State and Local Prevalence of Firearms Ownership: Measurement, Structure, and Trends

Of the readily computed proxies for the prevalence of gun ownership, one, the percentage of suicides committed with a gun, performs consistently better than the others in cross-section comparisons. It is readily computed for states and counties and has a high degree of validity when tested against survey-based estimates. It also appears valid as a proxy for changes over time in gun prevalence, at least at the regional level. Our analysis of this proxy measure for the period 1979-1997 demonstrates that the geographic structure of gun ownership has been highly stable. That structure is closely linked to rural tradition. There is, however, some tendency toward homogenization over this period, with high-prevalence states trending down and low-prevalence states trending up.

Identifying and Tracking Gas Suicides in the U.S. Using the National Violent Death Reporting System, 2005–2012

IntroductionIdentifying the source and specific type of gas used in suicides is difficult using most data systems owing to limitations in ICD-10 coding. The National Violent Death Reporting System (NVDRS), with its rich collection of both coded and free-text variables, has the potential to overcome these limitations. This study used a multipronged approach to identify gas-specific suicides in NVDRS and to track the incidence of these suicides over time.MethodsUsing suicide cases from the 16 NVDRS states that participated throughout 2005–2012, free-text and code searches were conducted for four types of variables—incident narratives, coroner/medical examiner cause-of-death statements, cause-of-death codes, and substance names—to identify suicides by carbon monoxide, helium, hydrogen sulfide, and four other gases. All analyses were conducted in 2015.ResultsApproximately 4% (3,242 of 80,715) of suicides recorded in NVDRS over the study period were the result of gas inhalation. Of these, the majority (73%) were carbon monoxide suicides (almost exclusively from motor vehicle exhaust and charcoal burning). Other types of gas (most notably helium), once rare, are now more common: At the start of the study period non–carbon monoxide gas suicides represented 15% of all gas suicides; at the end of the study period, they represented 40%.ConclusionsPublic health policies to reduce a suicidal person’s access to more lethal suicide methods require a reliable source of surveillance data on specific methods used in suicide. Small changes to NVDRS could make it an efficient and nimble surveillance system for tracking these deaths

Opioid Analgesics and the Risk of Fractures in Older Adults with Arthritis: OPIOIDS AND FRACTURES IN OLDER ADULTS

To compare the risk of fracture associated with initiating opioids vs. non-steroidal anti-inflammatory drugs (NSAIDs), and the variation in risk by opioid dose, duration of action, and duration of use

Antidepressant Dose, Age, and the Risk of Deliberate Self-harm

IMPORTANCE A comprehensive meta-analysis of randomized trial data suggests that suicidal behavior is twice as likely when children and young adults are randomized to antidepressants compared with when they are randomized to placebo. Drug-related risk was not elevated for adults older than 24 years. To our knowledge, no study to date has examined whether the risk of suicidal behavior is related to antidepressant dose, and if so, whether risk depends on a patient's age. OBJECTIVE To assess the risk of deliberate self-harm by antidepressant dose, by age group. DESIGN, SETTING, AND PARTICIPANTS This was a propensity score-matched cohort study using population-based health care utilization data from 162 625 US residents with depression ages 10 to 64 years who initiated antidepressant therapy with selective serotonin reuptake inhibitors at modal or at higher than modal doses from January 1,1998, through December 31.2010. MAIN OUTCOMES AND MEASURES International Classification of Diseases, Ninth Revision (ICD-9) external cause of injury codes E950.x-E958.x (deliberate self-harm). RESULTS The rate of deliberate self-harm among children and adults 24 years of age or younger who initiated high-dose therapy was approximately twice as high as among matched patients initiating modal-dose therapy (hazard ratio [HR], 2.2 [95% Cl, 1.6-3.0]), corresponding to approximately 1 additional event for every 150 such patients treated with high-dose (instead of modal-dose) therapy. For adults 25 to 64 years of age, the absolute risk of suicidal behavior was far lower and the effective risk difference null (HR, 1.2 [95% CI, 0.8-1.9]). CONCLUSIONS AND RELEVANCE Children and young adults initiating therapy with antidepressants at high-therapeutic (rather than modal-therapeutic) doses seem to be at heightened risk of deliberate self-harm. Considered in light of recent meta-analyses concluding that the efficacy of antidepressant therapy for youth seems to be modest, and separate evidence that antidepressant dose is generally unrelated to therapeutic efficacy, our findings offer clinicians an additional incentive to avoid initiating pharmacotherapy at high-therapeutic doses and to closely monitor patients starting antidepressants, especially youth, for several months

An Interactive Web-Based Lethal Means Safety Decision Aid for Suicidal Adults (Lock to Live): Pilot Randomized Controlled Trial

BACKGROUND: Counseling to reduce access to lethal means such as firearms and medications is recommended for suicidal adults but does not routinely occur. We developed the Web-based Lock to Live (L2L) decision aid to help suicidal adults and their families choose options for safer home storage. OBJECTIVE: This study aimed to test the feasibility and acceptability of L2L among suicidal adults in emergency departments (EDs). METHODS: At 4 EDs, we enrolled participants (English-speaking, community-dwelling, suicidal adults) in a pilot randomized controlled trial. Participants were randomized in a 13:7 ratio to L2L or control (website with general suicide prevention information) groups and received a 1-week follow-up telephone call. RESULTS: Baseline characteristics were similar between the intervention (n=33) and control (n=16) groups. At baseline, many participants reported having access to firearms (33/49, 67%), medications (46/49, 94%), or both (29/49, 59%). Participants viewed L2L for a median of 6 min (IQR 4-10 min). L2L also had very high acceptability; almost all participants reported that they would recommend it to someone in the same situation, that the options felt realistic, and that L2L was respectful of values about firearms. In an exploratory analysis of this pilot trial, more participants in the L2L group reported reduced firearm access at follow-up, although the differences were not statistically significant. CONCLUSIONS: The L2L decision aid appears feasible and acceptable for use among adults with suicide risk and may be a useful adjunct to lethal means counseling and other suicide prevention interventions. Future large-scale studies are needed to determine the effect on home access to lethal means. TRIAL REGISTRATION: ClinicalTrials.gov NCT03478501; https://clinicaltrials.gov/ct2/show/NCT03478501

Association between neighborhood safety and overweight status among urban adolescents

<p>Abstract</p> <p>Background</p> <p>Neighborhood safety may be an important social environmental determinant of overweight. We examined the relationship between perceived neighborhood safety and overweight status, and assessed the validity of reported neighborhood safety among a representative community sample of urban adolescents (who were racially and ethnically diverse).</p> <p>Methods</p> <p>Data come from the 2006 Boston Youth Survey, a cross-sectional study in which public high school students in Boston, MA completed a pencil-and-paper survey. The study used a two-stage, stratified sampling design whereby schools and then 9^th–12^thgrade classrooms within schools were selected (the analytic sample included 1,140 students). Students reported their perceptions of neighborhood safety and several associated dimensions. With self-reported height and weight data, we computed body mass index (BMI, kg/m²) for the adolescents based on CDC growth charts. Chi-square statistics and corresponding <it>p</it>-values were computed to compare perceived neighborhood safety by the several associated dimensions. Prevalence ratios (PRs) and 95% confidence intervals (CI) were calculated to examine the association between perceived neighborhood safety and the prevalence of overweight status controlling for relevant covariates and school site.</p> <p>Results</p> <p>More than one-third (35.6%) of students said they always felt safe in their neighborhood, 43.9% said they sometimes felt safe, 11.6% rarely felt safe, and 8.9% never felt safe. Those students who reported that they rarely or never feel safe in their neighborhoods were more likely than those who said they always or sometimes feel safe to believe that gang violence was a serious problem in their neighborhood or school (68.0% vs. 44.1%, <it>p </it>< 0.001), and to have seen someone in their neighborhood assaulted with a weapon (other than a firearm) in the past 12 months (17.8% vs. 11.3%, <it>p </it>= 0.025). In the fully adjusted model (including grade and school) stratified by race/ethnicity, we found a statistically significant association between feeling unsafe in one's own neighborhood and overweight status among those in the Other race/ethnicity group [(PR = 1.56, (95% CI: 1.02, 2.40)].</p> <p>Conclusion</p> <p>Data suggest that perception of neighborhood safety may be associated with overweight status among urban adolescents in certain racial/ethnic groups. Policies and programs to address neighborhood safety may also be preventive for adolescent overweight.</p

Guns and Suicide among Black Americans

Suicide is a growing cause of premature mortality among Black Americans, with suicide rates increasing 39% overall and 62% among those aged 15-29 over the past decade. About half of all Black (and white) suicides are with firearms. Among Blacks, suicide rates are highest among those in their 20s, and people under the age of 30 make up 40% of suicide decedents; among Whites, rates are highest among the middle-aged, and people under the age of 30 made up just 18% of suicide decedents. Individual-level studies have found that living in a home with guns increases the risk of suicide death (Anglemyer, 2014). Ecologic studies have used estimates of levels of household gun ownership (sometimes survey-based, sometimes proxies) to examine the relationship between household gun ownership with suicide rates across regions, states and cities. These studies find that in places where there are more guns, more people die by suicide, due to higher rates of firearm suicide (Siegel, 2016; Opoliner, 2014; Miller, 2015; Birckmayer, 2001; Miller, 2002; Hemenway, 2002; Miller, 2004; Miller, 2006). Few such studies, however, have disaggregated by race (Riddell, 2018; Kubrin, 2009), and the one study that addressed Black suicide at the state level did so only in a limited way. In this study, we will use publicly available mortality data, census data, crime data and survey data from the CDC’s large Behavioral Risk Factor Surveillance System to create a state-level data set that will allow us to explore the extent to which state level overall, white and black firearm ownership (measured directly via the BRFSS or indirectly (through proxies) is associated with rates of Black suicide (by firearms and overall), by age group

2001) “State and Local Prevalence of Firearms Ownership: Measurement, Structure, and Trends

The authors wish to thank Dr. Huiyun Xiang of the Colorado Department of Public Health and the many BRFSS coordinators who provided us with data and information. David Hemenway and Jens Ludwig offered valuable suggestions on earlier drafts. Our research assistant was Jason Powell. The authors made equal contributions to this article. The views expressed herein are those of the authors and not necessarily those of the National Bureau of Economic Research