Firearm Injuries Research Articles

Reinterpreting the NRA’s Eddie Eagle GunSafe® program as a corporate political activity

Abstract Background In the US firearm injuries are the leading cause of death among children and adolescents. However, and despite there being limited evidence to support the adoption of gun safety education programs, firearm industry-funded groups like the National Rifle Association (NRA) promote the delivery of their education-based Eddie Eagle Gunsafe® program while lobbying against other firearm policies less favourable to the firearm industry. The study aimed to address an important research gap by examining how the NRA frame gun ownership, safety and the role of the Eddie Eagle GunSafe® program as an effective firearm safety intervention and whether the design, promotion and delivery of the program serves the corporate political interests of the firearm industry, and if so, how. Methods We conducted a critical analysis of program-related texts and films and the NRA’s practices to promote its legitimacy and effectiveness, guided by the application of published taxonomies of corporate framing and action strategies. Data was collected from the program-specific websites and other NRA outlets to capture the breadth of strategies used to promote their education program. Results The NRA’s practices support the corporate political agenda of the firearm industry. The NRA adopts framing and action strategies that present the presence of firearms in homes and communities as inevitable and normal and the education of children through the delivery of their “lifesaving” program as the common-sense and effective way of keeping children safe from firearm injuries. They make misleading claims about the effectiveness of the program while undermining the credibility of those who advocate for the safety of children and adolescents. Conclusions The ongoing delivery of the Eddie Eagle GunSafe® program needs to be questioned. Policies based on a recognition that children and adolescents are safest when their homes and communities are free of firearms are needed to prevent firearm injuries. Key messages • The NRA makes misleading claims about their program’s effectiveness and distorts understanding of what is needed to prevent firearm injuries and ensure the safety of all children. • The firearm industry needs more attention from the global public health community. Evidenced policy measures that prioritize the prevention of firearm injuries are needed to save children’s lives.

Frequency, Causes and Medico-Legal Aspects of Grievous Injury to the Eye after Physical Assault

Aims: A medicolegal report is prepared by the medicolegal officer in conjunction with an ophthalmologist in cases of physical assault claiming vision loss. The objective was to report the frequency and cause of grievous injury to the eye after a physical assault. Methods: This was a descriptive cross-sectional study, conducted in the Department of Ophthalmology of a tertiary care hospital in Pakistan from October 2019 to August 2022. A total of 378 medicolegal cases were reported in the ophthalmology outpatient. Among them, 285 patients of physical assault were included with consecutive sampling technique. Results: The mean age of the patients was 33.93±12.96 years. The mean reporting time to an ophthalmologist was 4.1±8.2 days. Simple and grievous injuries were found in 278 (97.5%) and 7 (2.4%) cases, respectively. Among the grievous injuries, 4 (57.2%) were close globe injuries and 3 (42.8%) were open globe injuries. Thirteen (4.5%) were malingers. Domestic violence was observed in 82 (28.8%) study subjects. Conclusion: The frequency of grievous injury to the eye is very low (2.4%) in patients with physical assault. The patients of assault-related grievous injury were mostly males, young age, low level of education, and doing manual jobs. Vitrolage with corneal melting, and firearm injury caused the grievous injury in open globe patterns. Vitreous hemorrhage, retinal detachment, macular hole, and secondary glaucoma were seen among close globe patterns. J Bangladesh Coll Phys Surg 2024; 42: 336-341

Exposure to firearm injury and suicide in a rural Pennsylvania county: implications for mental and behavioral health.

To evaluate the association between self-reported gun violence exposures and mental health and behavioral health indicators in a rural population. Using cross-sectional survey responses from 630 residents of a rural county in Pennsylvania, logistic regression models estimate the likelihood of residents indicating moderate or severe levels of health outcomes as a function of gun violence exposure. We control for a series of variables related to gun ownership, behavior, history with firearms and demographic characteristics. Personal firearm victimization was associated with self-reported depressive symptoms and interrupted sleep. Secondary exposure to firearm violence, particularly exposure to friends attempting or completing a suicide, was associated with higher odds of reporting severe levels (14days or more in the past month) of depressive symptoms, anxiety, and poor sleep. For firearm suicide involving a friend or family member, the odds of reporting severe levels of all three outcomes are 3 times greater (OR 2.984, 95% CI 1.457-6.108). For each additional firearm exposure, the odds of experiencing severe levels of mental health and sleep difficulties are 1.4 times greater (OR 1.384, 95% CI 1.115-1.720). Cumulative exposures also increase the odds of reporting binge drinking and drug use. Firearm violence exposure was associated with adverse health indicators in this rural population. Approaches to counter the effects of cumulative firearm exposure and firearm suicide exposure, including reinvigorating community spaces and strengthening social supports, may help to reduce mental health burden in rural communities.

Evaluation Of Characteristic Findings Suggestive Of Manner Of Firearm Injury: An Autopsy Based Retrospective Study

Incidence of deaths due to firearm weapons are rising in developing countries. There are only a few studies published on firearm injury in Gujarat. Pattern wise distribution of firearm injury is largely uncovered. This study is on characteristic findings suggestive of manner of firearm injury. Here a retrospective study of15 years is conducted. In this study, young aged males are affected the most as they are socially most active so are having high probability of interpersonal violence.On the spot death of the victim is observed in 85% cases. Rifled firearm is most commonly used. Single shot observed in majority of cases. Homicide is observed more than suicide.Stricter legislation on the ownership and use of firearm weapon is needed. Increase in suicidal pattern in police officials by using firearm weapon is major concern and proper psychological evaluation with mental support will definitely reduce this mortality.

Using EMS data to explore community-level factors associated with firearm violence in North Carolina

BackgroundFirearm violence is a significant public health issue. However, it is unclear if there is an association between the Social Vulnerability Index (SVI) and the intent of both fatal and nonfatal firearm injuries, and if these associations are modified by community race and ethnic composition. This study examines the association between community-level social vulnerability and firearm injury incidence in North Carolina (NC) using 2021–2022 emergency medical services (EMS) data. Additionally, it investigates how these associations vary by the intent of injury (assault, self-inflicted, and unintentional), and whether they are modified by community racial/ethnic composition.MethodsThis cross-sectional study utilized NC EMS data, capturing firearm incidents from January 1, 2021, to December 31, 2022. The SVI from the Centers for Disease Control and Prevention (CDC) was used to assess community-level vulnerability. The SVI’s racial/ethnic minority status component was removed for stratification analysis. Firearm injury rates were calculated per 100,000 population, and negative binomial regression models were used to estimate Incidence Rate Ratios (IRRs) for different SVI levels and intents of firearm injuries.ResultsDuring the study period, we identified 7,250 EMS encounters at non-healthcare locations related to firearm injuries, encompassing 2,648 NC census tracts. Assault was the leading cause of firearm injuries (n = 3,799), followed by self-inflicted (n = 1,498), and unintentional injuries (n = 722). High-SVI communities had significantly higher rates of firearm injuries compared to low-SVI communities, particularly for assault-related injuries. When the minority status component was excluded from SVI, racial/ethnic minority status emerged as a significant modifier, with higher rates of firearm injuries being observed in communities with larger racial/ethnic minority populations.ConclusionCommunity-level social vulnerability is significantly associated with firearm injury incidence, with the effect being more pronounced in racial/ethnic minority communities. These findings underscore the need for targeted public health interventions that address underlying social determinants of health (e.g., access to education) to reduce firearm violence. Future research should further explore the intersection of social vulnerability and racial/ethnic composition to develop effective prevention strategies.

Racial disparities persist in mortality after firearm assault injuries: A national analysis of the Trauma Quality Improvement Program database

ObjectivesIt is unclear whether improvements in the delivery of trauma care over the last decade have diminished racial disparities in mortality after firearm injuries. MethodsThe American College of Surgeons Trauma Quality Improvement Program was queried for patients (≥18 years old) who experienced penetrating firearm assault injuries between 2008 and 2018. Multivariable logistic regression was used to assess the association between mortality and race, controlling for demographics, comorbidities, shock index, injury severity score injury location, and hospital characteristics. ResultsThis retrospective cohort study included 261,116 patients who experienced firearm injuries secondary to assault between 2008 and 2018. Patients most frequently identified as Black (64.1%, n = 167,494), followed by White (16.3%, n = 42,649), Hispanic/Latino (15.7%, n = 41,044), and other racial groups (3.8%, n = 9,929). On multivariable logistic regression, Black patients (odds ratio, 1.53; 95% confidence interval, 1.45–1.62), and Hispanic/Latino patients (odds ratio, 1.11; 95% confidence interval, 1.03–1.19) were more likely to die after a firearm assault injury than White patients. Black patients were more likely to die in the emergency department (62.2%, n = 13,438) compared with White patients (52.7%, n = 2,838), Hispanic/Latino patients (53.0%, n = 2,635), and patients of other races (54.8%, n = 681). Across all years of the study period, Black patients had a greater risk-adjusted mortality rate than White patients and Hispanic/Latino patients. ConclusionSignificant racial disparities in mortality after firearm assault continue to persist. Early death within the emergency department appears to be a significant driver of these persistent disparities.

Development, dissemination and survey evaluation of layered education for healthcare professionals to support implementation of firearm injury and mortality prevention strategies in emergency care settings, New York, USA

BackgroundThere 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...

Firearm-related Hospitalizations and Newly Acquired Morbidities in Children and Adolescents: A Nationally Representative Study

BackgroundFirearm injury is the leading cause of pediatric death in the United States (US), but few investigations have focused on the healthcare cost and burden of hospitalized survivors. We aimed to delineate the landscape of pediatric firearm hospitalizations, with a focus on sociodemographic characteristics and on acquired morbidity among survivors. MethodsWe performed a retrospective cohort study of hospitalized children (<21 years old) with firearm injuries using the 2019 Kids’ Inpatient Database, representing 80% of pediatric hospitalizations nationally. ResultsThere were 5998 hospitalizations with 5592 hospital survivors, giving a US population-adjusted hospitalization rate of 9.7 per 100,000 subjects <21 years. Black subjects (37.9 per 100,000) were admitted at higher rates than other races and ethnicities (3.8–6.2 per 100,000). Non-survivors were overrepresented in White subjects who were disproportionately victims of suicide. There were 199 new invasive medical devices placed (3.3% of hospitalized subjects), including 194 in 5592 survivors (3.5% of survivors): 87 tracheostomies, 30 feeding tubes, and 77 both. Suicide attempt was overrepresented as a cause of injury in subjects needing new devices. Charges and length of stay were longer for subjects needing new devices. Total charges for all hospitalized subjects exceeded $1.05 billion for 2019, $136 million (13%) of which represented the 3.3% of admissions needing new devices. ConclusionsAmong pediatric firearm hospitalizations in 2019, Black children were overrepresented among assaults, and White children for suicide attempts. Suicide attempts were overrepresented among non-survivors, those requiring new devices, and contributed disproportionately to total hospital charges. Level of EvidenceLevel 3.

Interactive associations of cannabis and alcohol outlet densities with assault injuries in California: A spatiotemporal analysis.

Recreational cannabis outlets may influence rates of interpersonal violence, but research has yielded inconsistent findings. Modification by alcohol outlet density may help explain inconsistencies. We estimated the impacts of recreational cannabis outlets on neighborhood-level assault injury rates in California and evaluated whether alcohol outlet density moderated these associations. We applied Bayesian spatiotemporal analyses to ZIP code-level statewide data on alcohol outlets, recreational cannabis outlets, and injuries and deaths due to firearm and nonfirearm assault, 2017-2019, accounting for confounders and spatial autocorrelation. Using the model posteriors, we estimated parameters corresponding to hypothetical shifts in outlet densities, overall and by age, sex, and race/ethnicity. If recreational cannabis outlets were never introduced, we estimated that nonfirearm assault injuries would have been 1.63 per 100,000 lower (95%CI: -3.08, 0.01) but we observed no association with firearm assault injuries (RD per 100,000: -0.07; 95%CI: -0.34, 0.21). These associations did not depend on alcohol outlet density, but a hypothetical 20% reduction in alcohol outlet densities was associated with fewer firearm (RD per 100,000: -1.89; 95%CI: -0.46, 0.09) and nonfirearm (RD per 100,000: -5.67; 95%CI: -7.44, -3.95) assault injuries. The introduction of recreational cannabis outlets may have contributed to a small increase in nonfirearm assault injuries.

At Home and at Risk: A Study on Pediatric Unintentional Firearm Injuries in the USA

Aim of the studyFirearm injury is the leading cause of death among pediatric patients in the United States. Unintentional firearm injury remains underexplored compared to intentional firearm injury. This study aims to characterize risk factors and demographics associated with pediatric unintentional firearm injury. MethodsRetrospective analysis of pediatric patients (≤18 years) with firearm injuries from 2017-2022 using the ACS National Trauma Databank. Firearm injuries were identified via ICD-10 codes, classified by intent, and place of injury. Analysis involved univariate, multivariate, and regression models to identify factors associated with unintentional injury. ResultsOf the 42,152 pediatric firearm injuries, 17.6% (n = 8043) were unintentional. Predominantly occurring at home (56.2%), these injuries mostly involved Black (45.7%) or White (42.0%) males (82.3%) aged 12-18 (74.1%). Children aged 2-5 experienced a higher number of unintentional injuries than intentional (1,064 vs. 770). Unintentional injuries were less severe (ISS >16: 10.9% vs. 17.3%, p<0.001) and less fatal (6.7% vs. 12.6%, p<0.001) compared to intentional injuries. Children aged 2-5 had higher odds of unintentional injury (OR 1.98, p<0.001), while adolescents aged 12-18 had lower odds (OR 0.32, p<0.001). Injuries at home were associated with higher odds of being unintentional (OR 1.61, p<0.001), while those on streets or roads were more likely intentional (OR 0.34, p<0.001). ConclusionsUnintentional firearm injuries, while less severe and fatal, represent a substantial proportion of pediatric firearm trauma in the U.S. These injuries pose significant risks to younger children, often in domestic settings. Levels of EvidenceIII

Nonfatal Firearm Injury & Subsequent Emergency Department Utilization Among Non-Elderly Adults

IntroductionThe mortality, long-term morbidity, and exacerbated healthcare needs due to firearm injury in the US are significant and growing. However, the relationship between exposure to a nonfatal firearm injury and long-term ED utilization is poorly understood. This study estimates the association between exposure to a nonfatal firearm injury and ED utilization in the subsequent year. MethodsUsing all-payer ED data among non-elderly adults in Georgia and New York, all ED visits for nonfatal firearm injuries from 2017-2018 were identified. Sociodemographic, clinical, and contextual characteristics between nonfatal firearm injury ED patients and the broader population of ED users were compared. ED utilization in the year following a nonfatal firearm injury relative to ED use in the year before, and compared to ED use by a propensity score matched control group was examined, using Poisson and negative binomial multivariable regressions. Analyses were performed in 2024. ResultsNonfatal firearm injury ED patients were disproportionately male, younger, non-Hispanic Black, uninsured, and residents of areas with low median income and high firearm ownership. Compared to a matched control group, multivariable analyses indicated that nonfatal firearm injury ED patients had significantly higher risks of having hospital admissions through the ED (aRR: 1.42), all-cause injury-related ED visits (aRR: 1.47), non-firearm injury-related ED visits (aRR: 1.26), and additional nonfatal firearm injury-related ED visits (aRR: 325.45) in the subsequent year (p<0.001 for all). About one in every eight ED users with a firearm-related injury at index also sought ED care for another nonfatal firearm injury within one year. ConclusionsNonfatal firearm-related injuries contribute to preventable harm, health inequity and increased ED utilization.

The State of Firearm Policy Research in the United States.

Firearm-related deaths lead to the most person-years of life lost in the US. There were 48,830 deaths from homicides and suicides in 2021 alone. Firearm access remains at an all-time high in most states - indicated by record manufacturing, sales, employment in firearm industry, taxes collected from sales, and the number of federal background check applications in 2020 and 2021. Yet, firearm injury is a politically contentious topic to the point of stalling progress on an important public health topic. This politicization led to nearly three decades of federal disinvestment in firearm research; reduced surveillance of firearm-related crime, injury, and death; and degraded data quality. This left generations of researchers with limited epidemiologic tools to conduct firearm policy research, jeopardizing the amount and quality of research conducted. Despite these limitations, research has persisted and promising approaches to reduce firearm morbidity and mortality have been identified. Yet the field has struggled to keep pace with methodological advancements and conceptualizations of racial and ethnic disparities as products of systemic racism. In this commentary, we highlight some existing evidence-informed policies, explicate some limitations in the field, and identify opportunities to address the limitations of prior work to strengthen future capacity for evidence-informed prevention.

Firearm Experiences, Behaviors, and Norms Among Rural Adolescents

Rural adolescents are at high risk for firearm-related injury, yet most existing prevention efforts are informed by research conducted in urban areas. Despite the need to account for rural perspectives, few studies have investigated the unique social ecological context of firearms for rural adolescents or have directly engaged with rural adolescents to understand their views on firearm use. To describe rural adolescents' firearm behaviors and perceptions of firearm-related social norms within their communities, peer groups, and families. This cross-sectional study used a convergent mixed-methods design and involved a community-based participatory research approach. Participants comprised 93 adolescents residing in rural Washington state and enrolled in a county or tribal reservation 4-H youth development program as an intermediate or senior age-level grouping (ie, aged 12-19 years). Adolescents completed a survey and participated in a semistructured focus group or interview between September 1, 2021, and September 30, 2022. Data were analyzed using descriptive and thematic analysis. Individual handgun behavior and peer, family, and community perceptions of firearm-related social norms. The sample included 93 adolescents (mean [SD] age, 15.7 [1.7] years; 49 female participants [52.7%]). Approximately half of participants (52 [55.9%]) had carried a handgun at some point in their lives, with a mean (SD) age at first carry of 10.9 (3.1) years. Primary themes across quantitative and qualitative data focused on social norms (specifically, acceptable and unacceptable ways to engage with firearms, reasons for carrying firearms, and places to carry a firearm). In this cross-sectional study, rural adolescents in 4-H programs generally understood acceptable and unacceptable firearm carrying behaviors, which aligned with state laws. Findings provide context for rural adolescent behaviors such as carrying a firearm predominantly for prosocial reasons (hunting, recreation, and sport) and adult behavior such as carrying for protection of person and personal property. Understanding firearm-related social norms in rural communities holds implications for firearm injury prevention efforts, especially related to enhancing training, developing norms-based prevention approaches, and tailoring efforts to rural settings.

Store safely: A firearm injury prevention strategy for rural families.

Store safely: A firearm injury prevention strategy for rural families.

Gaining Insight: Data Needs for Firearm Injury Prevention Researchers

ABSTRACTBetween 1996 and 2018, there was little federally funded research on gun violence, even though it remains a perennial issue, resulting in considerable loss of life. Advocacy and academic groups piece together data to conduct their research, but the U.S. firearms data infrastructure is limited. A current National Institute of Health (NIH)‐funded coordinating center led by researchers at the University of Michigan aims to help confront that problem. This Quality Improvement (QI) study seeks to uncover the information needs of researchers in firearm injury prevention and community‐based interventions through interviews with public health, medical, and criminal justice researchers. Interviews reveal problems associated with existing databases and infrastructures, as well as what researchers need to support their research. We find fragmented data resources and a lag in public health data availability create obstacles to obtaining many datasets. The researchers also describe problems and opportunities for data harmonization across intervention‐focused studies.

Preinjury and Event-Related Characteristics of Pediatric Firearm Injuries: The American College of Surgeons Firearm Study, United States, March 2021‒February 2022.

Objectives. To assess differences in contextual factors by intent among pediatric firearm injury patients and determine factors associated with data missingness. Methods. We retrospectively queried the American College of Surgeons Firearm Study database (March 1, 2021-February 28, 2022) for patients aged 18 years or younger. We stratified preinjury, firearm-related, and event-related factors by intent and compared them by using Fisher exact, χ2, or 1-way analysis of variance testing. Secondary analysis estimated the adjusted odds of missingness by using generalized linear modeling with binominal logit link. Results. Among 17 395 patients, 2974 (17.1%) were aged 18 years or younger; 1966 (66.1%) were injured by assault, 579 (19.5%) unintentionally, and 76 (2.6%) by self-inflicted means. Most contextual factors differed by intent, including proportion of youths with previous adverse childhood experiences, mental illness, and violent assaults or injury, firearm type and access, perpetrator relationship, and injury location. In adjusted analyses, age, trauma center designation, intent, and admission status were associated with missingness. Conclusions. Contextual factors related to pediatric firearm injury vary by intent. Specific predictors associated with missingness may inform improved future data collection. Public Health Implications. Contextual factors related to pediatric firearm injury can be obtained in a systematic manner nationally to inform targeted interventions. (Am J Public Health. 2024;114(10):1097-1109. https://doi.org/10.2105/AJPH.2024.307754).

Geriatric falls: an enormous economic burden compared to firearms

BackgroundThis study aimed to assess the medical costs, and the combined costs of fatal firearm injury and fatal falls during a 5 year period. While fatal firearm injury represents a...

Collaboration for Firearm Injury Prevention—Asking Questions to Save Lives

Collaboration for Firearm Injury Prevention—Asking Questions to Save Lives

Linking Data on Nonfatal Firearm Injuries in Youths to Assess Disease Burden

This cross-sectional study estimates the incidence of nonfatal firearm injuries among children and young adults after linking patient-level police and trauma registry data.

Emergency Department Visits Among Adolescents for Intentional Assault, Firearm, Poison, and Self-Harm Injuries Before and During the COVID-19 Pandemic in the United States.

Purpose This study aimed to examine changes in adolescent emergency department (ED) visits for firearm, poison, self-harm, and intentional assault injuries before and during the COVID-19 pandemic and to identify sociodemographic factors influencing these variations. Methods Utilizing the Nationwide Emergency Department Sample (NEDS), the study analyzes data for intentional self-harm, poison-related, intentional assaults, and firearm injuries from 2019 to 2021 in adolescents aged 10 to 18 years. A difference-in-differences analysis was conducted to investigate the potential impacts of COVID-19 on injury-associated ED visits, accounting for adjustments related to year, patient factors, and hospital characteristics. Results There was a substantial decline in the number of all ED visits from pre-COVID to during the COVID, but we observed increases in the volume of ED visits for firearm-related injuries (13,248 to 20,611; p-value < 0.0001), poison-related injuries (147,812 to 213,753; p-Value < 0.0001), and intentional self-harm-related injuries (153,297 to 229,591; p-value < 0.0001). Conversely, intentional assault-related injuries decreased (167,614 to 154,940; p-value < 0.0001). During the COVID-19 pandemic, ED visits for intentional self-harm increased by 15% (95% CI = 1.09-1.21), intentional assault by 6% (95% CI = 1.02-1.09), and poison-related injuries by 17% (95% CI = 1.11-1.21) compared to pre-pandemic levels. Racial disparities were observed, with Black individuals having lower odds of self-harm (aOR = 0.63) and poison-related visits (aOR = 0.69) but higher odds of assault-related visits (aOR = 1.40) compared to Whites. Hispanic individuals had fewer ED visits across all injury types, while Native Americans had higher odds across all injury types. Disparities between Black and White individuals in assault-related visits narrowed during the pandemic (aOR = 1.40 to 0.94), but disparities for Native Americans in assault-related injuries widened. Insurance status influenced ED visits, with Medicaid recipients having higher odds of self-harm (aOR = 1.11) but lower odds of assault visits (aOR = 0.82) compared to those with private insurance. Uninsured adolescents had lower odds of self-harm (aOR = 0.85) and poison-related visits (aOR = 0.95), but higher odds of assault-related visits (aOR = 1.17). Gender disparities persisted, with females having higher odds of self-harm (aOR = 1.66) and poison-related visits (aOR = 1.42) but lower odds of assault-related visits (aOR = 0.91) compared to males, with these disparities widening for self-harm and poison-related visits during the pandemic. Conclusions The findings underscore the heightened vulnerability of adolescents to certain injuries during the COVID-19 pandemic. Targeted interventions and policies to support mental health, firearm safety measures, and strategies to prevent poisoning are recommended. Addressing socioeconomic disparitiesis necessary to mitigate the impact of intentional injuries among racially/ethnically diverse adolescents during future pandemics.