Violence and Public and Personal Health: Outcomes of Adverse Childhood Experiences

Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium. Adverse childhood experiences include direct abuse, such as emotional, physical, or sexual abuse; neglect, which can be emotional or physical; and family or household problems. Exposure to violence is one of several types of adverse childhood experiences that can affect individuals for the rest of their lives. The effects of exposure to violence during childhood include associated physical and mental health conditions, as well as concerns about involvement in intimate partner violence in adulthood. Family physicians can aid in the prevention of and response to adverse childhood experiences in several ways. On an individual level, they can assess patients for such experiences and provide trauma-informed care. They also can educate children and their parents and caregivers about exposure to violence and adverse childhood experiences. On a societal level, they can advocate for safer media, communities, schools, and home environments for children and adolescents. Early results of studies of physician education in this area have yielded promising results

The agitated patient: Steps to take, how to stay safe.

Situations involving agitated patients are not uncommon in health care settings. And no matter where on the spectrum an incident involving an agitated patient falls, it can leave those involved with various levels of physical, emotional, and psychological harm. It can also leave everyone asking themselves: How can I better prepare for such occurrences? This article offers some answers by providing tips and guidelines for handling agitated and/or violent patients in various settings

Violence and Public and Personal Health: Gun Violence

Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium. The rate of death due to guns is higher in the United States than in other high-income countries. More than 200 Americans are murdered or assaulted with a firearm daily. In the United States, more than 300,000 individuals have died from firearm injuries in the past decade. Firearm injuries cost more than $3 billion per year, and deaths from guns cause more than$20 billion in lifetime work loss and medical costs. Risk factors for being a perpetrator of gun violence include a personal history of or exposure to individuals with violent tendencies, untreated mental disorders, substance abuse, and access to weapons. Physicians can screen patients for risk of firearm-related injury and share strategies to prevent injury and death in the home. Health care-based interventions may increase rates of safe storage of firearms for high-risk groups. Standardized protocols can assist with responses to violent threats in the medical workplace. Various laws have been proposed to prevent gun violence in communities. Laws involving universal background checks and identification requirements at the time of gun purchase have been shown to be most closely related to decreases in mortality rates

Violence and Public and Personal Health: Sexual Violence, Sexual Assault, and Sex Trafficking

Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium. In the United States, approximately 1 in 5 women will experience a sexual assault in her lifetime. In most reported cases, men are identified as perpetrators regardless of the sex of the individual assaulted. There typically is some form of relationship between the survivor and the perpetrator-whether it be an acquaintance, friend, family member, or authority figure. As such, female patients should be asked routinely about a history of sexual assault, particularly if the patient reports relevant physical symptoms and/or substance abuse. Factors that could lead to children experiencing sexual assault (particularly via domestic minor sex trafficking) include a history of abuse, substance use, mental health issues, family dysfunction, and the involvement of Child Protective Services. Short-term goals of primary care include management of physical injuries and psychological needs, evaluation for pregnancy, and prevention of sexually transmitted infections. Long-term effects may include sexual dysfunction, mental disorders (eg, depression, posttraumatic stress disorder), and medical symptoms (eg, chronic headache, infections)

Violence and Public and Personal Health: Intimate Partner Violence

Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium. Intimate partner violence (IPV) refers to abuse (eg, physical, financial, emotional, sexual, contraceptive, reproductive abuse; stalking; coercion) perpetrated by an individual with whom a patient has, or previously had, a personal and/or sexual relationship. IPV is a global public health concern that affects individuals in all categories of socioeconomic status, sex, age, race/ethnicity, and sexual orientation. The U.S. Preventive Services Task Force recommends screening for IPV in all women of childbearing age. Additional red flag signs and symptoms may signal that further investigation is needed. If IPV is identified, the physician should assess basic patient safety, provide referrals, and document details appropriately. Mandatory reporting laws for IPV vary among states in the United States. The approach to prevention of IPV includes a focus on educating patients from a young age about healthy relationships as well as education of physicians and other clinicians about signs of IPV and how to intervene with patients. At a societal level, promotion of stable, nurturing early environments and relationships for children and enactment of laws to support such environments are essential