next few years, in a situation where they believe political violence is justified, “I will be armed with a gun”; 1.1% (95% CI 0.9%, 1.4%) thought it very or extremely likely that “I will shoot someone with a gun.” Support for political violence and for the use of firearms in such violence frequently declined with increasing age, education, and income. Conclusions Small but concerning proportions of the population consider violence, including lethal violence, to be usually or always justified to advance political objectives. Prevention efforts should proceed urgently based on the best evidence available.

Ballistic injuries cause both a temporary and permanent cavitation event, making them far more destructive and complex than other penetrating trauma. We hypothesized that global injury scoring and physiologic parameters would fail to capture the lethality of gunshot wounds (GSW) compared to other penetrating mechanisms. The 2019 American College of Surgeons Trauma Quality Programs participant use file was queried for the mortality rate for GSW and other penetrating mechanisms. A binomial logistic regression model ascertained the effects of sex, age, hypotension, tachycardia, mechanism, Glasgow Coma Scale, ISS, and volume of blood transfusion on the likelihood of mortality. Subgroup analyses examined isolated injuries by body regions. Among 95,458 cases (82% male), GSW comprised 46.4% of penetrating traumas. GSW was associated with longer hospital length of stay (4 [2-9] versus 3 [2-5] days), longer intensive care unit length of stay (3 [2-6] versus 2 [2-4] days), and more ventilator days (2 [1-4] versus 2 [1-3]) compared to stab wounds, all P < 0.001. The model determined that GSW was linked to increased odds of mortality compared to stab wounds (odds ratio 4.19, 95% confidence interval 3.55-4.93). GSW was an independent risk factor for acute kidney injury, acute respiratory distress syndrome, venous thromboembolism, sepsis, and surgical site infection. Injury scoring systems based on anatomical or physiological derangements fail to capture the lethality of GSW compared to other mechanisms of penetrating injury. Adjustments in risk stratification and reporting are necessary to reflect the proportion of GSW seen at each trauma center. Improved classification may help providers develop quality processes of care. This information may also help shape public discourse on this highly lethal mechanism. [ABSTRACT FROM AUTHOR]

Urban firearm violence (UFV) is associated with inequities rooted in structural racism and socioeconomic disparities. Social vulnerability index (SVI) is a composite measure that encompasses both. We sought to understand the relationship between SVI and the incidence of UFV in Chicago using geospatial analysis for the first time. Firearm assaults in Chicago 2001-2019 were obtained from the Trace. Locations of incidents were geocoded using ArcGIS and overlaid with census tract vector files. These data were linked to 2018 SVI measures obtained from the Center for Disease Control and Prevention. Shooting rates were calculated by tabulating the total number of shootings per capita in each census tract. We used Poisson regression with robust error variance to estimate the incident rate of UFV in different levels of social vulnerability and Local Moran's I to evaluate spatial autocorrelation. In total, 642 census tracts were analyzed. The median shooting rate was 2.6 per 1000 people (interquartile 0.77, 7.0). When compared to those census tracts with very low SVI, census tracts with low SVI had a 1.7-time increased incident rate of shootings (incidence rate ratio [IRR] 1.74, 95% CI 1.08, 2.81), tracts with moderate SVI had a 3.1-time increased incident rate (IRR 3.07, 95% CI 2.31, 4.10), and tracts with high SVI had a 7-time increased incident rate (IRR 7.03, 95% CI 5.45, 9.07). In Chicago, social vulnerability has a significant association with rates of firearm violence, providing a focus point for policy intervention to address high rates of interpersonal violence in similar cities. [ABSTRACT FROM AUTHOR]