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Spatial de-concentration of firearm violence in Boston

It is a “law” of criminology that urban crime chronically recurs at the same microplaces (i.e., street segments and intersections). An influential study found high concentrations of firearm violence at micropl…

Education for healthcare professionals and firearm injury

Background

There is consensus on the need and ability to address firearm injury risk in healthcare settings; however, the lack of education for healthcare professionals hinders the implementation of evidence-based firearm injury and mortality prevention strategies. The objectives of this study are to develop, disseminate and evaluate education for team members to facilitate implementation in emergency departments

Method

Two-tiered education was developed in partnership with stakeholders and disseminated to the healthcare team, covering evidence-based screening and interventions for firearm access and violence risk. The implementation, development and dissemination strategies followed the framework used for systemwide Screening, Brief Intervention and Referral to Treatment implementation for substance use. Team members who screened patients for firearm injury risk received screening education and team members meeting with patients who screened positive received intervention education. Participants completed surveys to evaluate the education and learning objectives.

Results

Across three emergency departments from March 2021 to May 2022, 267 team members completed screening education. Key takeaways reported by 173 participants were how to screen (24.9%), the 5L’s of Firearm Safety (19.7%) and the prevalence of firearm injury (11.0%). Participants still had questions about workflow, resources and safety. 34 of 67 (50.7%) intervention education participants completed the postsurvey. 100% were confident they could screen, 79% were confident they could provide brief interventions and 88% were confident their site could implement firearm injury prevention strategies.

Conclusion

Tiered education for firearm injury prevention screening and intervention achieved learning objectives and facilitated programme implementation. Education increased knowledge and confidence regarding firearm injury risk screening and its importance in healthcare settings.

Unintentional firearms mortality disparities across states ’01-21

Background

Firearms kill over 130 Americans daily. Most deaths are the result of intentional acts, but in 2021, 549 deaths (1.5 deaths/day) were unintentional. Strategies to prevent unintentional versus intentional firearms deaths differ. This study describes unintentional firearm-related mortality across the US states and within individual states between 2001 and 2021 and considers factors that might explain disparities across states.

Methods

Unintentional firearms mortality from 2001 to 2021, both for the full country and by state, was obtained online along with data for five state-level predictors: rurality, non-white population, poverty, population and gun ownership.

Results

The highest unintentional firearm-related mortality rates clustered in Southeastern states, followed by states in the Northern Plains and Mountain West. The lowest rates were in the Northeast, followed by scattered states in the West and Midwest. At the state level, unintentional firearms mortality correlated positively with per cent below the poverty level (r=0.54, p<0.01), rural (r=0.59, p<0.01) and owning firearms (r=0.72, p<0.01). In a multivariable regression model predicting unintentional firearms mortality by state, three factors emerged as significant: per cent white (β=–0.22, p<0.05), below the poverty level (β=0.43, p<0.01) and owning firearms (β=0.54, p<0.01).

Conclusions

Large disparities exist across the 50 US states in unintentional firearms mortality. Crude rates in the most afflicted states are ~10 times those in the least afflicted states. Nationwide, over 12 000 lives were lost to unintentional firearms mortality between 2001 and 2021. Factors that create disparities are multifaceted and include rurality, poverty and firearms ownership.

Gun violence exposure and population health inequality

This essay establishes a conceptual framework to understand how direct, secondary and community exposures to gun violence converge to influence population health. Our framework asserts that persistent gun violence in structurally disadvantaged communities enacts broad consequences for mental, physical and behavioural health, operating as a key driver of racial and socioeconomic health disparities. We discuss the applications of this framework for research and improved data collection with a focus on establishing timely and accurate measures of gun violence alongside individual and community health measures. We then address the policy implications of the framework, emphasising the need for long-term, institutional investment in gun violence prevention and intervention, survivor service provision and evidence-based policies at all levels of government.