California Safety Research Articles

Optimism Bias Among Gun Owners: Associations With Firearm Injury Prevention Practices and Policy Support.

Optimism bias is common across health risk assessments, including firearm injury risk, and can have behavioral consequences. Using data from the 2018 California Safety and Wellbeing Survey, we examine whether optimism bias influences firearm injury prevention practices and policy support by comparing the characteristics, behaviors, and opinions of gun owners who believed having a gun at home is comparatively safer for themselves than for similar others (Optimism Bias group) with (1) those who unequivocally believe guns increase safety for themselves and others (Always Safer group), and (2) those who said they "don't know" or "it depends" in both the self and other scenarios (Uncertain group). Weighted multinomial logistic regression results indicated that gun owners in the Optimism Bias group were more often female, members of minoritized racial or ethnic groups, and new gun owners than the Always Safer and Uncertain groups; they also demonstrated greater support for 4 of 5 firearm injury prevention policies/interventions. Despite similar prevalence of owning a gun for protection, gun owners in the Optimism Bias group less often carried a loaded firearm or stored a gun in an unsecure way compared with the Always Safer group. Findings suggest that gun owners characterized by optimism bias, who acknowledged some risk associated with firearms, even if only or more so for others than for themselves, may represent a "movable middle" that is more receptive to firearm injury prevention efforts. Public health messages emphasizing other-oriented (vs. personal) risk and collective responsibility may be perceived as less threatening to the symbolic significance of guns to individual identity, thus enhancing effectiveness.

Challenges and approaches when addressing dementia in the context of chronic comorbid conditions in primary care settings

AbstractBackgroundA diagnosis of dementia impacts all other comorbid conditions and areas of patient care. Yet, in primary care settings, dementia is often underdiagnosed and misdiagnosed due to competing clinical concerns. Delayed diagnosis and care of dementia can lead to more rapid cognitive decline, and increased hospitalizations, health care costs, and mortality. The objective of this work was to understand the challenges and successful approaches among primary care providers working in safety net settings when caring for patients with dementia and co‐existing chronic conditions.MethodsQualitative interviews focused on practices and challenges diagnosing and caring for patients with dementia, challenges related to comorbidities, needs for practice improvement, and successful approaches. Data was analyzed using thematic analysis.ResultsWe interviewed primary care physicians (n = 29) and primary care nurse practitioners (n = 6) based in California safety net settings in the SF Bay Area, Central Valley, and Southern California. PCPs identified the following comorbidities as most challenging to co‐manage with dementia: mental illness (depression/anxiety), hypertension, diabetes, heart disease, stroke, pain, substance use, and trauma. Most PCPs made a distinction between poorly controlled and well‐controlled chronic conditions. Challenges identified included: difficulty differentiating symptoms of dementia from other conditions, medication management and adherence; time constraints when making decisions about prioritizing acute comorbidities or dementia; need for family/caregiver involvement; and challenges controlling comorbid conditions when dementia is present. Successful approaches included: using team‐based care and targeted referrals (e.g. social work, community health workers, geriatrics); the importance of familiarity and long‐term relationships with patients; finding ways to involve family members; and simplifying visits, care plans, and communication.ConclusionPCPs face difficulties when providing care to patients with dementia and comorbid conditions, but they also identified opportunities for improvement by sharing successful approaches used in challenging healthcare settings. Findings can help shape intervention development to better support PCPs.

Fire and Explosion Machine Learning Model for the Port of Los Angeles - California Safety Code and NFPA for Fire-Break Zoning

A correlative Hazard case study of Los Angeles Port has been performed on a tremendous dock fire that occurred on 22nd September 2014 at the Wilmington Dock along with a proposed Machine Learning approach concerning remote sensing techniques, a time-related air quality survey, and port safety codes, which are assessed and based on a modern port governance emergency intervention. The methodology of this research embraces a possible case of high fire severity urban zoning of the Los Angeles Harbour, on the occasion of the severe application of Health and Safety Code Section 18930 by the State Fire Marshal to respond opportunely to the recent extensive ignition across California. Set rules, dispatched by LA Port System, are detected following a Landsat 8/OLI (Operational Land Imager) remote sensing-based geospatial comparison with ground-based air samples. In order to target opportunely risk barriers in favour of Oil Tankers and critical garrisons, an extensive pre-processing calibration of spaceborne datasets has been performed for enhancing minor changes on the platforms. Besides, intrinsic limits of the OLI definition do not permit appropriate accuracy of small-scale evaluations; a decision tree model has been therefore engaged by embracing high variance and low bias of these compensated datasets. In this manner, four Regions of Interest have been marked to strengthen the sub-samples of these features. The flexibility of RF computation delivers positive automation for the missing values, categorical and continuous values; on the other side time consuming and interpretability drawbacks, notice a disadvantage of the implementation in terms of computational training, validation, and testing. In defence of this intervention approach, an air-model geostatistical distribution carried out pixel values based on the pre-burn weighted trained model and finally ensembled to buffer protection zones, according to the Safety Code Section 18930 as an endorsement of further sustainable and financial liabilities that are vital parameters in the post-Covid-sars19 crisis and demonstrate growth limits of Ports as periodically issued to theirs Internal Consistency Analysis. The advisory assessment research moreover a hardware performance to support on-time prediction models, by listing variable dependent regressive accuracy samples.

Decisions to Choose COVID-19 Vaccination by Health Care Workers in a Southern California Safety Net Medical Center Vary by Sociodemographic Factors.

Background: Limited information exists regarding COVID-19 vaccine hesitancy among healthcare workers (HCWs). Our previous survey analyzed the reasons for HCWs’ decisions to accept vaccination, suggesting that a “one-size fits all” approach may not suffice to increase vaccine uptake. Methods: Based on the vaccination acceptance group (acceptor, hesitant, refuser), we examined differences by sociodemographic factors (race/ethnicity, household income, education) from Likert Scale responses to fourteen influences affecting a decision to be vaccinated using the Kruskal–Wallis test and multinomial logistic regression with mutual adjustment for these sociodemographic factors, age, and sex. Results: Non-Hispanic White vaccine acceptors ranked lower confidence in preventing, withstanding, or treating COVID-19, while Non-Hispanic Blacks more highly regarded the motivation of a religious leader, colleague, or family member. Social media was ranked more influential among Non-Hispanic Asians. Acceptors with lower incomes ranked a job requirement influential; conversely, higher income vaccine hesitant HCWs highly rated this reason. More highly educated acceptors ranked being motivated by colleagues, family, and other HCWs higher. Adjustment weakened some but not all the differences between groups. Conclusions: Sociodemographic factors affect HCWs’ decisions to be vaccinated against COVID-19. Our findings may help develop more focused and tailored strategies to improve vaccination acceptance.

“We need to bring them out from the shadows:” A qualitative study of safety net physician leaders’ perspectives on caregivers

ObjectiveTo explore physician leaders’ perspectives on processes and priorities for engaging with caregivers in their clinical practices as well as within their safety net health systems. MethodsWe conducted in-depth semi-structured interviews with primary care physicians in care management leadership at three California safety net health systems. Interviews explored physicians’ experiences managing medically and socially complex patients with caregivers. Using thematic analysis, two qualitative researchers independently analyzed interview transcripts and established consensus with the broader research team through iterative input to derive major themes. ResultsFifteen physicians completed interviews. Nine participants were women, 8 were White and 10 reported Spanish language proficiency. Participant interviews generated six major themes: challenges uncovering caregiver identities, recognizing variation in caregivers’ roles, adapting visit communication strategies to include caregivers, engaging caregivers in patient care, and caring for the caregiver. ConclusionsEngaging caregivers is challenging given the limited recognition of caregiver involvement in patient care by health systems. Adapting visit communication to include caregivers requires bridging language and literacy barriers. Practice implicationsDeveloping mechanisms to enable the consistent identification of patients’ caregivers, facilitate ongoing communication with caregivers, and extend support for them could improve outcomes for vulnerable patients and their families.

Firearm Practices, Perceptions of Safety, and Opinions on Injury Prevention Strategies Among California Adults

Safe firearm storage and other interventions may reduce pediatric firearm deaths and injuries. To compare firearm ownership and storage practices, opinions on firearm injury prevention strategies, and perceptions of safety among adults in California households with and without children and/or adolescents. This survey study used data from the 2018 California Safety and Well-being Survey, a California-representative, probability-based internet survey. Respondents were part of the Ipsos KnowledgePanel, an online research panel that uses address-based sampling and provides survey weights to produce estimates representative of the adult population of California. Topics included firearm storage practices, opinions on interventions to reduce pediatric firearm injury, and perceptions of household safety related to firearm ownership. Respondents were stratified by firearm ownership and household presence or absence of children and/or adolescents. Weighted percentages and 95% CIs are presented. Of 5232 invited panel members, 2558 (48.9%) completed the survey. Among respondents, 52.5% (95% CI, 49.3%-55.7%) were women, 42.9% (95% CI, 39.9%-45.9%) were White, 30.0% (95% CI, 26.8%-32.9%) lived in homes with children, and the mean (SD) age was 48.0 (17.1) years. Among those in homes with children, more than two-thirds of individuals who owned firearms (70.6% [95% CI, 50.1%-85.2%]) and more than half of individuals who did not own firearms but lived in homes with guns (54.9% [95% CI, 37.9%-70.8%]) reported that they believed a firearm in the home made it safer. Half of those who owned firearms (52.3% [95% CI, 34.9%-69.2%]) and more than three-quarters of individuals who did not own firearms but lived in homes with guns (78.4% [95% CI, 57.5%-90.7%]) reported it was always appropriate for parents to inquire about unlocked guns in homes where their children play. Among those who had previously owned at least 1 gun but no longer did, 13.3% (95% CI, 7.1%-23.8%) reported getting rid of guns at least in part due to concern for the safety of a child in the home. Nearly two-thirds of those who owned firearms living with children and/or adolescents (64.5% [95% CI, 46.5%-79.2%]) did not store all firearms in the most secure manner (ie, unloaded and locked up), compared with 36.4% (95% CI, 29.4%-44.1%) of individuals who owned firearms but did not live with children. In this study, although a substantial percentage of individuals who owned guns and lived with children did not store all firearms as recommended, parents and caregivers who owned firearms reported being amenable to interventions that reduce young people's risk of firearm-related harm. Future work should investigate acceptable risk reduction and safe storage interventions.

Public Awareness of and Personal Willingness to Use California's Extreme Risk Protection Order Law to Prevent Firearm-Related Harm.

Extreme risk protection order (ERPO) laws temporarily suspend firearm and ammunition access by individuals whom a judge has deemed to be at substantial risk of harming themselves or others. Despite widespread recent adoption of these laws, use of ERPOs has been limited. Barriers to ERPO uptake remain unclear. To assess public awareness and perceived appropriateness of and willingness to use ERPOs in various risk scenarios, and to identify reasons for being unwilling, overall and by firearm ownership status, to inform efforts to improve ERPO implementation. This was a cross-sectional study using data from the 2020 California Safety and Wellbeing Survey, a statewide internet survey on firearm ownership and exposure to violence and its consequences, conducted from July 14 to July 27, 2020. Adult respondents were recruited from the Ipsos KnowledgePanel using probability-based sampling methods. Responses were weighted to be representative of the adult population of California. Awareness and perceived appropriateness of gun violence restraining orders (GVROs; California's official term for ERPOs), willingness to use a GVRO for a family member at risk of harm, and reasons for being not at all willing to use a GVRO in 1 or more risk scenarios, overall and by firearm ownership status. Of the 5018 panel members invited, 2870 (57%) completed the survey. Of these respondents (mean [SD] age: 47.9 [16.9] years; 52.3% women; 41.9% White, 34.7% Latinx, 14.4% Asian, and 5.8% Black individuals), 65.6% (95% CI, 63.0%-68.1) had never heard of a GVRO or a red flag law. Firearm owners were significantly more likely (20.5%; 95% CI, 15.9%-26.0%) than nonowners who live with owners (6.1%; 95% CI, 3.7%-10.0%; P < .001) and nonowners (9.6%; 95% CI, 7.8%-11.6%; P < .001) to have heard of both a GVRO and a red flag law. After reading a brief description of California's GVRO law, 72.9% (95% CI, 70.2%-75.4%) to 78.4% (95% CI, 75.9%-80.8%) of respondents, depending on the risk scenario, indicated that GVROs were in general at least sometimes appropriate, while 73.2% (95% CI, 70.5%-75.6%) to 83.6% (95% CI, 81.2%-85.8%) said they would be somewhat or very willing to use a GVRO for a family member at risk of harm. Firearm owners reported the highest levels of GVRO appropriateness in 4 of 5 risk scenarios (depending on the scenario, 80.0% [95% CI, 73.6%-85.1%] to 85.6% [95% CI, 79.9%-89.8%]). Nonowners who live with owners reported the highest levels of personal willingness to use a GVRO (depending on the scenario, 83.7% [95% CI, 74.7%-90.0%] to 94.7% [95% CI, 86.2%-98.1%]). The most frequently cited reasons for being unwilling to use a GVRO were not knowing enough about GVROs (44.9%; 95% CI, 39.7%-50.3%), believing the risk scenarios are personal or family matters (26.6%; 95% CI, 22.2%-31.6%), and distrust that the system will be fair (23.1%; 95% CI, 19.1%-27.6%). In this cross-sectional survey study, public awareness of GVROs was low, but perceived appropriateness of and willingness to use these tools at least some of the time was high. Foci for efforts to address barriers to GVRO use in California were identified; similar challenges likely exist in other jurisdictions.

Public Concern About Violence, Firearms, and the COVID-19 Pandemic in California

Violence is a significant public health problem that has become entwined with the coronavirus disease 2019 (COVID-19) pandemic. To describe individuals' concerns regarding violence in the context of the pandemic, experiences of pandemic-related unfair treatment, prevalence of and reasons for firearm acquisition, and changes in firearm storage practices due to the pandemic. This survey study used data from the 2020 California Safety and Well-being Survey, a probability-based internet survey of California adults conducted from July 14 to 27, 2020. Respondents came from the Ipsos KnowledgePanel, an online research panel with members selected using address-based sampling methods. Responses were weighted to be representative of the adult population of California. Topics included worry about violence for oneself before and during the pandemic; concern about violence for someone else due to a pandemic-related loss; experiences of unfair treatment attributed to the pandemic; firearm and ammunition acquisition due to the pandemic; and changes in firearm storage practices due to the pandemic. Of 5018 invited panel members, 2870 completed the survey (completion rate, 57%). Among respondents (52.3% [95% CI, 49.5%-55.0%] women; mean [SD] age, 47.9 [16.9] years; 41.9% [95% CI, 39.3%-44.6%] White individuals), self-reported worry about violence for oneself was significantly higher during the pandemic for all violence types except mass shootings, ranging from a 2.8 percentage point increase for robbery (from 65.5% [95% CI, 62.8%-68.0%] to 68.2% [95% CI, 65.6%-70.7%]; P = .008) to a 5.6 percentage point increase for stray bullet shootings (from 44.5% [95% CI, 41.7%-47.3%] to 50.0% [47.3%-52.8%]; P < .001). The percentage of respondents concerned that someone they know might intentionally harm themselves was 13.1% (95% CI, 11.5%-15.3%). Of those, 7.5% (95% CI, 4.5%-12.2%) said it was because the other person had experienced a pandemic-related loss. An estimated 110 000 individuals (2.4% [95% CI, 1.1%-5.0%] of firearm owners in the state) acquired a firearm due to the pandemic, including 47 000 new owners (43.0% [95% CI, 14.8%-76.6%] of those who had acquired a firearm). Of owners who stored at least 1 firearm in the least secure way, 6.7% (95% CI, 2.7%-15.6%) said they had adopted this unsecure storage practice in response to the pandemic. In this analysis of findings from the 2020 California Safety and Well-being Survey, the COVID-19 pandemic was associated with increases in self-reported worry about violence for oneself and others, increased firearm acquisition, and changes in firearm storage practices. Given the impulsive nature of many types of violence, short-term crisis interventions may be critical for reducing violence-related harm.

Immigration Arrests and Educational Impacts: Linking ICE Arrests to Declines in Achievement, Attendance, and School Climate and Safety in California

With increased tensions and political rhetoric surrounding immigration enforcement in the United States, schools are facing greater challenges in ensuring support for their students of immigrant and Latinx origin. This study examined the associations between county-level immigration arrests and academic achievement, absenteeism, and measures of school climate and safety for students in the California CORE districts. Using ordinary least squares regression analyses with year, grade, school, and student fixed effects, we found that immigration arrests corresponded to declines in academic achievement, attendance, and various measures of school climate and safety for Latinx students and Latinx students who were English learners. We also find small declines in measures of school climate and safety for students who ever received special education services via an Individualized Education Program. Associations were strongest for arrests that occurred during the Trump administration compared with those that occurred during the second term of the Obama administration. Policy implications are discussed.

Exposure to Violence, Firearm Involvement, and Socioemotional Consequences Among California Adults.

Violence is a leading cause of injury and death, and its impacts extend far beyond physical harm to the victim. We estimated the prevalence of direct or indirect exposure to violence, factors associated with exposure, and effects of exposure on socioemotional health-with effect modification by firearm involvement during the violent event-among a state-representative sample of California adults. We also examined effects of exposure on subsequent intent to purchase firearms. The sample comprised 2,558 California adults who completed the 2018 California Safety and Wellbeing Survey. An estimated 4% of respondents-1.2 million Californians-said they or a household member were exposed to violence while living in their current neighborhood. Half of those exposed to violence reported the event was "severely" distressing, and 47% experienced social functioning problems (i.e., problems with job/school and/or family/friends); for comparison, only 12% of unexposed adults reported having such problems in the past 12 months. When the violent event involved a weapon, respondents who did (versus did not) experience severe distress were significantly more likely to report that a firearm was present (69% versus 14%); those with (versus without) social functioning problems were significantly more likely to report other types of weapons were involved (67% versus 22%). Exposed adults considered buying a gun in response to the violent event more often than did unexposed respondents in the past 12 months (33% versus 17%). These findings highlight the need to address the physical and psychological sequelae of violence exposure among direct and indirect victims and can inform violence prevention research, programs, and policies across the nation.

In Memory of Professor Wilfred Iwan

Wilfred D (Bill) Iwan, professor of Civil Engineering, emeritus, at the California Institute of Technology, passed away on 29 October 2020, at the age of 85 years, in Pasadena, California. Iwan received his bachelor's, master's, and doctorate degrees from Caltech, in 1957, 1958, and 1961, respectively. He did his dissertation work under Prof. Donald Hudson. In 1961, he and his wife and young son, moved to the newly opened United States Air Force Academy, in Colorado Springs, where he taught engineering. By the time he left the service he had been trained as a flight pilot and had attained the rank of captain. In 1964, Bill returned to Caltech as an Associate Professor, and settled with his growing family in Sierra Madre, where he lived for the rest of his life. In 1970, he became a tenured full professor at Caltech, and focused his research on seismic structural engineering. During his 40 years at Caltech, Iwan served as the Executive Officer for Civil Engineering and Applied Mechanics in the Division of Engineering and Applied Science from 1980–86 and became professor emeritus in 2004. Iwan's research focused on fundamental areas of mechanics, including work to understand and characterize strong earthquake ground motion and the analysis and monitoring of the response of structural systems subjected to extreme events; he also was involved in the development of public policy regarding natural disasters. His research achievements include the development of methods to represent complex nonlinear structures with simpler linear systems, the development of practical methods for earthquake-resistant design, and the development of simplified methods for the analysis of seismic isolation systems for critical equipment. In 1979, he proposed an earthquake early-warning system for urban regions. Iwan was very active in many national and international organizations, notable among them the International Association for Structural Control and Monitoring (IASCM), the Engineering Mechanics Institute (EMI) of the American Society of Civil Engineers (ASCE), and the Consortium of Organizations for Strong Motion Observation Systems (COSMOS), in each of which he held leadership positions and served for many years. In 1982 he was appointed by then-Governor Jerry Brown to serve on the California State Seismic Safety Commission, which recommends seismic standards and guidelines for earthquake safety in California. He was re-appointed to the Commission by Governor George Deukmejian, and again by Governor Pete Wilson, during which time he became the chairman of the Commission. Iwan was elected to the National Academy of Engineering in 1999 “for research on seismic performance of structures, and for leadership in earthquake hazard mitigation and improvement of public safety.” He was a Distinguished Member and Fellow of the American Society of Civil Engineers, which awarded him the Nathan M. Newmark Medal (1997), the William H. Wisely Award (2006), and the Theodore von Kármán Medal (2013). In 2002, the California Earthquake Safety Foundation awarded him the 2002 Alfred E. Alquist Medal “for his lifetime of service to the profession of structural engineering and its application to the safety of the people of California and the world.”

Marijuana Use and Perinatal Outcomes Among Obstetric Patients in a Southern California Safety Net Hospital [22K

INTRODUCTION: Recreational marijuana use is increasing and poses a risk to both mother and the fetus. We aimed to assess marijuana use and perinatal outcomes in the local obstetric population at our hospital. METHODS: An IRB approved retrospective chart review identified a cohort of women with singleton gestations who delivered at LAC/USC hospital between 2015 and 2018. Women with self-reported marijuana use were compared with a control group. Demographic characteristics, maternal and perinatal outcomes were evaluated. Associations between these factors and marijuana use were assessed with univariate and multivariate regression. RESULTS: Of 2792 women who delivered during the study period, 151 (5.4%) had documented marijuana use. Compared to 192 non-users, marijuana users were more likely to be younger, non-Hispanic, undomiciled, unemployed and use other illicit substances. Marijuana users entered prenatal care later (14.2 vs. 22.1 weeks, P&lt;.001), were more likely to have preeclampsia (P=.046) and cesarean delivery (P=.01) and had infants with average birth weight 106 grams less (P=.02) than controls. After adjusting for confounders, marijuana use was not significantly associated with preterm birth or composite perinatal morbidity, but remained associated with 4.1-fold greater likelihood of delivering a small for gestational age (SGA) infant (95% CI 1.95-8.74). CONCLUSION: At a safety net hospital, antepartum marijuana use is significantly associated with SGA at birth. Marijuana users have higher maternal morbidity including preeclampsia and cesarean delivery, and are more likely to enter prenatal care later and report poly-substance use. Healthcare disparities associated with marijuana use make this a population of critical interest.

Generalist Palliative Care in the California Safety Net: A Structured Assessment to Design Interventions for a Range of Care Settings

To provide high quality care to all patients who have serious illness, health-care systems must develop effective generalist palliative care strategies. To identify palliative care quality gaps within a range of settings in the California safety net and to develop theory-based interventions to address them. Structured assessment using the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines and a Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation intervention planning model-based worksheet, which integrates behavior theories to identify factors that predispose, enable, and reinforce clinicians to perform recommended behaviors. Adviser pairs-one from palliative care and one from a partner service line-from 10 California public health-care systems conducted assessments at their sites. A steering committee provided educational webinars, best practices, and assessment tools. Adviser pairs interviewed at least 6 partner service line stakeholders to identify palliative care quality gaps, behaviors clinicians should perform to close gaps, and factors that predispose, enable, and reinforce those behaviors. Partner service lines were primary care (n = 4), surgery (n = 3), emergency department (n = 2), and radiation oncology (n = 1). Selected gaps were advance care planning and goals of care communication (n = 6), identifying patients with serious illness (n = 3), and pain management (n = 1). All sites designed multiple interventions to address gaps, based on factors that predispose, enable, and reinforce a target audience to perform a target behavior. Advisers reported that the program strengthened relationships between palliative care and the partner service line. This structured assessment helped busy clinicians develop theory-based generalist palliative care interventions.

Firearm ownership and acquisition in California: findings from the 2018 California Safety and Well-being Survey

ObjectiveTo describe the prevalence of and factors associated with firearm ownership; the types, subtypes and quantity of firearms owned; and when, where and why firearms were acquired in California.MethodsA cross-sectional...

Firearm ownership in California: A latent class analysis

ObjectiveTo examine whether firearm ownership and ownership-related motivations and practices can be classified into reasonably distinct types.MethodsCross-sectional data on firearm owners (n=429) were obtained from the 2018 California Safety and...

California Public Opinion On Health Professionals Talking With Patients About Firearms.

Medical and public health organizations have recommended that health professionals discuss firearm safety with patients at risk for gun-related injury, yet few health professionals do so. Concerns that patients may view conversations about firearms as inappropriate have been reported in prior studies. Using state-representative data from the 2018 California Safety and Wellbeing Survey, this study found that most Californians report gun safety conversations with health professionals to be at least sometimes appropriate when these conversations involved a patient who had a known risk factor for firearm-related harm (depending on the risk factor, 83.7-90.2percent among all respondents and 70.0-91.2percent among firearm owners). Majorities of respondents also found intervention by health professionals for those at imminent risk to be at least sometimes appropriate (depending on the intervention, 84.0-89.9percent among all respondents and 82.6-91.0percent among firearm owners). These findings can inform health policy and education on clinical strategies for preventing firearm-related harm.

A longitudinal analysis of the effectiveness of California’s ban on cellphone use while driving

Cellphone use while driving is an increasingly serious threat for traffic safety and is prohibited in many jurisdictions. In California, the use of handheld cellphones while driving has been prohibited since July 1, 2008. Using interrupted time series analysis, this study explores the effectiveness of the ban by specifically analyzing the crashes caused by cellphone usage in California from 2002 to 2014. These crashes were thought to be able to reflect the role of the ban more accurately than total crashes. The ban was found effective in reducing the cellphone usage-caused crashes in terms of both crash frequency and crash proportion. The study also confirms that crashes caused by cellphone use produce more severe outcomes than other crashes. These findings show that the ban on handheld cellphone use while driving plays an important role for improving traffic safety in California. In addition, it is found that the ban motivates drivers to switch from handheld cellphones to hands-free cellphones, but in terms of crash severity, hands-free cellphone usage and handheld cellphone usage do not show significant differences. These findings support a complete ban on cellphone use while driving--not just a prohibition of handheld cellphone use. The study results are expected to provide new insights for future policy-making related to cellphone use while driving.

The moderating role of sportsmanship and violent attitudes on social and personal responsibility in adolescents. A clustering-classification approach.

The aim of this study was to classify a randomized sample of adolescents according to their violent and sportsmanship attitudes to determine the influence of personal and social responsibility levels on each cluster. The sample comprised of 595 adolescents, aged between 12 and 15 years old (M ± SD = 13.9 ± 2.3 yr). Participants completed the Multidimensional Orientations Towards Sports Scale, the California School Climate and Safety Survey and the Personal and Social Responsibility Questionnaire. Cluster analysis was conducted to classify adolescent’ profiles according to the violence and sportsmanship scores. Discriminant analysis, Pearson correlation and ANOVA tests were performed to identify the relationships between personal and social responsibility levels on each cluster. Cluster analysis identified three well-defined profiles: cluster 1 (sportsmanlike and nonviolent), cluster 2 (sportsmanlike and violent) and cluster 3 (unsportsmanlike and nonviolent). Results confirmed a negative impact of aggressiveness on obedience and pro-social behaviours during school stages, but sportsmanship mitigated this negative influence. The sportsmanlike and nonviolent profile obtained the highest personal and social responsibility level. The lowest personal responsibility scores came from sportsmanlike and violent adolescents. This study emphasizes the potential of positive attitude towards sport and physical education to magnify (or mitigate) adolescents’ responsibility according to specific profiles. To reduce violent behaviour and improve sportsmanship attitudes would contribute to a better development of personal and social responsibility in adolescents. The current findings may serve to orientate professionals dealing with adolescents in the role of sportsmanship development as an educational tool to mitigate violent behaviour.

Volunteerism as co-production in public service management: application to public safety in California

ABSTRACTThis study analyses volunteerism in public safety as a case of ‘participative coproduction’ that has the potential to improve administrative efficiency through substitution of labour but at the cost of administrative complexity. Coordination costs relate to the interdependent character of the public service relationship and the non-excludability of public safety benefits. The analysis considers the influence of fiscal and institutional factors on volunteerism through a two-stage empirical model where the first stage involves the presence of a volunteer programme, and the second stage the relative reliance on volunteer versus paid employees among such programmes. The findings demonstrate distinct differences across programme types in the factors associated with volunteerism in public safety. Volunteerism in policing appears more common in smaller cities with higher property crime rates and a more politically conservative population, while volunteerism in firefighting is associated with scale, fiscal capacity and organizational form.

Improving Patient Safety in Public Hospitals: Developing Standard Measures to Track Medical Errors and Process Breakdowns.

The aim of the study was to develop standards for tracking patient safety gaps in ambulatory care in safety net health systems. Leaders from five California safety net health systems were invited to participate in a modified Delphi process sponsored by the Safety Promotion Action Research and Knowledge Network (SPARKNet) and the California Safety Net Institute in 2016. During each of the three Delphi rounds, the feasibility and validity of 13 proposed patient safety measures were discussed and prioritized. Surveys and transcripts from the meetings were analyzed to understand the decision-making process. The Delphi process included eight panelists. Consensus was reached to adopt 9 of 13 proposed measures. All 9 measures were unanimously considered valid, but concern was expressed about the feasibility of implementing several of the measures. Although safety net health systems face high barriers to standardized measurement, our study demonstrates that consensus can be reached on acceptable and feasible methods for tracking patient safety gaps in safety net health systems. If accompanied by the active participation key stakeholder groups, including patients, clinicians, staff, data system professionals, and health system leaders, the consensus measures reported here represent one step toward improving ambulatory patient safety in safety net health systems.