Debra Houry

Violence in the United States: Status, Challenges, and Opportunities

IMPORTANCE Interpersonal violence, which includes child abuse and neglect, youth violence, intimate partner violence, sexual violence, and elder abuse, affects millions of US residents each year. However, surveillance systems, programs, and policies to address violence often lack broad, cross-sector collaboration, and there is limited awareness of effective strategies to prevent violence. OBJECTIVES To describe the burden of interpersonal violence in the United States, explore challenges to violence prevention efforts and to identify prevention opportunities. DATA SOURCES We reviewed data from health and law enforcement surveillance systems including the National Vital Statistics System, the Federal Bureau of Investigations Uniform Crime Reports, the US Justice Departments National Crime Victimization Survey, the National Survey of Childrens Exposure to Violence, the National Child Abuse and Neglect Data System, the National Intimate Partner and Sexual Violence Survey, the Youth Risk Behavior Surveillance System, and the National Electronic Injury Surveillance System-All Injury Program. RESULTS Homicide rates have decreased from a peak of 10.7 per 100,000 persons in 1980 to 5.1 per 100,000 in 2013. Aggravated assault rates have decreased from a peak of 442 per 100,000 in 1992 to 242 per 100,000 in 2012. Nevertheless, annually, there are more than 16,000 homicides and 1.6 million nonfatal assault injuries requiring treatment in emergency departments. More than 12 million adults experience intimate partner violence annually and more than 10 million children younger than 18 years experience some form of maltreatment from a caregiver, ranging from neglect to sexual abuse, but only a small percentage of these violent incidents are reported to law enforcement, health care clinicians, or child protective agencies. Moreover, exposure to violence increases vulnerability to a broad range of mental and physical health problems over the life course; for example, meta-analyses indicate that exposure to physical abuse in childhood is associated with a 54% increased odds of depressive disorder, a 78% increased odds of sexually transmitted illness or risky sexual behavior, and a 32% increased odds of obesity. Rates of violence vary by age, geographic location, sex, and race/ethnicity, and significant disparities exist. Homicide is the leading cause of death for non-Hispanic blacks from age 1 through 44 years, whereas it is the fifth most common cause of death among non-Hispanic whites in this age range. Additionally, efforts to understand, prevent, and respond to interpersonal violence have often neglected the degree to which many forms of violence are interconnected at the individual level, across relationships and communities, and even intergenerationally. The most effective violence prevention strategies include parent and family-focused programs, early childhood education, school-based programs, therapeutic or counseling interventions, and public policy. For example, a systematic review of early childhood home visitation programs found a 38.9% reduction in episodes of child maltreatment in intervention participants compared with control participants. CONCLUSIONS AND RELEVANCE Progress has been made in reducing US rates of interpersonal violence even though a significant burden remains. Multiple strategies exist to improve violence prevention efforts, and health care providers are an important part of this solution.

New Data on Opioid Use and Prescribing in the United States

The United States is in the midst of an opioid overdose epidemic. Between 1999 and 2010, prescription opioid–related overdose deaths increased substantially in parallel with increased prescribing of opioids.1 In 2015, opioid-involved drug overdoses accounted for 33 091 deaths, approximately half involving prescription opioids.2 Additionally, an estimated 2 million individuals in the United States have opioid use disorder (addiction) associated with prescription opioids, accounting for an estimated

The CDC Injury Center’s response to the growing public health problem of falls among older adults

78.5 billion in economic costs annually.3 Proven strategies are available to manage chronic pain effectively without opioids, and changing prescribing practices is an important step in addressing the opioid overdose epidemic and its adverse effects on US communities. On July 6, 2017, the US Centers for Disease Control and Prevention reported that between 2006 and 2015 the amount of opioids prescribed in the United States peaked in 2010 at 782 morphine milligram equivalents (MME) per capita and then decreased each year through 2015 to 640 MME per capita. Prescribing rates increased from 72.4 to 81.2 prescriptions per 100 persons between 2006 and 2010, were constant between 2010 and 2012, and then declined to 70.6 per 100 persons from 2012 to 2015, a 13.1% decline.1 Yet the amount of opioids prescribed in 2015 remains more than 3 times higher than in 1999, when the amount prescribed was 180 MME per capita, and is nearly 4 times higher than in Europe in 2015.

Dating violence and injury among youth exposed to violence

Background. Older adult falls are a significant cause of morbidity and mortality in the United States. This leading cause of injury in adults aged 65 and older results in

Announcing the CDC guideline for prescribing opioids for chronic pain

35 billion in direct medical costs. Objective. To project the number of older adult falls by 2030 and the associated lifetime medical cost. A secondary objective is to review what clinicians can do to incorporate falls screening and prevention into their practice for community-dwelling older adults. Methods. Using the Centers for Disease Control and Prevention’s Web-based Injury Statistics Query and Reporting System and the US Census Bureau data, the number of older adults in 2030, fatal falls, and medical costs associated with fall injuries was projected. In addition, evidence-based interventions that can be integrated into clinical practice were reviewed. Results. The number of older adult fatal falls is projected to reach 100 000 per year by 2030 with an associated cost of

The National Violent Death Reporting System

100 billion. By integrating screening for falls risk into clinical practice, reviewing and modifying medications, and recommending vitamin D supplementation, physicians can reduce future falls by nearly 25%. Conclusion. Falls in older adults will continue to rise substantially and become a significant cost to our health care system if we do not begin to focus on prevention in the clinical setting.

TEMPORARY REMOVAL: Emergency Department Implementation of the Centers for Disease Control and Prevention Pediatric Mild Traumatic Brain Injury Guideline Recommendations.

OBJECTIVES: To assess gender differences in the proportion of adolescents reporting teen dating violence (TDV) and the frequency of TDV at multiple age points across adolescence in a high-risk sample of youth with previous exposure to violence. METHODS: A cross-sectional, high-risk sample of boys and girls (n = 1149) ages 11 to 17 years completed surveys assessing TDV and self-defense. Indices of TDV included perpetration and victimization scales of controlling behaviors, psychological TDV, physical TDV, sexual TDV, fear/intimidation, and injury. RESULTS: More girls reported perpetrating psychological and physical TDV, whereas twice as many boys reported sexual TDV perpetration. More girls reported fear/intimidation victimization than boys. When comparing the frequency of TDV across adolescence, boys reported more sexual TDV victimization at younger ages, and girls demonstrated a trend toward more victimization at older ages. Likewise, younger boys reported more fear/intimidation and injury perpetration and injury victimization than younger girls. However, by age 17, girls reported more injury perpetration than boys, and reports of injury victimization and use of self-defense did not differ. Notably, despite potential parity in injury, girls consistently reported more fear/intimidation victimization associated with TDV. CONCLUSIONS: Contrary to data suggesting that girls experience far more sexual TDV and injury, these data suggest that at specific times during adolescence, boys among high-risk populations may be equally at risk for victimization. However, the psychological consequences (fear) are greater for girls. These findings suggest a need to tailor strategies to prevent TDV based on both age- and gender-specific characteristics in high-risk populations.

PW 0673 The changing opioid overdose epidemic in the united states – CDC response

This guideline provides recommendations for primary care providers who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses: (a) when to initiate or continue opioids for chronic pain; (b) opioid selection, dosage, duration, follow-up, and discontinuation; and (c) assessing risk and addressing harms of opioid use. This guideline is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including abuse, dependence, overdose, and death (Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep 2016;65:1-49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1.).

Saving lives and protecting people from injuries and violence

Each and every day in the U.S., more than 160 people die as a result of violence due to homicides and suicides.1 These violent deaths constitute an urgent public health problem. Homicide and suicide, taken together, were the fourth leading cause of years of potential life lost in the U.S. in 2014.2 Each year, more than 55,000 people die in the U.S. as a result of violence-related injuries.3 In 2014, suicide was the tenth leading cause of death, claiming more than 42,000 lives1 and resulting in an economic cost estimated to be

Underlying Factors in Drug Overdose Deaths

53.2 billion, largely associated with lost work productivity.4,5 From 2005 to 2014, the national suicide rate rose for 9 straight years from 10.9 per 100,000 in 2005 to 13.0 per 100,000 in 2014, an increase of more than 18%,6 and now ranks as the second leading cause of death among adolescents and young adults.7,8 Homicide rates in the U.S. have declined over the long term, but are still a major problem resulting in an economic cost estimated at