Abstract Background Unintentional pediatric cannabis ingestion has been rising following medical and recreational legalization. In this study, we aimed to examine the epidemiology of pediatric cannabis ingestion following legalization and to assess the impact of demographic and socioeconomic factors on equity of social management. Methods A retrospective cohort study was conducted at two high-volume children’s hospitals with level 1 trauma centers in the United States of America. Emergency department records from June 2016 to September 2024 were reviewed for children aged 0–6 years with a positive urine drug screen for tetrahydrocannabinol. Dates included were inclusive of medical (5/2011, 6/2016) and recreational legalization (4/2023, 11/2023) of cannabis products within both respective sites. Data collected included demographics, home zip code (used to assign a deprivation index), Emergency Severity Index triage level, and disposition. Manual chart review assessed ingestion type, location, suspected source owner, and involvement of social work, child protective services, and safe disposition planning. Descriptive statistics were used to characterize the population, and linear and logistic regression were used to determine the relationship between deprivation index, population characteristics, and social management. Results Among 266 cases, most children were under age 2 (58.3%), male (52.3%), non-Hispanic White (43.2%), English speaking (98.9%), and publicly insured (71.4%). Ingestions increased over time, with 51.8% occurring in the last two years (2023–2024). Edibles (51.1%) were the most common ingestion type, often belonging to a primary guardian (40.2%). Most cases were triaged as ESI 1or ESI 2 (83.5%), with 41.7% evaluated in a trauma bay. Hospital admission was common (82.0%), with 20.7% of admitted children requiring critical care. Social work (95.5%) and child protective services (80.1%) were involved in most cases. No relationship was found between deprivation index and social work consultation ( p = 0.52), child protective service reporting ( p = 0.41), discharge to a primary guardian ( p = 0.26), or discharge to a primary residence ( p = 0.144). Conclusions The incidence of unintentional cannabis ingestion presenting to the pediatric emergency department is increasing. Findings suggest equitable management across demographic and socioeconomic strata, highlighting high acuity and significant toxicity at presentation.
Rapid motorcycle fleet expansion has profoundly altered patterns of transport-related mortality in many low- and middle-income countries. Brazil has experienced one of the world’s largest increases in motorcycle use over the past two decades; however, nationwide evidence characterizing the long-term transition from pedestrian- to motorcycle-dominated transport mortality remains limited. This study aimed to characterize the nationwide transition from pedestrian- to motorcycle-dominated transport mortality and its regional heterogeneity in Brazil between 2004 and 2024. We conducted a nationwide ecological time-series study using official mortality data from the Brazilian Mortality Information System (SIM/DATASUS). Transport-related deaths were classified according to ICD-10 road-user categories, and annual population estimates from the Brazilian Institute of Geography and Statistics (IBGE) were used to calculate mortality rates. Following formal assessment of Poisson model assumptions, negative binomial regression was adopted as the primary inferential approach. Segmented regression was performed as a sensitivity analysis to identify temporal changes in mortality trends. Regional heterogeneity was evaluated using pooled models with calendar year × geographic region interaction terms. Exploratory ecological analyses assessed the relationship between motorcycle fleet expansion and mortality trends using official data from the Brazilian National Traffic Secretariat (SENATRAN). Between 2004 and 2024, Brazil recorded 756,633 transport-related deaths, including 227,409 motorcycle occupant fatalities, becoming the leading category of transport-related mortality during the study period. Motorcycle mortality increased from 2.75 to 7.27 deaths per 100,000 inhabitants, whereas pedestrian mortality declined from 5.54 to 2.67 deaths per 100,000 inhabitants, demonstrating a nationwide transition from pedestrian- to motorcycle-dominated transport mortality. Adjusted analyses showed an average annual increase of 3.2
Abstract Background Texas bears a disproportionate burden of pediatric drowning in the United States. Functional pool fencing prevents pediatric drownings, but its economic impact on drowning-related costs remains unclear. We estimated the potential cost savings of implementing a universal pool fencing program for households with young children. Methods We conducted a cost-benefit analysis of universal pool fencing for Texas households with one or more children ages 1–9 years. Drowning burden was estimated from Texas data with a case-fatality rate of 1:6. Direct medical and lifetime indirect costs per patient and caregiver were derived from hospital discharge data and literature. Prevented drownings were estimated using a population-wide risk model incorporating fence effectiveness and current fence coverage (percent of homes with functional fences). Average pool fence cost was obtained from industry experts, assuming a 10-year lifespan and no maintenance costs. Population and household estimates were derived from U.S. Census data to determine the number of fences required. Total program costs were calculated by multiplying the number of fences required by the average cost per fence. Annual cost savings were calculated from prevented cases and per-case costs. Benefits over a 10-year period were estimated as the present value of annual savings discounted at 5%. Net benefit was defined as 10-year benefits minus total fencing program costs. Results The annual fatal and non-fatal drowning burden in Texas among children ages 1–9 years is 264 cases. With 76% fence effectiveness and 38% current fence coverage, an estimated 174 drownings could be prevented annually. The average cost per drowning is $337,435 (direct medical: $60,860; lifetime indirect: $276,575). With 7% of Texas households having a pool, an estimated 98,905 new fences are required at a cost of $3,343 each, totaling $330,642,758 in program costs. Annual cost savings are $58,713,690, corresponding to $453,371,551 in 10-year benefits and a net benefit of $122,728,793. Conclusions Universal pool fencing in Texas could prevent pediatric drownings and yield significant economic savings. These findings support stronger residential pool safety standards, including statewide mandates, robust inspection and enforcement tied to permitting, and financial incentives such as rebates or insurance discounts to offset installation costs.
Long-term trends in emergency department (ED)-based pediatric injury surveillance during and after the COVID-19 pandemic remain poorly characterized, particularly in settings that experienced additional system-level disruption. In February 2024, South Korea experienced a second healthcare-system disruption following the mass resignation of trainee physicians from teaching hospitals after a government decision to expand medical school admissions. We analyzed National Emergency Department Information System data for children aged under 10 years with injury diagnoses (S00–T79) or external cause codes (V01–Y98), January 2016 to December 2024 (108 months). Monthly ED-recorded injury visit rates were calculated using resident-registration pediatric population denominators. Interrupted time-series analysis used two prespecified breakpoints (COVID-19 onset, March 2020; mass resignation of trainee physicians, February 2024). Recovery Indices compared 2023 with 2018–2019, stratified by resource intensity (KTAS 1–2, ICU, death, or transfer-in) and facility type. Among 2,783,933 pediatric injury-related ED visits over 9 years, population-adjusted injury contact burden remained incompletely recovered by 2023 (Recovery Index 78.7
Abstract Background Preventable injuries are the leading cause of pediatric death. Most healthcare organizations and the general public engage in social media (SoMe) to disseminate and consume health-related information. It is unknown how frequently pediatric hospitals leverage their SoMe platforms to educate on injury prevention (IP) topics. We sought to better characterize SoMe messaging and IP content by children’s hospitals. Methods This was a retrospective cross-sectional study of US children’s hospitals’ primary SoMe Facebook, Twitter/X, and Instagram accounts. Included hospitals were associated with Injury Free Coalition for Kids (IFCK), a current or past Centers for Disease Control and Prevention Injury Control and Research Center, a level I pediatric trauma center, or a pediatric surgery fellowship. Accounts established after 1/1/23 or covering adult health topics were excluded. Abstractors reviewed all available posts from 2023; posts were dichotomized into IP vs. non-IP content, with further subcategorization based on injury mechanisms and other topics covered. Descriptive statistics and frequencies with ranges were calculated. Chi-square analyses were used for comparisons between groups. Results Of 82 unique hospitals with eligible SoMe accounts, all used Facebook and 69 (84.1%) used all 3 SoMe platforms. Of the 55,339 posts, 3,863 (7.0%) posts covered IP. Among IP posts, the most frequently covered specific topics were mental health/suicide, poisonings, and child passenger safety. Most non-IP posts were focused on general publicity/goodwill; other frequently covered medical categories were cardiac conditions, cancer, and neonatal diseases. Hospital affiliation with a pediatric surgery fellowship ( X 2 = 93.79; p <.001) and IFCK ( X 2 = 4.56; p =.03) were associated with more IP content. More affiliations with IP-oriented organizations were also associated with more IP content ( X 2 = 119.8; p <.001). Conclusion Although children’s hospitals have large SoMe followings, IP is rarely discussed. While ties to IP-oriented organizations improve coverage of IP content, this represents a critical missed opportunity to address the leading causes of pediatric deaths.
The effects of firearm violence extend beyond those who are directly injured, affecting families, friends, and communities through experiences such as knowing someone who has been shot. Although indirect exposure to firearm violence has been associated with adverse health outcomes, less is known about the prevalence, timing, and cumulative burden of socially proximate firearm violence exposure across the life course. We analyzed data from the 2024 California Safety and Wellbeing Survey, a probability-based survey of California adults (N = 3,531). Overall, 20.7
Understanding long-term trends in causes of injury mortality is essential for informing prevention strategies and public health priorities. In Canada, most studies focused on individual causes of injury deaths, with limited examination of how leading causes evolved collectively over time. This study aimed to assess trends in leading causes of injury mortality and changes in the rankings of leading causes in Canada from 2000 to 2023, overall and by sex and age group. Mortality data were obtained from the Canadian Vital Statistics - Death database, Canadian Coroner and Medical Examiner Database and provincial/territorial chief coroner or chief medical examiner offices. Leading causes of injury deaths were ranked based on their annual crude mortality rates. A joinpoint regression model was applied to quantify trends by annual percent change of age-standardized or crude mortality rates for each leading cause with stratification by sex and age group. Falls, poisonings, suicide and land transport incidents were consistently the top four leading causes of injury deaths for both males and females during the study period, although their relative rankings and trends varied by sex. Age groups had different leading cause rankings and trends. Overall, age-standardized mortality rate (ASMR) increased annually for poisonings (9.2
Wrestling World Championships represent the highest level of competition in the sport, featuring hundreds of elite athletes across three styles and ten weight classes. This study aims to analyze injury patterns and risk factors in senior-level wrestling. Injury data were recorded during the 2022 and 2023 Senior Wrestling World Championships. Athlete gender, wrestling style, injury severity, type, and location were documented. Among 1,686 competitors and 3,882 athletic exposures (AEs), 107 injuries were recorded, yielding an overall injury incidence rate of 27.56 per 1,000 AEs. Injury incidence rates per style were 25.55/1,000 AEs in Greco-Roman, 34.31/1,000 AEs in Freestyle, and 21.22/1,000 AEs in Women’s Wrestling. The most common injuries were strains (33.6
Intent-based injury surveillance requires distinction between injury intent and mechanism, particularly when datasets include anatomical trauma and non-traumatic external-cause injuries such as drug intoxication. This study compared mechanisms, incidence, regional variation, transfer pathways, and short-term outcomes between intentional and unintentional severe external-cause injuries in South Korea. This retrospective nationwide study used the Korea Disease Control and Prevention Agency Community-Based Severe Trauma Survey (2016–2020). The source population comprised patients with severe trauma, non-traumatic severe injury, or mass casualty incidents transported to emergency departments by 119 Emergency Medical Services and confirmed through hospital record review. Intentional injury was defined as self-harm/suicide or violence/homicide, and unintentional injury as recorded unintentional injury. Drug intoxication was treated as a mechanism, not as intent. Descriptive analyses used the full cohort, whereas primary multivariable models used the prespecified non-intoxication cohort. Age-specific incidence and mortality were calculated as pooled 2016–2020 rates using summed annual population denominators. Logistic regression estimated adjusted odds ratios (aORs) for emergency department (ED) and post-admission survival. Among 230,302 transported cases, 55,513 were intentional and 174,789 were unintentional; 45,093 involved drug intoxication. Intentional injuries were more commonly associated with drug intoxication and hanging or strangulation, whereas unintentional injuries were mainly transportation- or fall-related. Out-of-hospital cardiac arrest was more frequent after intentional injuries (21.8
Extreme Risk Protection Orders (ERPOs) temporarily restrict firearm access from those at risk of harming themselves and/or others. This case series describes when and how ERPOs have been used for people experiencing homelessness. We examined ERPO court case files previously abstracted in California (n = 37, 1/1/2016–6/30/2020) and Colorado (n = 12, 1/1/2020–12/31/2022) involving housing insecurity among respondents. We determined whether the respondent was experiencing homelessness (i.e., sleeping in a public place, shelter, vehicle, motel, or temporarily “couch surfing” with a friend). For each such case, we created narrative summaries and conducted thematic analysis. We identified 25 ERPO respondents experiencing homelessness in California and 11 in Colorado; 83
Abstract Background Steeplechase jockeys compete in high-risk races requiring horses and riders to clear fixed obstacles at speed. Although rider dislodgement events are recognized hazards, their incidence and participation consequences are not well characterized. Methods This retrospective observational study used publicly available race charts from United States National Steeplechase Association races (2023–2025). Dislodgement events were defined as falls or lost rider events. Incidence rates were calculated per 1,000 starts, and timber and hurdle races were compared using Poisson regression. Rider interruption was defined as ≥ 30 days, with censoring for incomplete follow-up. Horse outcomes were assessed using ≥ 60-day interruption and non-return to jump racing. Results Among 3,072 starts involving 83 riders and 710 horses, 187 dislodgement events occurred (60.9 per 1,000 starts; 95% confidence interval (CI), 52.2 to 69.6). Rates were higher in timber than hurdle races (103.5 vs. 51.8 per 1,000 starts; incidence rate ratio 2.00, 95% CI 1.46–2.73). Of 173 evaluable events, 26 (15.0%) were followed by rider interruption. At the rider level, 19 of 44 riders (43.2%) experienced ≥ 30-day interruption, and 7 of 38 (18.4%) did not return to jump racing. Among horses with dislodgement events in 2023–2024, 26 of 111 (23.4%) had no subsequent jump-racing start through 2025, although some continued racing on the flat. Conclusions Rider dislodgement events were common and more frequent in timber races. Most riders returned quickly, but a subset experienced interruption or non-return. Participation-based measures may complement traditional injury surveillance in jump racing.
Abstract Background Violent crime is a prominent cause of injury in the United States and a significant public health issue. Hospital-Based Violence Intervention Programs (HVIPs) have emerged as multidisciplinary programs that improve wellbeing of violent assault victims and minimize recidivism through culturally competent bedside and post-discharge mentorship, connection to mental health and social services, and follow-up care. Because victims are prone to develop post-traumatic stress disorder (PTSD), it is important for HVIPs to engage in early PTSD screening and mental health interventions. Current research describing HVIP impacts on PTSD symptoms has not been aggregated; therefore, a systematic review was performed answering to what extent HVIP participation affects PTSD symptoms of violent assault victims. Methods A literature search was performed on five databases on 07/21/2025. Inclusion criteria were studies that used valid measurement tools to report PTSD symptoms over time of U.S. violent assault victims who participated in an HVIP. Exclusion criteria were studies without hospital-based or hospital-linked violence intervention programs; studies including victims of violence other than interpersonal assault; and non-primary, non-peer-reviewed, or non-English sources. Articles were screened by title and abstract, then by full text using Rayyan software. Eligible articles were appraised using the Strengthening the Reporting of Observational studies in Epidemiology checklist. Results 616 non-duplicated articles were identified, of which four were included for final analysis. Two studies were single arm field trials, one was a quasi-experiment, and one was a pilot randomized controlled trial. Studies showed inconsistent effectiveness of HVIPs on PTSD symptoms, though two studies that tested a specific mental health intervention incorporated into an HVIP found significant symptom reduction. Sample characteristics, intervention components, and methodology were heterogenous across studies, impacting result comparability. Conclusion While these studies show promise for PTSD symptom reduction, this review warrants more research to further elucidate the association between HVIP interventions and PTSD symptoms to better inform HVIP practices. Only 4 studies met inclusion criteria, indicating a lack of research evaluating this association, especially studies not testing an added specific mental health intervention. Moreover, findings support consideration for adding targeted mental health treatments within HVIPs to increase impact on PTSD symptoms.
Abstract Background Firearm injury remains the leading method of suicide among U.S. veterans. Knowledge of the prevalence of firearm access, storage, and beliefs about firearms and suicide risk among veterans is necessary to inform firearm-related suicide prevention initiatives. Methods A 2022 population-based survey of veterans (ASCEND), with responses weighted to the veteran population. Results In 2022, 57.4% (95% CI: 56.4–58.4) of veterans had access to firearms in their home; of those, 53.7% (95% CI: 52.3–55.1) stored at least some household firearms unlocked and 49.0% (95% CI: 47.6–50.4) stored at least some firearms loaded with ammunition. The most common reason for having household firearms was protection against people (74.3%; 95% CI: 73.2–75.3). The majority of veterans reported agreement with beliefs regarding firearm access impacting suicide risk (e.g., that having a firearm in the home increases risk; 55.2%–71.0%) and indicated willingness to alter their access if thinking about suicide (74.9%–84.6%). Veterans reported the most willingness to discuss firearms with a family member (88.4% willing; 95% CI: 87.7–89.1), compared to friends (84.0%; 95% CI: 83.1–84.7) or providers (72.4%; 95% CI: 71.4–73.4). Although most were willing to discuss firearms with a primary care or mental health provider, only 12.9% (95% CI: 12.1–13.6) indicated that a healthcare provider had ever asked them about their firearm access. Firearm risk perceptions, willingness to change firearm access and discuss firearms, and prior discussions with a healthcare provider differed based on household firearm access responses: those who declined to respond (7.7%; 95% CI: 7.2–8.4) reported the least agreement with firearm risk statements (34.4%–57.7%) and the least willingness to change firearm access (54.5%–73.6%) or discuss firearms with others (75.5% family; 69.0% friends), particularly healthcare providers (35.0%; 95% CI: 31.1–39.0). Conclusions More than half of veterans have access to firearms in their home, an important risk factor for suicide. Results suggest a preference to include family in firearm suicide prevention efforts and a need to increase provider firearm discussions in healthcare settings. Additionally, as veterans who decline to respond to firearm access questions appear to differ in their firearm risk perceptions and willingness to reduce firearm access when risk is elevated, better understanding these veterans is essential.
BACKGROUND:The Fire service Organizational Culture of Safety (FOCUS) survey, is an industry-specific assessment tool used to examine aspects of safety climate and leadership, safety behaviors, organizational outcomes, and mental health outcomes. The FOCUS survey provides participating U.S. fire departments with critical information to improve their work environment. The current iteration of the survey (FOCUS 3.0) includes expanded leadership and mental health modules. METHODS:This study consisted of a convenience sample of 9,078 firefighters nested within 89 fire departments (career, combination, volunteer) who assessed with the FOCUS 3.0 survey wave. A descriptive epidemiologic analysis of the FOCUS 3.0 survey metrics was conducted. We examined individual-level and department-level characteristics for the participating departments as well as average department scores. Pearson correlation matrices identified potential relationships between the survey metrics. RESULTS:Of the 9,078 individuals included in our analysis, the majority were male (88.3%), straight (89.7%), non-officers (66.1%), and non-veterans (83.4%). Our sample consisted of majority career departments (67.4%), with an average of 11 stations, and more than 5,000 calls per year (67.4%). Supervisor support for safety scores were on average 14-points higher than management commitment to safety scores. On average, 12% of respondents endorsed depression symptoms, 10% of respondents reported having anxiety symptoms, and 9% of respondents reported having suicidal ideations within the past month. We observed high positive correlations between management commitment to safety and four leadership metrics (participation in decision making, leadership communication, safety-specific transformational leadership, team psychological safety). Additionally, management commitment to safety was highly negatively correlated with emotional exhaustion (burnout), intent to leave the profession, and mental health metrics. CONCLUSIONS:The findings from this study of FOCUS 3.0 departments are consistent with prior FOCUS waves (beta-test, 1.0, and 2.0). This study identified that the newly added leadership metrics are highly correlated with safety climate metrics. Thus, they may be avenues for departments to improve their organizational safety climate. This study provides an important first look into the proportion of firefighters who participated in FOCUS 3.0 that experience mental health symptoms. Future research should further investigate the mental health metrics and relationships with safety climate.
To identify medications frequently mentioned in suicide plans by texters at a crisis intervention service, and to evaluate age differences. We developed a natural language processing pipeline to extract medications mentioned in suicide plans. In conversations from 5,691 texters, we examined the frequency with which each medication was mentioned in texters under age 18 (N = 2,332) versus age 18 and older (N = 3,359). The ten most frequently mentioned medications during discussions of planned suicide by overdose were: ibuprofen (16.5
BACKGROUND:During this period of heightened risk for political violence and authoritarian government in the United States (US), there is an urgent need for information on the public's support for authoritarianism and government-initiated violence and its willingness to engage in pro- or anti-government violence. METHODS:Findings are from Wave 4, conducted May 23-June 13, 2025, of a nationally representative annual longitudinal survey of adult members of the Ipsos KnowledgePanel. Findings are presented for the cohort as a whole and for demographic and political affiliation subgroups. Outcomes are expressed as weighted prevalences and adjusted prevalence differences, with p-values adjusted for the false discovery rate. RESULTS:The survey completion rate was 89.9%. Of 8248 respondents, 15.0% (95% confidence interval (CI) 13.9%, 16.1%) strongly or very strongly agreed that "having a strong leader for America is more important than having a democracy." One in 10 (9.6%, 95% CI 8.8%, 10.6%) strongly or very strongly agreed that "the [federal] government should use the military to help enforce its policies in the United States," and 4.4% (95% CI 3.7%, 5.2%) strongly or very strongly agreed with the use of "private armed militia groups" for that purpose. Between 5% and 7% of respondents strongly or very strongly agreed that the federal government should arrest its critics, and about 2% were very or completely willing to personally engage in violence in support of (or opposition to) "government policies or the President" and against individual opponents (or supporters) of the government. Younger respondents tended to be less supportive of democracy as a form of government, more supportive of statements consistent with authoritarianism, and more willing to engage in pro- or anti-government violence. Compared with strong Democrats, "Make America Great Again" (MAGA) Republicans were more supportive of statements consistent with authoritarianism and the current federal government's use of the military and private militia groups but were not more willing personally to engage in violence. CONCLUSIONS:In 2025, substantial minorities of US adults endorsed statements consistent with authoritarianism. Smaller minorities endorsed and were willing to engage in pro- or anti-government violence. These findings call for sustained, concerted action to avert widespread political violence and preserve democracy in the United States.
Mass public shootings represent a significant source of fatal and nonfatal injury in the United States. This study examines patterns of strain among individuals who carried out these events, with attention to the prevalence, co-occurrence, and cumulative burden of stressors. Data were drawn from a database of mass public shootings in the United States from 1999 to 2024, comprising 171 incidents and 175 perpetrators. Information was collected using a structured, multi-source approach including official records, secondary reports, and triangulated media sources. Eighteen dichotomous indicators of strain were coded. Descriptive statistics assessed prevalence and cumulative strain, and phi coefficients examined pairwise associations. Perpetrators experienced multiple, overlapping forms of strain (mean = 4.78; SD = 2.78). Psychiatric concerns, job-related difficulties, and interpersonal stressors were most common. Strains frequently co-occurred, with strong associations among interpersonal and psychological factors and between structural stressors and ideological motivations. Most perpetrators experienced multiple concurrent stressors, indicating that these events rarely are preceded by a single, isolated grievance. Mass public shootings may be better understood as the result of cumulative and co-occurring strains rather than isolated risk factors. Injury and violence prevention efforts may be strengthened by emphasizing patterns of stressors, early identification, and coordinated, systems-level responses, including threat assessment.
Abstract Background Each year, hundreds of thousands of firearms are stolen, and vehicles are the leading source of firearm thefts in the United States. A precursor to these events is leaving a firearm in a vehicle unattended. Yet, the correlates and patterns of leaving firearms unattended in vehicles remain poorly understood. The purpose of this study was to examine the prevalence, correlates, and patterns of leaving firearms unattended in vehicles among US firearm owners. Methods Using a cross-sectional survey of firearm-owning adults administered online by YouGov in February–March 2026 (n = 1,856), ordinal logistic regression examined correlates of leaving firearms in unattended vehicles, including sociodemographic, perceptions of safety, strength of state firearm policies, and geographic factors. Among those reporting vehicle firearm storage (n = 468), firearm type, storage location, and reasons for leaving firearms in vehicles were descriptively examined. Results Overall, 73.2% of respondents reported never leaving a firearm in a vehicle unattended, 14.7% reported rarely, 5.7% reported sometimes, 3.2% reported most of the time, and 3.2% reported always. Male sex (v. female) (aOR = 1.48; 95% CI, 1.07–2.06), non-Hispanic Black race/ethnicity (v. non-Hispanic White) (aOR = 2.06; 95% CI, 1.17–3.61), prior firearm theft (v. no prior firearm theft) (aOR = 2.54; 95% CI, 1.60–4.03), higher perception of fear of being shot (aOR = 1.09, 95% CI = 1.03, 1.15), higher perceived likelihood of defensive gun use (1.08, 95% CI = 1.03, 1.14), conservative ideology (v. very liberal) (aOR = 2.46, 95% CI = 1.34, 4.52), and rural residence (v. metropolitan) (aOR = 2.21; 95% CI, 1.49–3.26) were associated with higher odds of leaving firearms in a vehicle more frequently. Among respondents who reported leaving firearms in vehicles unattended, handguns were the most common type of firearm left in vehicles (74.5%). Respondents most commonly reported leaving a firearm in the center console (24.6%) or the glovebox (16.7%); 19.7% used a designed for firearm storage. Top reasons for storing in a vehicle included legal carry restrictions, wanting a firearm nearby, and convenience. Conclusions Future research, intervention development, and testing are needed to reduce the leaving of firearms in vehicles unattended.
Abstract Background Trauma is the leading cause of death for individuals under age 45 and disproportionately affects underserved populations. Trauma recidivism is defined as recurrent hospital admissions for injury—a substantial burden on healthcare systems. In regions such as Allegheny County, Pennsylvania, which has a large, aging population, recidivism is often influenced by social, behavioral, and structural determinants. This study examines patterns of trauma recidivism at an urban tertiary trauma center and identifies associated risk factors to guide targeted interventions in both hospital and community settings. Methods We conducted a retrospective cohort study using a trauma registry at a level I urban trauma center, including 13,967 patients admitted between January 2021 and September 2024. Patients were categorized as recidivists (n = 245) or non-recidivists (n = 13,455) based on repeated trauma admissions due to the same mechanism of injury. Demographic, injury, hospital course, and discharge variables were compared between recidivists and non-recidivists using chi-square tests, t-tests, or nonparametric equivalents as appropriate. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of recidivism. Results Recidivists accounted for 3.7% of the cohort. Compared to non-recidivists, recidivists were older (mean age 68.5 vs. 55.7 years, p < 0.001) and more likely to be female (53.9% vs. 40.5%, p < 0.001). Falls were the predominant injury mechanism (84.6% vs. 52.6%, p < 0.001), frequently occurring in home (56.4%, p < 0.001), particularly in bedrooms and bathrooms. Recidivists were less often discharged home (42.8% vs. 63.2%, p < 0.001). Risk of recidivism was higher among patients with injuries due to falls and self-harm, older age, female sex, and those discharged against medical advice or to a drug and alcohol rehabilitation facility. Conclusions Trauma recidivism is increasingly driven by older adults with blunt injuries, highlighting a shift in the at-risk population. Prevention efforts should adapt to focus on age-related risks such as falls and frailty. Tailored discharge planning, psychosocial support, and post-discharge follow-up care may help reduce recurrent injury and improve outcomes in this growing patient group. Level of Evidence Level IV, Prognostic/Epidemiological.
The Temporary Commission to Prevent Childhood Drowning (NYS Drowning Commission) was signed into law by the New York State (NYS) Governor to address the public health issue of childhood drownings. This article documents the NYS Drowning Commission’s formation and highlights findings and recommendations contained in the 339-page final report. The comprehensive report found that both children and adults face evolving water-related risks associated with the state’s geography of extensive coastlines, rivers, lakes, and increasing exposure to extreme weather and flooding. Legislation that created the NYS Drowning Commission stipulated five major goals. In fulfillment of these goals, NYS Drowning Commission formulated more than 190 recommendations toward creation of a unified, multi-pronged, equity-centered culture of water safety and a NYS Office of Water Safety to provide coordination across the multiple agencies and sectors responsible for water safety. Short-term and long-term strategic solutions are recommended including building and upgrading physical pool infrastructures, adoption of advanced technologies, enhancement of the early warning system for dams and levees, public awareness campaigns that address water proficiency, water competence and situational knowledge of water, and aquatic training for physical education teachers. Other recommendations address standardized ages for initiation of water safety education, aquatic learning standards, vulnerable/disabled populations, data needs, community public-private partnerships, and gaps in services for underserved and/or under-resourced populations. Several water safety-related topics, including flood zones, storm surge areas, low-lying regions, aging infrastructure such as dams, hazardous coastal infrastructure, and climate-related hazards outside the scope of the NYS Drowning Commission are identified.
