The Case for Enhanced Data Collection of Gun Type

Background: National surveillance systems have differentiated long guns into rifles and shotguns but fail to do so for handgun type. We sought to determine whether specific gun type data could be collected and whether knowledge of specific gun types (rifle, shotgun, pistol, revolver) could be used to distinguish gun homicide victims with respect to important injury parameters such as number of wounds. Methods: Data on gun fatalities over a 5-year period in three communities were abstracted from medical examiner/coroner, police, and crime laboratory records. Results: Gun type was obtained for 92% of 490 guns linked to 405 gun homicides. Handguns were associated with more wounds per gun than long guns (p = 0.001) and more entry wounds per gun than long guns (p = 0.002). Among handguns, pistols were associated with more wounds per gun (p \u3c 0.001) and entry wounds per gun (p = 0.001) than revolvers. These same associations were not found among specific long gun types (i.e., rifles and shotguns). Conclusion: Our findings demonstrate that information about gun type can be obtained and that significant differences exist in wounds per gun between long guns and handguns and between pistols and revolvers. Classification of long guns into rifles and shotguns and handguns into pistols and revolvers should be included in local, regional, and national data collection systems

Recruitment of Community-Residing Youth Into Studies on Aggression

Recruitment of community-based youth into studies is challenging. We examined access issues, minority status, and personal costs of participation for a study of children with aggressive behaviors, designed to identify which ones are at risk for future violent behaviors, to identify protective factors, and to test interventions to reduce aggression. Of 1,038 contacts, 112 declined, 239 could not be re-contacted, and 124 were ineligible. Three hundred and fifty of 563 scheduled child-parent dyads completed intake assessment. Most were recruited through targeted mailings (33%) and community flyers (22%), 12% through regional news advertisement, 8% by Craigslist, and 5% through healthcare providers/clinics. Factors contributing to enrollment rates by zip code showed the percentage of Black residents per zip code and targeted mailings positively contributed (Beta = .200 & .419, respectively) and estimated transit travel time negatively contributed (Beta =.299) to enrollment rates (R2 = 0.562). Targeted mailings proved to be the most efficient strategy in successful recruitment

Effective Trauma Center Partnerships to Address Firearm Injury: A New Paradigm

Background: Firearm violence is the second leading cause of injury-related death. This study examined the use of local trauma centers as lead organizations in their communities to address firearm injury. Methods: Three trauma centers in cities with populations less than 100,000 were linked with a university-based firearm injury research center. A trauma surgeon director and coordinator partnered with communities, recruited and directed advisory boards, established a local firearm injury surveillance system, and informed communities using community-specific profiles. Primary process and outcome measures included completeness of data, development of community-specific profiles, number of data-driven consumer media pieces, number of meetings to inform policy makers, and an analysis of problems encountered. Results: Local trauma centers in smaller communities implemented a firearm injury surveillance system, produced community-specific injury profiles, and engaged community leaders and policy makers to address firearm injury. Community-specific profiles demonstrated consistent firearm suicide rates (6.58–6.82 per 100,000) but variation in firearm homicide rates (1.08–12.5 per 100,000) across sites. There were 63 data-driven media pieces and 18 forums to inform community leaders and policy makers. Completeness of data elements ranged from 57.1% to 100%. Problems experienced were disconnected data sources, multiple data owners, potential for political fallout, limited trauma center data, skills sets of medical professionals, and sustainability. Conclusion: Trauma centers, when provided resources and support, with the model described, can function as lead organizations in partnering with the community to acquire and use community-specific data for local firearm injury prevention

Early childhood mortality in late nineteenth century Philadelphia, determinants of trends and variation

Western nations experienced dramatic declines in mortality levels during the course of industrialization. Attempts to identify the specific processes influencing the nature of these declines have put forward a range of possible factors, which are both numerous and complex. One means of attempting to disentangle these relationships is to focus analysis on selected populations in a single area. Locally-specific studies can provide important detail on the determinants of changes in mortality. Such detail, in conjunction with broader theories based on a national or regional scope, provides an important balance in understanding the mortality transition. This study examines the determinants of early childhood mortality in Philadelphia during the late nineteenth century. Information available for this city provides the opportunity to create a fairly detailed picture of the hazards and advantages of urban life for young children during this period. More specifically these data support a variety of methods for examining the general determinants of early childhood mortality patterns in the city, including both cross-sectional and temporal variations in mortality. During the period of study, many causes of death were ill-defined and a large portion of the decline cannot be attributed to causes that were diagnosed with great specificity. Among older children, significant portions of the decline could be linked to infectious diseases with specific diagnoses. For younger children, the data point toward the importance of diarrheal disease, which exhibited a highly seasonal pattern dominated by summer mortality. This analysis focuses on summer diarrheal mortality. A striking pattern of summer mortality was quite pronounced in the late nineteenth century for infants and one year olds, disappearing in the second decade of the twentieth century. For the period 1860 to 1880, one year olds displayed a decline in summer mortality, while the indices for infants actually increased. Following a period of no decline for either age group between 1880 and 1895, summer mortality began its final stage of decline for infants and one year olds. The relative contributions of breastfeeding, weaning, supplemental foods, water and milk supplies, sanitation and urban infrastructure and public health activities to these observed declines are examined