Charles C. Branas

State Firearm Laws and Interstate Firearm Deaths From Homicide and Suicide in the United States: A Cross-Sectional Analysis of Data by County

Importance Firearm laws in one state may be associated with increased firearm death rates from homicide and suicide in neighboring states. Objective To determine whether counties located closer to states with lenient firearm policies have higher firearm death rates. Design, Setting, and Participants This cross-sectional study of firearm death rates by county for January 2010 to December 2014 examined data from the US Centers for Disease Control and Prevention for firearm suicide and homicide decedents for 3108 counties in the 48 contiguous states of the United States. Exposures Each county was assigned 2 scores, a state policy score (range, 0-12) based on the strength of its state firearm laws, and an interstate policy score (range, −1.33 to 8.31) based on the sum of population-weighted and distance-decayed policy scores for all other states. Counties were divided into those with low, medium, and high home state and interstate policy scores. Main Outcomes and Measures County-level rates of firearm, nonfirearm, and total homicide and suicide. With multilevel Bayesian spatial Poisson models, we generated incidence rate ratios (IRR) comparing incidence rates between each group of counties and the reference group, counties with high home state and high interstate policy scores. Results Stronger firearm laws in a state were associated with lower firearm suicide rates and lower overall suicide rates regardless of the strength of the other states’ laws. Counties with low state scores had the highest rates of firearm suicide. Rates were similar across levels of interstate policy score (low: IRR, 1.34; 95% credible interval [CI], 1.11-1.65; medium: IRR, 1.36, (95% CI, 1.15-1.65; and high: IRR, 1.43; 95% CI, 1.20-1.73). Counties with low state and low or medium interstate policy scores had the highest rates of firearm homicide. Counties with low home state and interstate scores had higher firearm homicide rates (IRR, 1.38; 95% CI, 1.02-1.88) and overall homicide rates (IRR, 1.32; 95% CI, 1.03-1.67). Counties in states with low firearm policy scores had lower rates of firearm homicide only if the interstate firearm policy score was high. Conclusions and Relevance Strong state firearm policies were associated with lower suicide rates regardless of other states’ laws. Strong policies were associated with lower homicide rates, and strong interstate policies were also associated with lower homicide rates, where home state policies were permissive. Strengthening state firearm policies may prevent firearm suicide and homicide, with benefits that may extend beyond state lines.

Racial Differences in Geographic Access to Medical Care as Measured by Patient Report and Geographic Information Systems

Background: Geographic access—the travel burden required to reach medical care—is an important aspect of care. Studies, which typically rely on geographic information system (GIS) calculated travel times, have found some evidence of racial disparities in spatial access to care. However, the validity of these studies depends on the accuracy of travel times by patient race. Objectives: To determine if there are racial differences when comparing patient-reported and GIS-calculated travel times. Research Design: Data came from the Philadelphia Area Prostate Cancer Access Study (P2 Access), a cohort study of men diagnosed with localized prostate cancer. We conducted cross-sectional analysis of 2136 men using multivariable linear mixed-effects models to examine the effect of race on differences in patient-reported and GIS-calculated travel times to urology and radiation oncology cancer providers. Results: Patient-reported travel times were, on an average, longer than GIS-calculated times. For urology practices, median patient-reported travel times were 12.7 minutes longer than GIS-calculated travel times for blacks versus 7.2 minutes longer for whites. After adjusting for potential confounders, including socioeconomic status and car access, the difference was significantly greater for black patients than white patients (2.0 min; 95% confidence interval, 0.58–3.44). Conclusions: GIS-calculated travel time may underestimate access to care, especially for black patients. Future studies that use GIS-calculated travel times to examine racial disparities in spatial access to care might consider including patient-reported travel times and controlling for factors that might affect the accuracy of GIS-calculated travel times.

A multi-decade joinpoint analysis of firearm injury severity

Background Non-fatal firearm injuries constitute approximately 70% of all firearm trauma injuries in the United States. Patterns of severity of these injuries are poorly understood. We analyzed the overall, age-, sex- and intent-specific temporal trends in the injury severity of firearm hospitalizations from 1993 to 2014. Methods We assessed temporal trends in the severity of patients hospitalized for firearm using Nationwide Inpatient Sample (NIS) data over a 22u2009year period. Firearm hospitalization was identified using assault (E965x), unintentional (E922x), intentional self-harm (E955x), legal (E970) and undetermined (E985x) International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9) codes. Injury severity was measured using the computed New Injury Severity Score (NISS). We used survey weighted means, SD and annual percent change (APC), and joinpoint regression to analyze temporal trends. Results A weighted total of 648u2009662 inpatient admissions for firearm injury were analyzed. Firearm injury severity demonstrated a significant annual increase of 1.4% (95% CI=1.3 to 1.6), and was driven by annual increases among young adults (APC=1.4%, 95% CI=1.3 to 1.5), older adults (APC=1.5%, 95% CI=1.3 to 1.6), female (APC=1.5%, 95% CI=1.3 to 1.6) and male (APC=1.4%, 95% CI=1.3 to 1.6) hospitalizations. The annual increase among assault/legal injuries was 1.4% (95% CI=1.3 to 1.5), similar to unintentional (APC=1.4%, 95% CI=1.3 to 1.6), intentional self-harm (APC=1.5%, 95% CI=1.4 to 1.6) and undetermined (APC=1.4%, 95% CI=1.3 to 1.6). Conclusions The severity of hospitalized firearm injuries increased significantly from 1993 to 2014. This annual increase reflects a move towards hospitalization of more serious injuries, and outpatient management of less serious injuries across the board, suggesting a mounting burden on the US healthcare system. Level of evidence Level IV.

Sleep debt at the community level: impact of age, sex, race/ethnicity and health

OBJECTIVESnInsufficient sleep has become recognized as a pervasive problem in modern society. Sleep debt is a novel measure of sleep adequacy that may be useful in describing those at risk for inadequate sleep. Our objective was to investigate factors that may be associated with sleep debt at the population level, as well as build upon previous data that showed that minority groups may be more likely to have sleep debt.nnnDESIGNnA cross-sectional population phone survey included questions regarding amount of sleep required and amount of sleep achieved. Sleep debt was calculated by subtracting sleep achieved from sleep required.nnnSETTINGnThis study was designed by the Philadelphia Health Management Corporation and conducted over landlines and cell phones.nnnPARTICIPANTSnThe Random Digit Dialing method was used to randomly choose 8,752 adults older than 18 years from several counties in and around Philadelphia to answer questions about sleep.nnnMEASUREMENTSnLogistic regression was performed to test associations between sleep debt and various sociodemographic factors in different population subgroups to identify those at risk for sub-optimal sleep duration.nnnRESULTSnSleep debt was seen to decrease with age, a novel finding that is in contrast with literature suggesting that older adults have poor sleep. Greater sleep debt was also associated with female gender, Hispanic/Latino ethnicity, <40 years of age, self-reported poor health, and increased stress.nnnCONCLUSIONSnAlthough older adults may sleep less as they age, they may also require less sleep to feel rested, resulting in less sleep debt. This and other demographic factors, such as female gender and Hispanic/Latino ethnicity, can be used to identify those at higher risk of inadequate sleep and potentially manage their sleep debt.

Blight Abatement of Vacant Land and Crime in New Orleans

Objectives: In 2005, Hurricane Katrina caused damage in New Orleans, Louisiana, and much of the land in low-resource neighborhoods became vacant and blighted. In 2014, New Orleans launched a program, Fight the Blight, which remediated properties in 6 neighborhoods. Our objective was to examine changes in crime rates near lots that were remediated (ie, debris removed and vegetation mowed). Methods: We used a quasi-experimental design to test whether crime rates changed from preremediation (January 2013–October 2014) to postremediation (July 2016–March 2017) near 204 vacant lots that were remediated compared with 560 control vacant lots that were not remediated between October 2014 and July 2016. We also examined differences between remediated lots that received 1 treatment (n = 64) and those that received ≥2 treatments (n = 140). Results: We found no significant differences between remediated and control lots in levels of violent, property, and domestic crimes from preremediation to postremediation. However, the number of drug crimes per square mile decreased significantly near all remediated lots (5.7% lower; P < .001) compared with control lots, largely driven by the significant decrease (6.4% lower; P < .001) in drug crimes found near lots that received ≥2 treatments. Conclusions: Investing in programs that improve neighborhood environments affected by high rates of physical disorder and vacancy may be a way to decrease violence. However, routine remediation may be needed to increase the public health impact of blight abatement programs in warmer climates, where weeds and vegetation grow rapidly.

Trauma centre synergies can move injury science to effective injury prevention

Since the advent of trauma systems in the USA in the 1960s, the treatment of traumatic injuries has evolved considerably. Although the magnitude of impact differs across geographies and timexa0frames, the value of trauma centres in reducing mortality from a variety of injury mechanisms has now been well documented. A national evaluation of trauma centres found approximately 20%–25%u2009lower mortality in both inpatients and at 1u2009year postdischarge for trauma centre-treated patients compared with those treated in non-trauma centres.1 Compared with these national numbers, motor vehicle crash patients had an adjusted improved survival of 9%2 with a third study that used a meta-analysis approach finding a 15% lowered mortality.3 nnKey features of trauma centres include teams of surgeons and specialists equipped to provide comprehensive medical care through the application of well-developed and timely infrastructure, technology and support personnel. While the criteria for the categorisation of trauma centre capabilities vary across states, …

Arming Schoolteachers: What Do We Know? Where Do We Go From Here?

An editorial is presented which addresses the authors views about a call to arm schoolteachers in America with firearms as a means of preventing school shootings, and it mentions a mass shooting event at a school in Parkland, Florida. Gun violence prevention research is examined, along with the impact that arming teachers might have on child development, student learning, and the school environment. School security is assessed, along with safety measures.

Priorities in Recovering From a Lost Generation of Firearms Research

An editorial is presented which addresses firearms research in America as of 2018, and it mentions gun-related violence in the U.S., media coverage of mass shootings, and school shootings at places such as Marjory Stoneman Douglas High School shooting in Parkland, Florida. Lobbyists for the firearms industry are examined, along with support for gun safety reform. The U.S. Centers for Disease Control and Prevention (CDC) and population health research are assessed.

Alcohol Outlets, Neighborhood Retail Environments, and Pedestrian Injury Risk

BACKGROUNDnAlcohol outlet density has been associated with increased pedestrian injury risk. It is unclear whether this is because alcohol outlets are located in dense retail areas with heavy pedestrian traffic or whether alcohol outlets contribute a unique neighborhood risk. We aimed to compare the pedestrian injury rate around alcohol outlets to the rate around other, similar retail outlets that do not sell alcohol.nnnMETHODSnA spatial analysis was conducted on census block groups in Baltimore City. Data included pedestrian injury emergency medical services (EMS) records from January 1, 2014 to April 15, 2015 (nxa0=xa0848); locations of alcohol outlets licensed for off-premise (nxa0=xa0726) and on-premise consumption (nxa0=xa0531); and corner (nxa0=xa0398) and convenience stores (nxa0=xa0192) that do not sell alcohol. Negative binomial regression was used to determine the relationship between retail outlet count and pedestrian injuries, controlling for key confounding variables. Spatial autocorrelation was also assessed and variable selection adjusted accordingly.nnnRESULTSnEach additional off-premise alcohol outlet was associated with a 12.3% increase in the rate of neighborhood pedestrian injury when controlling for convenience and corner stores and other confounders (incidence rate ratio [IRR]xa0=xa01.123, 95% confidence interval [CI]xa0=xa01.065, 1.184, pxa0<xa00.001). The attributable risk was 4.9% (95% CIxa0=xa00.3, 8.9) or 41 additional injuries. On-premise alcohol outlets were not significant predictors of neighborhood pedestrian injury rate in multivariable models (IRRxa0=xa00.972, 95% CIxa0=xa00.940, 1.004, pxa0=xa00.194).nnnCONCLUSIONSnOff-premise alcohol outlets are associated with pedestrian injury rate, even when controlling for other types of retail outlets. Findings reinforce the importance of alcohol outlets in understanding neighborhood pedestrian injury risk and may provide evidence for informing policy on liquor store licensing, zoning, and enforcement.

Youth's Daily Activities and Situational Triggers of Gunshot Assault in Urban Environments

PURPOSEnAlthough previous research has made progress in identifying individuals predicted to face an elevated risk of being shot, it is not clear how that risk varies within individuals based on the contexts they encounter as they navigate daily life. The current study examines how the convergence of individual risk activity and neighborhood disadvantage and disorder triggers the risk of being shot.nnnMETHODSnUsing a novel geographic information system application, 123 male gunshot assaultxa0victims between 10 and 24xa0years old in Philadelphia, Pennsylvania, described their minute-by-minute movements over the course of the day of the gunshot assault. Through latent class analysis, the primary exposure was real-life circumstance where nine theoretically informed risk factors converged, compared with two other circumstances. Case-crossover analyses of subjects 10-minute segments of full-day activities compared gunshot assault victims at the time of assault with themselves earlier in the day.nnnRESULTSnCompared to when individuals were exposed to minimal situational risk or were mainly exposed to neighborhood disadvantage and disorder, the concurrence of risk activity and neighborhood disadvantage and disorder was associated with a 9.90 (95% CI: 2.72-36.14) and 6.06 (95%xa0CI: 2.78-13.22) times higher risk of being shot. Importantly, the likelihood of being in the high-risk circumstance increased systematically over the course of the day leading up to the time when young individuals were shot.nnnCONCLUSIONSnAfter controlled individuals propensity to be shot (e.g., inherent traits), the concurrence of situational risks emerged as significant triggers of gunshot assault. The findings suggest potential for community-based gunshot violence interventions.