This commentary highlights the potential of case–control studies to strengthen the evidence base for injury prevention in low- and middle-income countries (LMICs). We argue that these designs are especially valuable in information-poor settings and across the full spectrum of injury topics—both unintentional and intentional. Our aim is to foster LMIC-led collaborations that build research capacity, support rigorous local studies and generate evidence that can inform policy and practice. We invite interested researchers to join this initiative.
Injuries are a leading cause of death and disability worldwide. The health loss from unintentional and intentional injuries exceeds that from HIV/AIDS, tuberculosis and malaria combined—diseases long recognised as major global health priorities.
Recent data indicate a rising frequency of school shootings over the past two decades. Although these events are relatively rare within the broader context of firearm violence, more than 357 000 students have been exposed to firearm violence in primary and secondary schools since 1999. However, the psychological impacts remain poorly understood. This scoping review synthesises existing evidence and highlights gaps for further research.
A systematic search was conducted across PubMed, PsycINFO, Web of Science and Criminal Justice Abstracts to identify empirical studies on school shootings and mental health outcomes. Inclusion criteria encompassed all publication dates, study designs and populations affected. Key attributes were extracted and analysed from included studies.
Of 2798 studies identified, 84 met inclusion criteria, with 13% being qualitative. Despite covering 19 unique shootings, 40% of the articles focused on Virginia Tech and Northern Illinois University. Most studies were cross-sectional (42%), and students were the primary population studied (80%). Post-traumatic stress disorder (29%) and depression (11%) were the most commonly studied outcomes. Common predictors included age (13%) and trauma history (12%). Higher exposure levels to school shootings, prior trauma and existing mental health conditions were key predictors of adverse mental health outcomes. Social support from family or peers emerged as protective factors.
While findings of this review suggest that there is a substantial impact of school shootings on survivors’ mental health, additional research is needed to encompass impacted communities beyond students, integrate qualitative methods and incorporate longitudinal studies to track mental health outcomes over time.
Falls from beds are a leading cause of unintentional injuries in infants under 1 year of age. While most cases result in mild outcomes, the potential for severe injuries, such as skull fractures or intracranial haemorrhages, exists. Despite the prevalence of these incidents, no systematic review has focused specifically on injuries from bed falls in this specific age.
To evaluate the risk and severity of injuries caused by falls from beds in infants under 1 year of age through a systematic review.
We searched in PubMed, Embase, Cochrane Library and Lilacs Scielo for studies published between 1984 and December 2024.
We included observational studies that reported injuries from falls from beds in infants under 1 year.
We extracted the relevant data from the included study details, recruitment setting, study design, sample size and outcome measures. We conducted a quality assessment using the Newcastle-Ottawa Scale.
Out of 297 initially identified studies, three met inclusion criteria, comprising a total of 2034 infants under 1 year of age. Most falls resulted in minor or no injuries. Warrington et al reported <1% of cases leading to concussion or fractures. Samuel et al identified two cases of intracranial haemorrhage and linear skull fractures without intervention. Kolulu et al observed significant injuries, including skull fractures and cerebral contusions, in 10.2% of infants.
Falls from beds are frequent in infants under 1 year, with most resulting in minor outcomes. However, serious injuries occur in around 5% of infants below 1-year old, emphasising the need for prevention strategies and clinical guidelines for managing post-fall assessments. Further research is required to refine understanding and improve prevention and management practices.
CRD42024626255.
Many home-based interventions have been demonstrated to reduce unintentional and intentional injuries in young children aged 0–4 years, but an understanding of their inclusion in federally-funded home visiting programmes in the USA is needed.
The study team administered a survey to key informants at each of the 21 home visiting models approved for United States Maternal, Infant, and Early Childhood Home Visiting program funding being implemented in 2023. Respondents were based across the United States and in other developed countries. The survey collected information about the content used by models to address unintentional injury, parental health/wellbeing, and child abuse/neglect in children aged 0-4 years.
Completed surveys were returned by all respondents (n=21). Most models reported the inclusion of some unintentional injury, parental health/well-being and child abuse/neglect content. While models on average covered four of the five child abuse/neglect topics listed, only five of the nine topics listed for unintentional injury and parental health/well-being were covered. Among the services used by models to address topics, covering content via standardised curriculum and referrals were the most frequent while less than one-quarter of models (n=5) provided families with safety equipment to address unintentional injury. Less than half of the models evaluated outcomes from their injury prevention services, and no models conducted cost-effectiveness evaluations.
Home visiting programmes are a promising way to reduce injuries in children at high risk, but further development and evaluation of their injury prevention content could increase their impact in the USA.
Adolescent firearm violence poses a serious public health concern. The aim of this study is to explore correlates of access to firearms and firearm carrying patterns among adolescents in 2022. While previous research has documented correlates and risk factors for firearm carrying, the majority of this research has relied on samples collected prior to the COVID-19 pandemic and recent shifts in national patterns of firearm violence.
We analysed data from the 2022 Florida Youth and Substance Use Survey (FYSAS) (N=41 768). Logistic regression models were used to examine associations between demographic, familial, temperamental, and behavioural factors and both ease of perceived firearm access and patterns of firearm carrying.
The results suggest that gender, grade level, race, residential setting, having a parent in the military, delinquency, depression, bullying and substance use are associated with perceived firearm access. In addition, gender, grade level, residential setting, ease of firearm access, delinquency, substance use, and bullying are all associated with firearm carrying.
Our findings suggest a host of demographic features and behavioural factors are associated with both perceived ease of firearm access and patterns of firearm carrying. Implications of these findings for reducing access to firearms is discussed.
Firearm suicides constitute a major public health issue. Policies that enhance economic security and decrease community-level poverty may be effective strategies for reducing risk of firearm suicide. This study examined the association between state minimum wage and firearm suicide.
State minimum wage, obtained from Temple’s Law Atlas and augmented by legal research, was conceptualised using the modified Kaitz Index and a continuous variable centred on the federal minimum wage. State-level suicide counts were obtained from 2000 to 2020 multiple-cause-of-death mortality data from the National Vital Statistics System. Log-linear regressions were conducted to model the associations between state minimum wage and firearm suicides, stratifying by demographic groups. Analyses were conducted in 2023.
A one percentage point increase in a state’s modified Kaitz Index was associated with a 0.3% (95% CI –0.6% to –0.0%) decrease in firearm suicides within a state. A US$1.00 increase in a state’s minimum wage above the federal minimum wage was associated with a 1.4% (95% CI –2.1% to –0.6%) decrease in firearm suicides. When stratified by quartile of firearm ownership, the modified Kaitz Index was associated with decreases in firearm suicides most consistently in the two lowest quartiles.
Increasing a state’s minimum wage may be a policy option to consider as part of a comprehensive approach to reducing firearm suicides. These findings expand the evidence base for how economic policies may be leveraged to reduce firearm suicides.
Too little is known about the effectiveness of efforts to prevent firearm violence. We evaluated California’s Armed and Prohibited Persons System (APPS), which identifies legal purchasers of firearms who have become prohibited persons and seeks to recover all firearms and ammunition to which they have access.
This cluster-randomised pragmatic trial was made possible by APPS’s expansion from a small pilot to a continuing statewide programme. We included 363 California cities, allocated to early (n=187) or later (n=176) intervention in blocks stratified by region within the state, and within region by population and violent crime rate. The study period began 1 February 2015; region-specific end dates ranged from 1 May 2015 to 1 February 2016. Analysis was on an intention-to-treat, difference-in-difference basis using generalised linear mixed models and generalised estimating equations with robust SEs. The population-level primary outcome measures were monthly city-level counts of firearm-related homicides, robberies and aggravated assaults. The primary model was adjusted for stratification variables; city-level population, population density, socioeconomic status and firearm purchasing; year; and month.
Allocation groups were well balanced on baseline characteristics and implementation measures. In adjusted models, allocation to early intervention was not associated with statistically significant differences in any primary outcome measure; these findings were robust to multiple sensitivity analyses. There was some heterogeneity across regions.
The APPS intervention directly affects a very small percentage of the population, limiting its potential for population-level effects. Individual-level analyses may provide a better estimate of the intervention’s effectiveness.
Information on acute traumatic cycling injuries (ATCIs) in the 12 months prior to entry in a cycling race and the predisposing factors have not been well-researched.
Determine factors associated with a history of ATCIs sustained in the previous 12 months by race entrants of a 109 km cycling race.
Descriptive, cross-sectional study on 60 941 Cape Town Cycle Tour race entrants from 2016 to 2020. Data on a history of ATCIs sustained in the previous 12 months were obtained through an online pre-race medical screening questionnaire (mandatory in 2016, and voluntary in 2017–2020). Factors investigated were demographics, cycling/training history and history of chronic disease, collapse, cramping, allergies and regular chronic prescription medication usage. We calculated the prevalence ratio (PR) for reporting a history of an ATCI in the previous 12 months for each category (multiple regression model).
Factors associated with an increased PR for a history of ATCIs gathered from race entrants (34% of the total entrants) were: increased years of participation in distance cycling events >2 hours (PR=1.05 per 5 years of distance cycling, p<0.0001), increased weekly average training/racing distance of a cyclist in the past 12 months (PR=1.11 per 50 km increase in weekly cycling). Other factors were: increased number of chronic diseases reported (PR=1.53, per two additional chronic diseases reported, p<0.0001), history of collapse (PR=1.75, p=0.0005), history of cramping (PR=1.65, p<0.0001) and history of allergies (PR=1.49, p<0.0001).
Subgroups of recreational cyclists at higher risk for ATCIs were identified. This information could assist in developing and implementing future strategies to mitigate ATCIs.
In 2021, among all age groups, falls ranked as the third leading cause of unintentional injury death in the USA. Unlike fatal data, which rely on death certificates as the gold standard, there is not a gold standard for non-fatal data. Non-fatal falls data are often based on insurance claims or administrative billing data. The purpose of our study is to compare three claims databases to estimate rates of unintentional fall-related hospitalisations in 2019, the most recent year of available data across the three sources.
Three databases were used to produce incidence rates of fall-related hospitalisations for the year 2019: (1) Merative MarketScan research databases, (2) Centers for Medicare and Medicaid Services (CMS) data and (3) Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample. Inpatient falls were identified using International Classification of Diseases, 10th Revision, Clinical Modification codes. Incidence rates per 100 000 people were then produced across all three datasets by payer type. Unadjusted incidence rate ratios were estimated with corresponding 95% CIs.
There were wide disparities among fall rates between the three datasets by payer type. HCUP had the highest rate of falls among Medicare (1087.6 per 100 000) and commercial enrollees (74.7 per 100 000), while CMS had the highest rates of falls among Medicaid enrollees (148.0 per 100 000).
This study shows wide variation in fall hospitalisation rates based on the claims data used to estimate rates. This study suggests that database selection is an important consideration when determining incidence of non-fatal falls.
Intentional fire or burn-related deaths are rare in the USA compared with some countries, but do occur, and our knowledge of their epidemiology is limited. The objective of this study is to epidemiologically describe fire or burn-related deaths resulting from violence, including victim and suspected perpetrator characteristics and incident circumstances.
This cross-sectional study uses National Violent Death Reporting System data from 2003 to 2020 to examine violent fire or burn-related deaths among individuals of all ages. Analyses include the following case types: (1) fire or burn-related injuries were immediate, underlying or antecedent cause of death; (2) death resulted from arson; or (3) weapon used was categorised as ‘fire or burns’. Precipitating circumstances were examined by manner of death (ie, suicide, homicide or undetermined intent) using 2 tests, with p values of <0.05 indicating statistical significance.
Among 4395 victims, most were male (64.6%), non-Hispanic white (60.8%) and 20–64 years (72.7%). Deaths by suicide were most common (38.9%), followed by homicides (32.6%) and undetermined deaths (28.5%). Current mental health (53.4%) and substance use problems (15.0%) were common among suicide deaths. One-half (49.8%) of homicide deaths were precipitated by another crime and 19.5% were related to intimate partner violence.
The prevalence of mental health and substance use problems among suicide victims underscores the urgency for targeted prevention strategies and timely interventions. Stressors, such as interpersonal conflicts and financial problems, may contribute to fire or burn-related violent deaths.
There is a lack of evidence on interventions to improve the safety of cycling use in low- and middle-income countries. We investigated the impact of road design and traffic characteristics on the fatality risk of bicyclists.
Our study population is the road sites in the peri-urban areas of New Delhi, India. We used a retrospective, population-based case–control study design. We identified 50 case sites (road locations) where a fatal cycle crash had occurred over a 3-year period. For control sites, we intercepted and interviewed three cyclists at each case site, mapped their route to the crash location using Google Maps and selected one random location on each of those routes as controls. We recorded traffic and road design characteristics at the case and control sites. We used a logistic regression model to estimate ORs of site characteristics.
We found a strong effect of the presence of U-turns on the likelihood of a bicycle fatality, with an OR of 4.4 (95% CI 1.8, 11.5). This effect is robust against multiple sensitivity analyses. We found that the volume of cars is associated with an increased likelihood and that of motorcycles with a reduced likelihood of bicycle fatalities.
Our results indicate that the presence of U-turns is a strong risk factor for bicycle fatalities in Delhi. Given the strong evidence of their impact on the safety of bicyclists, their construction should be discontinued in zones of high bicycle presence.
Femoral shaft fractures tend to be rare among children; however, these injuries are the most common major paediatric injuries treated by orthopaedic surgeons. The purpose of this study is to characterise the demographics and mechanisms of femoral injury associated with consumer products in the age group treated with spica casting, children 6 months to 6 years, to identify areas for injury prevention.
Data from 2012 to 2021 were obtained from the National Electronic Injury Surveillance System maintained by the Consumer Products Safety Commission, documenting emergency department visits for unintentional injuries associated with consumer products. Narrative descriptions were analysed to identify common factors in the injury events such as location, products and mechanisms of action.
From 2012 to 2021, the estimated incidence of femur fractures was 23.5 cases per 100 000 children with no significant difference in yearly frequency. The most common mechanism of injury was a fall with the most frequent fracture sources being bed/bunk beds (16.1%), floor (slips/falls, 9.7%) and trampolines (9.7%). Most fractures occurred at the patient’s home (58.4%). The incidence of injury outside of the home and frequency of fractures involving play structures/trampolines increased with age.
The incidence and demographic characteristics of paediatric femur fractures associated with consumer products have remained consistent over the past 10 years. As home was the most common location of fracture, prevention of femur fractures should focus on caregiver education around high-risk sources of fracture (bed, stairs and trampolines) and manufacturers should consider design alternatives that discourage potential misuse.
This study investigated whether honor ideology, or a belief that one’s reputation must be defended at all costs, is related to firearms ownership in soldiers.
N=301 active-duty soldiers completed online self-report measures in this cross-sectional study.
Honor ideology was higher in soldiers who privately own a firearm compared with those who do not currently own and do not plan to after military separation. Higher honor ideology was correlated with a disbelief that private firearms ownership is related to soldier suicide risk. Levels of honor ideology were equal in soldiers who own a private firearm for protection versus other reasons (eg, hunting, maintaining a collection).
Honor ideology may be related to suicide risk through increased likelihood of owning a private firearm and disbelief in private firearm ownership being related to one’s own suicide risk in soldiers. Honor ideology could be relevant to consider when means safety initiatives are developed for active-duty military personnel.
Road traffic injuries (RTIs) are the leading cause of mortality among children and adolescents. This study aimed to compare clinical characteristics and identify factors associated with severe RTIs based on types of road users among children and adolescents with RTIs.
A retrospective multicentre observational study was conducted using the Emergency Department-based Injury In-depth Surveillance registry in South Korea. A total of 78 021 participants younger than 19 years who presented with RTIs to the participating emergency departments from 2011 to 2021 were classified into four groups: passengers, pedestrians, motorcyclists and bicyclists. Demographic and injury-related factors were analysed using a multivariate logistic regression model to determine associations with severe RTIs, as indicated by the Excess Mortality Ratio-based Injury Severity Score of ≥16. The prevalence of traumatic brain injury (TBI), hospitalisations, intensive care unit (ICU) admissions and severe RTIs among road users was compared.
Head injuries were most prevalent in passengers (55.3%), motorcyclists (46.7%) and bicyclists (50.1%). Motorcyclists exhibited the highest proportion of TBI (8.3%), total admissions (28.8%), ICU admissions (8.2%), severe RTIs (41.0%) and mortality (2.0%). Safety devices significantly reduced severe RTIs in passengers and motorcyclists (adjusted OR (95% CI) 0.77 (0.70 to 0.85) and 0.69 (0.62 to 0.76), respectively.
The distinct clinical characteristics and factors associated with severe RTIs among different road user types in children and adolescents highlight the need for targeted interventions. Tailoring strategies to the specific requirements of each group is essential for effectively mitigating the occurrence of severe RTIs in this vulnerable demographic.
WHO guidance supports implementation of drowning prevention interventions. This study aimed to examine barriers and facilitators of use of WHO guidance on basic swimming and water safety skills in low-resource settings, gathering insights inform codesign of technical resources.
Mixed methods were used comprising WHO guidance gap analysis, participant surveys and thematic analysis of workshop discussions (17 participants and 13 countries). WHO document analysis and analysis of pre-workshop survey responses were combined to identify topic areas where additional guidance was required. Inductive thematic analysis of workshop discussions spanned current practice, challenges and opportunities. Postworkshop anonymous evaluation forms were also analysed.
Four topic areas were identified that required additional technical guidance to support implementation: Site Safety Auditing; Medical Screening of Participants; Informed Consent and Emergency Action Planning. Barriers broadly spanned a lack of trained personnel and equipment as well as a lack of community understanding and varying support from external agencies. Opportunities identified included partnering with local organisations with specific expertise (ie, medical, emergency planning), improving programme administration and challenging traditional community practices (ie, informed consent, superstitions). Participants agreed the workshop would lead to changes in practice, however this remains to be confirmed.
Additional technical resources to address gaps and support implementation were suggested and should now be developed, implemented and evaluated.
This study identified additional technical resources and the development of a community of practice to support effective teaching of school age children swimming and water safety skills in low-resource settings.
Spain has the largest olive-growing area in Europe. The goal of the present research is to evaluate the psychosocial risks faced by workers in the olive groves of Jaén (the largest olive grove region of Spain).
This method consists of 15 questions that analyse a total of 12 variables (mental load, demands, health, etc). A total of 502 questionnaires were completed. The method was performed using a non-stratified (with respect to the location of the growing areas) random selection with ‘Universal Transverse Mercator’ coordinates on a map of Jaen extracted from Andalusia region mapping. Multiple correspondence analysis, the Burt table and descriptive statistics (with a 2 test) have been used to analyse the results.
The responses of all the workers are identified in detail in the Burt table. Olive grove workers, regardless of their characteristics or the type of farm, are at a medium risk level for the different psychosocial factors (around 57% on average). The low-risk level is the next most common (around 36% on average). On average, only 7% of individuals are found at the high-risk level (only intensive olive groves exceed 10% of individuals at this risk level). Using multiple correspondence analysis, a video has been created to demonstrate the relationship between all the categories of all the variables studied from various perspectives in three dimensions. The first dimension captures mainly aspects of the social working environment (relation, recognition, support, compensation, control, mental load), whereas the second dimension captures mainly work demands (rhythm, demands). The third dimension is more about physical status (weight, body mass index).
The risks found will improve injury prevention and are possibly caused by mismanagement of prevention. The extreme drought conditions of the 2022/2023 agricultural season could have affected the demands faced by workers.
Previous research usually focused on high-frequency crash clusters (surrounded by high-frequency crashes), which overlooked outlier locations where high-frequency crashes were surrounded by low-frequency crashes. Neglecting spatiotemporal outliers might overlook critical factors for safety improvements.
Using pedestrian-vehicle crash data in North Carolina from 2007 to 2019, this study proposes an enhanced spatiotemporal analysis framework (combined with Approximate Nearest Neighbour and the Global Moran I index) to distinguish spatiotemporal crash outliers from aggregated/dispersed patterns. Random parameters ordered logit models with heterogeneity in means are used to model ordered injury severities, identify significant factors and explore in-depth heterogeneity across observations.
Likelihood ratio test results indicate significant instability exists in factors across four spatiotemporal patterns: high-low outlier, low-high outlier, high-high cluster and low-low cluster. Also, spatiotemporal variations and shifts in the proportion of crashes that suffer more severe injuries are founded on the marginal effects of several factors. Specific countermeasures and policy guidance are suggested under different patterns. In high-low outliers, drunk drivers increase the probability of more severe crash outcomes in public vehicular areas from 16.3% to 92.8%. Meanwhile, in low-high outliers, 64.8% of the crashes with speed limits between 45 and 75 mph would result in more severe outcomes. By increasing the mean, older pedestrians, drunk pedestrians and urban areas increase this proportion to 91.6%, 87.2% and 78.2%, respectively.
These findings underscore the importance of strengthening alcohol tests and setting safety crossing facilities for older pedestrians in identified high-speed urban areas. All these propose a calling for spatiotemporal outlier investigation in future crash analysis and prevention.
With social restrictions serving as a mitigating factor against the severe consequences of public health emergencies, this study investigates the impact of episodic travel restrictions on road traffic injuries (TIs) in Macao during the pandemic, employing Interrupted Time Series Analysis (ITSA) models.
We used ITSA models, including Bayesian Structured Time Series and Seasonal Autoregressive Integrated Moving Average models, to assess traffic outcomes, particularly focusing on total road traffic crashes (RTCs) and TIs. Predictive models were developed for traffic fatalities, fatal RTCs, RTCs involving injuries and vehicles sustaining damage.
From 2014 to 2020, Macao recorded a total of 99 541 RTCs. Over the study period, there were 32 562 reported injuries. After the outbreak of the epidemic, traffic volume decreased by 53.03%, leading to a 25.54% reduction in RTCs. The severity of crashes also declined, with TIs decreasing by 20.35% compared with the same period in 2019, and fatalities and damaged vehicles decreasing by 37.50% and 26.62%, respectively. Analysis of the interrupted time-series data revealed that the actual number of RTCs after COVID-19 in 2020 was 20% (95% CI: 14% to 26%) lower than expected, and TIs were reduced by 11% (95% CI: 3% to 19%).
This study demonstrates that the implementation of episodic travel restrictions significantly reduced TIs and crashes in Macao, providing crucial insights for traffic management and resource allocation during pandemics. These findings contribute to understanding the dynamic relationship between travel restrictions and road traffic outcomes.
In 2021, a spike in Asian American hate crimes resurged discussion on Asian health disparities. This study describes the association between education and assault among Asian Americans and their subgroups.
This cross-sectional study used individual-level data from the mortality multiple cause-of-death data from the National Center for Health Statistics from 2009 to 2021. Non-Hispanic Asians or Pacific Islanders age>25 years who died from assault (X85–Y09) were disaggregated into Chinese, Japanese, Filipino, Indian, Korean and Vietnamese. The gross proportion of decedents who attained at least bachelor’s degrees was calculated for Asians or Pacific Islanders and each subgroup and compared with data from the National Center for Education Statistics reported in 2016.
Based on US Census estimates in 2016, 55% Chinese, 52% Japanese, 50% Filipino, 56% Korean, 75% Indian and 29% Vietnamese>25 years held at least bachelor’s degrees. Between 2009 and 2021, there were 3495 assault mortalities involving Asians or Pacific Islanders, 22.3% of whom had at least attained bachelor’s degrees. On disaggregating the data, 35.6% Chinese, 27.7% Japanese, 33.2% Filipino, 43.0% Indian, 36.3% Korean and 15% Vietnamese decedents attained at least a bachelor’s degree.
Higher educational attainment is correlated with fewer assault deaths across all Asians. Variation in the proportion of Indian and Vietnamese victims with at least bachelor’s degrees may be explained by significantly different rates of bachelor’s degrees. However, the variation in proportion of Chinese, Japanese, Filipino and Korean victims with at least bachelor’s degrees requires further investigation into underlying factors that contribute to assault disparities.
Extreme risk protection order (ERPO) laws may be effective tools for preventing firearm suicide. Oregon’s ERPO law allows family/household members or law enforcement officers (LEOs) to petition a civil court for an order to temporarily restrict a person’s access to firearms when at imminent risk of harming themselves or others. We analysed Oregon’s ERPO petitions to describe the law’s utilisation for the potential prevention of suicide.
ERPO petitions were obtained from the Oregon Judicial Department. Data were abstracted for the 6-year period after the law took effect (2018–2023). A 20% random sample of records was double-coded. Inter-rater agreement was >80% for key variables. Descriptive analyses were conducted to examine petitions citing suicide risk; cross-tabulations compared suicide-related petitions to those unrelated to suicide.
There were 835 petitions filed and 650 (78%) initially granted. Suicide risk was identified in 516 petitions (62%), 421 of which were initially granted (82%). Suicide-related petitions were more likely to be granted than non-suicide-related petitions (72%; p=0.001). Threats to others were also cited in 80% of suicide-related petitions. LEOs filed 60% and family/household members filed 29% of suicide-related petitions. Concerns cited in suicide-related petitions included substance use (56%) and mental health diagnoses (27%). Respondents were hospitalised or referred for services in 41% of suicide-related petitions.
Oregon’s ERPO law is being used to address firearm suicide risk, but implementation gaps may exist, including missed opportunities for healthcare or other services. Further research examining barriers and facilitators to ERPO use for suicide prevention is needed.
Xylazine, a veterinary sedative and analgesic, has emerged as a novel adulterant in the US illicit drug supply, frequently co-occurring with fentanyl. This study examines trends in fentanyl-xylazine overdose death rates from 2018 to 2023.
This serial cross-sectional study examined death certificates from the CDC WONDER database to identify International Classification of Diseases, 10th Revision codes for overdose deaths likely coinvolving fentanyl (T40.4) and xylazine (T42.7 or T46.5). Crude mortality rates per 100 000 were calculated overall and by sex, race/ethnicity, US Census Divisions and state to examine demographic and geographical trends.
Fentanyl-xylazine deaths increased from 99 in 2018 to 6020 in 2023. Crude mortality rates rose from 0.03 (95% CI 0.02 to 0.04) to 1.80 (95% CI 1.75 to 1.84) per 100 000. In 2023, rates were higher among males than females (2.63 (95% CI 2.55 to 2.71) vs 0.99 (95% CI 0.93 to 1.03) per 100 000), and higher among black than white individuals (3.21 (95% CI 3.04 to 3.38) vs 1.86 (95% CI 1.80 to 1.92) per 100 000). The Middle Atlantic and New England Census Divisions had the highest regional rates at 5.72 (95% CI 5.49 to 5.95) and 4.32 (95% CI 3.99 to 4.65) per 100 000, respectively.
The sharp increase in fentanyl-xylazine deaths, particularly among black individuals, highlights both the growing infiltration of xylazine into the illicit drug supply and persistent structural disparities in addiction treatment. Addressing this escalating epidemic requires routine toxicological testing for xylazine and expanded access to trauma-informed care, harm reduction services and interventions such as naloxone, opioid agonist therapies and wound care.
Drowning causes more than 4500 deaths annually and is the leading cause of death among children aged 1–4 years old in the USA. Isolation pool fencing (ie, four-sided fencing to limit access from all adjoining areas including residences and yards) and use of US Coast Guard-approved life jackets while boating can prevent drowning, but preventable deaths still occur. This study aimed to estimate the annual health and economic burden of drowning likely attributable to inadequate pool fencing and not wearing life jackets while boating to highlight the unrealised value of these known prevention strategies.
A simple mathematical model used the most recent annual number of drowning deaths by decedent age in combination with previous study data to estimate the number of drowning deaths that might have been prevented through: (1) adequate isolation fencing for swimming pools among children aged <5 years old and (2) use of life jackets while boating for people of all ages. Prevention effectiveness estimates of pool fencing and life jackets were based on previous studies. Unit costs for drowning-related medical spending and avoidable mortality using the value of statistical life were from existing sources.
Proper use of swimming pool isolation fencing and always wearing a life jacket while boating could prevent an estimated 348 US drowning deaths and an economic cost of US$4.5 billion per year.
Highlighting the effectiveness of drowning prevention strategies can help inform public attention to this issue and support cost-effective public health decision-making.
Restricting access to means is a highly effective suicide prevention strategy for some methods. We evaluated the effectiveness of nets installed at the Golden Gate Bridge to prevent suicides by jumping at this site.
We used Poisson regression analyses to model suicide before, during and after the installation of safety nets at the Golden Gate Bridge between January 2000 and December 2024. We also modelled the number of times a third party intervened with someone showing signs of imminent suicide risk on the bridge.
There were 681 suicides at the site. There were 2.48 suicides per month before installation of the safety nets, 1.83 during installation and 0.67 after installation. During the installation of the nets, suicides declined by 26% (rate ratio (RR)=0.74, 95% CI 0.60 to 0.90) and after installation by 73% (RR=0.27, 95% CI 0.13 to 0.54). There were 2901 instances where a third party intervened, 8.22 per month before installation, 14.42 during installation and 11.00 after installation. The number of interventions by a third party increased during installation by 75% (RR=1.75, 95% CI 1.62 to 1.90) and after installation by 34% (RR=1.34, 95% CI 1.12 to 1.60).
The early evidence indicates the installation of safety nets on the Golden Gate Bridge is associated with an immediate and substantial reduction in suicides at the site. This finding highlights the value of installing nets on this bridge and the importance of barriers as a strategy to prevent suicides by jumping.
To offer a brief assessment of the association between economic connectedness and violence.
Using data from Facebook’s Social Connectedness Index (SCI), I assess the relationship between social connectivity and homicide and suicide rates, relative to other traditional structural estimates of violence. I further assess whether social connectivity mediates the relationship between economic disadvantages and violence.
Economic connectedness is associated with county-level homicide and suicide rates and has the strongest connection with violence of any of the social connection measures examined. Traditional measures of economic disadvantage explained 57% of the county-level variation in economic connectedness. Economic connectedness in turn mediated a significant proportion of the association between economic disadvantages and both homicide and suicide. Including other control variables, higher economic connectedness was consistently associated with lower rates of violence, irrespective of county rurality, economic disadvantage or firearm availability.
Violence researchers can incorporate a much-needed focus on social capital and cohesiveness into large-scale national studies using SCI data. Economic connectedness specifically may be a significant protective factor for violence, thus incorporating economic connectedness and social connection into violence research may provide support for new violence prevention efforts.
Button battery (BB) injuries in children represent a severe and growing public health burden. The literature on the topic is extensive; however, there is a notable lack of structured public health initiatives addressing the problem. The present study aimed to test the feasibility of using large language models (LLMs) to draft recommendations for preventing and managing BB ingestion in children.
A set of questions was generated and submitted to ChatGPT-4o and ChatGPT-o1-preview. Questions were based on statements and websites of scientific societies and not-for-profit organisations and were developed to produce comprehensive recommendations that provided information on BB risks, primary and secondary prevention, clinical management and follow-up, and general public health initiatives. Two independent reviewers rated the accuracy and readability of the questions submitted to the LLMs. The accuracy was rated using a four-level scale, while the readability was assessed using two established readability tools, the Flesch Reading Ease (FRE) and the Flesch-Kincaid Grade Level (FKGL).
None of the answers provided by the LLMs were rated as completely incorrect or partially incorrect. ChatGPT-o1-preview outperformed ChatGPT-4o in accuracy, with eight answers rated as accurate and complete. Both models showed similar readability levels, with high FKGL and FRE scores indicating college-level comprehension.
LLM demonstrated a strong performance in this study, with no responses rated as incorrect or partially incorrect, showing its great potential and feasibility for use in public health.
The present findings suggested the potential feasibility of LLMs in public health for preventing paediatric injuries.
Firearm injuries and fatalities adversely affect individual and community health and are important public health issues. Identifying factors that protect against firearm violence and related harms is needed. We aimed to identify neighbourhoods with lower-than-expected and higher-than-expected firearm injuries and fatalities based on social vulnerability and their differing structural and social characteristics.
We used Gun Violence Archive data from the RISE Lab Firearm Injury Data Hub to estimate firearm injury and fatality counts between 2015 and 2020 in Pittsburgh, Pennsylvania. We used a negative binomial regression model to estimate the relationship between the Centers for Disease Control and Prevention’s social vulnerability index and firearm injuries and fatalities, and the residual percentile method to identify neighbourhoods with lower (resilient) and higher (at-risk) counts than expected based on social vulnerability. T-tests were used to compare resilient and at-risk neighbourhoods for 158 US Census American Community Survey demographic, socioeconomic, housing and transportation variables.
Resilient neighbourhoods (n=19, bottom quartile residuals) had lower rates of firearm injuries and fatalities (p=0.0002) compared with at-risk neighbourhoods (n=19, top quartile residuals). Resilient and at-risk neighbourhoods differed for 2 (per cent male never married and female widowed) of the variables included in the analyses.
Some neighbourhoods, despite facing risk factors, experienced fewer firearm injuries and fatalities than would be expected based on neighbourhood social vulnerability. Existing sources of secondary data on neighbourhoods may fail to adequately capture potential factors that prevent against firearm violence and to measure resilience in thriving neighbourhoods. Future community-engaged studies are needed to understand and measure neighbourhood-level protective factors.
Youth aged 15–24 experience high rates of firearm homicide and suicide, yet there is limited research on the impact of promising preventative policies, such as firearm purchaser licensing (FPL) laws, among this age group. The purpose of this study was to evaluate the effect of adopting or repealing an FPL law on homicide and suicide among those aged 15–24, by age subgroup (ie, 15–17, 18–20, 21–24).
Mortality data from 1990 to 2019 were obtained from the National Center for Health Statistics. We used augmented synthetic controls to estimate the effect of FPL law adoption in Connecticut and Maryland and repeal in Missouri and Michigan on youth homicide and suicide rates. Analyses were stratified by age subgroup and firearm involvement.
FPL adoption was associated with decreases in firearm homicide and suicide among those aged 15–24 overall and among most age subgroups in Connecticut. FPL repeal was consistently associated with increases in firearm suicide among each age subgroup, with less consistent results for firearm homicide.
FPL law changes had meaningful impacts on firearm homicide and suicide among youth aged 15–24, with consistent protective effects observed following adoption in Connecticut and consistent harmful effects following repeal in Missouri. Mixed results in Maryland and Michigan highlight the importance of policy features and sociopolitical context in shaping the effectiveness of these laws. These findings reinforce the effectiveness of FPL laws as a strategy to reduce firearm-related mortality among youth.
Measuring the impact of non-fatal injuries and violence is essential for informed public health policy-making and communications. This study aimed to generate new health-related quality of life data for a prominent US non-fatal injury surveillance source using disability weights derived from general population survey estimates.
Disability weights reflecting severity as measured on a 0 (no disability) to 1 (death) scale, for 47 natures of injury from the Global Burden of Diseases, Risk Factors and Injuries Study (GBD) were mapped to 492 injury types in the US National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP). The matching of GBD natures of injury to NEISS-AIP injury types was based on the underlying definitions for each injury diagnosis.
The average disability value weighted by incidence for all NEISS-AIP types was 0.073 (95% uncertainty interval: 0.050–0.097), and the range by injured body part and diagnosis was 0.006–0.408. Injuries that impacted large or critical body parts (lower trunk, upper trunk, head and neck) had the highest disability weights. Internal injuries, crushing, burns, nerve damage and fractures had higher disability weight values than lacerations, avulsions and contusions. The three most common NEISS-AIP non-fatal injury types during 2015–2020 were poisoning, internal injuries of the head and face lacerations, with disability weights of 0.163 (0.109–0.227), 0.168 (0.112–0.232) and 0.018 (0.010–0.029), respectively.
Mapping of publicly available disability weights data to a prominent non-fatal injury surveillance source can improve opportunities to measure and communicate the health and economic impact of injuries and violence.