Motivated by the study of state opioid policies, we propose a novel approach that uses autoregressive models for causal effect estimation in settings with panel data and staggered treatment adoption. Specifically, we seek to estimate the impact of key opioid-related policies by quantifying the effects of must access prescription drug monitoring programs (PDMPs), naloxone access laws (NALs), and medical marijuana laws on opioid prescribing. Existing methods, such as differences-in-differences and synthetic controls, are challenging to apply in these types of dynamic policy landscapes where multiple policies are implemented over time and sample sizes are small. Autoregressive models are an alternative strategy that have been used to estimate policy effects in similar settings, but until this paper have lacked formal justification. We outline a set of assumptions that tie these models to causal effects, and we study biases of estimates based on this approach when key causal assumptions are violated. In a set of simulation studies that mirror the structure of our application, we show that our proposed estimators frequently outperform existing estimators. In short, we justify the use of autoregressive models to evaluate the effectiveness of four state policies in combating the opioid crisis.

Fatal police shooting rates vary greatly across U.S. states, and states with higher firearm ownership rates tend to have higher rates of police shootings. Yet, despite well-documented national racial and ethnic disparities in fatal police shootings, prior research has not established how much these disparities vary across states, nor whether firearm ownership rates are associated with racial and ethnic disparities in police shootings. This article characterizes state-level fatal police shooting rates and racial/ethnic disparities in those rates, and tests whether firearm ownership rates are associated with these outcomes. Using 2015-2020 data on police shootings from the Washington Post, we predict fatal police shooting rates by state, year, and race/ethnicity using Bayesian multilevel count models. The degree of Black-White disparities in fatal police shooting rates varies by an order of magnitude across states, although Black rates exceed White rates in every state. In contrast, though Hispanic rates exceed White rates nationally, the opposite is true for 31 states. Southwestern states with large Hispanic-White disparities, relatively high shooting rates, and large Hispanic populations contribute most to the observed national disparity. Fatal police shooting rates are strongly associated with firearm ownership rates, but racial/ethnic disparities are either not related to firearm ownership rates or are larger in states with lower firearm ownership rates, depending on the group comparison and disparity metric. While state-level variation in firearm ownership may impact fatal police shooting rates, it is unlikely that higher firearm ownership rates explain why some states have such large racial/ethnic disparities compared to others.

Objectives. To estimate the effects of 7 state firearm policies on yearly rates of firearm mortality (homicide and suicide) among racial demographic groups. Methods. We studied yearly firearm homicide and suicide counts by race for all US states from 1981 to 2022 via de-biased, autoregressive, Bayesian negative binomial models. Results. Permissive policies were associated with 1.97 more homicides (86% posterior probability of increased mortality; 80% credible interval [CrI] = -0.31, 4.38) and 0.32 more suicides (93% probability of increase; 80% CrI = 0.04, 0.58) per 100 000 Black population. Restrictive policies were associated with 0.51 fewer Black suicides per 100 000 (> 99% probability of decrease; 80% CrI = -0.71, -0.31). Policies had similar rate-ratio effects in both groups, but they shifted absolute homicide risk more for Black (and suicide more for non-Black) populations because of differing absolute rates: per 100 000, permissive laws were associated with 1.81 more Black homicides than non-Black (85% probability higher), and restrictive laws with reductions of 0.70 fewer Black suicides than non-Black (> 99% probability smaller). Conclusions. Harms and benefits of firearm policies on firearm homicide have accrued more to Black populations than to non-Black ones, with the opposite true for firearm suicide. (Am J Public Health. Published online ahead of print August 13, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308523).

Abstract Background Civilian justifiable firearm homicides (CJFH), an important component of defensive gun use, are central to debates on gun policy and ownership but have received limited scholarly attention. This study examines the prevalence and characteristics of CJFH across two national datasets, with a focus on understanding differences across datasets in the relationship of decedent race with the determination of justifiability. Methods This cross-sectional study used data from 2016 to 2022 from the National Violent Death Reporting System (NVDRS) and Supplementary Homicide Reports (SHR). Descriptive statistics and logistic regressions assessed the association between coded decedent race and the likelihood that a firearm homicide was coded as justifiable. Results After geographically harmonizing the datasets, CJFH incidents were more common in NVDRS (n = 1887) than SHR (n = 1576). NVDRS had a lower proportion of Black CJFH decedents (58%) compared to SHR (67%). Restricting to a more closely matched set of incidents, adjusted models showed higher odds of coding the decedents of CJFH as Black in SHR (OR: 1.17; 95% CI: 0.93–1.46) than NVDRS (OR: 1.00; 95% CI: 0.82–1.22). Conclusions Discrepancies in the racial composition of CJFH across NVDRS and SHR do not arise for other decedent characteristics or among non-CJFH cases. Differences in the coding of CJFH highlight potential issues with evaluating racial disparities and the need to address biases in firearm data infrastructure.

BACKGROUND:Veterans have higher suicide rates than matched non-veterans, with firearm suicides being especially prevalent among veterans. We examined whether state firearm laws and state firearm ownership rates are important risk factors for suicide among veterans. METHODS:US veteran's and demographically matched non-veteran's suicide rates, 2002-2019, are modelled at the state level as a function of veteran status, lethal means, state firearm law restrictiveness, household firearm ownership rates and other covariates. RESULTS:Marginal effects on expected suicide rates per 100 000 population were contrasted by setting household firearm ownership to its 75th versus 25th percentile values of 52.3% and 35.3%. Ownership was positively associated with suicide rates for both veterans (4.35; 95% credible interval (CrI): 1.90, 7.14) and matched non-veterans (3.31; 95% CrI: 1.11, 5.77). This association was due to ownership's strong positive association with firearms suicide, despite a weak negative association with non-firearm suicide. An IQR difference in firearm laws corresponding to three additional restrictive laws was negatively associated with suicide rates for both veterans (-2.49; 95% CrI: -4.64 to -0.21) and matched non-veterans (-3.19; 95% CrI: -5.22 to -1.16). Again, these differences were primarily due to associations with firearm suicide rates. Few differences between veterans and matched non-veterans were found in the associations of state firearm characteristics with suicide rates. DISCUSSION:Veterans' and matched non-veterans' suicide risk, and specifically their firearm suicide risk, was strongly associated with state firearm characteristics. CONCLUSIONS:These results suggest that changes to state firearm policies might be an effective primary prevention strategy for reducing suicide rates among veterans and non-veterans.

In this study, part of RAND's Gun Policy in America initiative, researchers systematically review the scientific literature that has examined the likely effects of various gun laws. In the fifth edition of this study, the authors incorporate more-recent research in their synthesis of the available scientific data regarding the effects of 18 state firearm policies on firearm injuries and deaths, violent crime, suicides, the gun industry, defensive gun use, and other outcomes. By highlighting where scientific evidence is accumulating, the authors hope to build consensus around a shared set of facts that have been established through a transparent, nonpartisan, and impartial review process. In so doing, they also illuminate areas in which more and better information could make important contributions to establishing fair and effective gun policies.

High rates of mental health issues among service members and a reluctance to access mental health services together represent one of the greatest ongoing threats to U.S. military readiness. Concerns about the confidentiality of mental health services received within the military have been documented as a significant barrier to service members obtaining needed treatment. At times, disclosing mental health information to commanding officers may be necessary so that informed decisions can be made about duty assignments, needed accommodations, unit resources, or deployments. The challenge the U.S. military faces is how to optimally protect service members' confidentiality so that mental health services are sought and needs are not driven underground-while also ensuring the successful execution of the military mission. In this study, the authors examine the potential impact of existing U.S. military mental health confidentiality policies on service members seeking assistance for mental health issues. The authors conducted a multimethod investigation involving key-stakeholder interviews with military mental health providers, commanding officers, and enlisted service members and a survey of the active component regarding knowledge, understanding, and practices associated with mental health confidentiality policies. Findings shed light on the perceptions held by service members on the limits to mental health confidentiality and how policy implementation influences service members' decisions regarding mental health care. The authors recommend steps that the U.S. Department of Defense could take to improve military personnel's understanding of confidentiality policies, strengthen processes to ensure that policies are implemented as intended, and mitigate the consequences associated with the limited confidentiality afforded to mental health services within the military.

Objectives. To create a comprehensive, publicly available data set of state-level nonfatal firearm injury inpatient hospitalizations (NFIIHs) in the United States from 2000 to 2021. Methods. We used Bayesian modeling to impute missing NFIIH rates for 334 state-year observations and correct for incomplete injury mechanism coding in 766 observations. Results. NFIIH rates increased nationally, with the largest rise between 2019 and 2020, up by one third to reach 1.31 (95% credibility interval [CrI] = 1.27, 1.35) per 10 000 population. State prevalences ranged from 0.18 (95% CrI = 0.14, 0.22) in Hawaii to 2.18 (2.04, 2.33) in Louisiana. South Central states (Mississippi, Arkansas, Missouri) had the largest increases. Twelve states-predominantly in the Northeast and West-experienced decreases. NFIIH rates correlated more strongly with firearm homicide rates (correlation = 0.86) than other intents (correlations < 0.28). Nationwide, there were 2.4 NFIIHs for every firearm homicide, but this ratio varied more than fourfold across states. Conclusions. NFIIH rates varied substantially across and within states. Despite strong correlation, many states diverged from the national NFIIH to firearm homicide ratio. Public Health Implications. Firearm deaths systematically underrepresent serious firearm injuries in some states. This new data set can inform how policies affect serious firearm injuries and injury lethality. (Am J Public Health. 2025;115(7):1106-1114. https://doi.org/10.2105/AJPH.2025.308069).

BACKGROUND:From 2019 to 2020, homicide showed its largest single-year increase in modern US history. While many have cited the COVID-19 pandemic or the police killing of George Floyd as initiating the rise, there has been limited systematic investigation of how the timing of the increase corresponded with these key events. We investigated trends in firearm and nonfirearm homicide across sociodemographic and geographic groups to clarify the timing and nature of the recent increase. METHODS:We conducted a descriptive epidemiologic study using the National Vital Statistics System weekly mortality data from January 2018 to December 2022 in the United States. We seasonally adjusted and smoothed weekly firearm and nonfirearm homicide data, quantifying changes in relation to key event dates for the COVID-19 pandemic, the killing of George Floyd, and the 2020 national election. We disaggregated trends by sociodemographic and geographic characteristics. RESULTS:Between January 2018 and December 2022, firearm homicide increased by 54% while nonfirearm homicide was stable. The increase in firearm homicide started in October 2019 and stabilized by November 2020; 28% of the eventual increase had already occurred by the time COVID-19 was declared a national emergency. All sociodemographic and geographic groups experienced large recent increases in firearm homicide. CONCLUSIONS:The magnitude and timing of the recent increase in homicide have been previously understated and obscured by crude data and seasonal patterns. Existing theories, including the COVID-19 pandemic, fall short in explaining the historic surge, which is specific to firearm homicide, started in late 2019, and affected all persons and places across the United States.

Introduction: Alcohol use is involved in a large proportion of homicides and suicides each year in the U.S., but there is limited evidence on how policies targeting alcohol influence fl uence violence in the U.S. context. Extant studies generally focus on individual policies in isolation of each other. This study examines the impacts of changes in states' ' alcohol policy restrictions on overall homicide and suicide rates and fi rearm-related homicide and suicide rates using a holistic measure of states' ' alcohol policy environments. Methods: Using a composite measure of state-level alcohol policies (Alcohol Policy Scale) and data from the National Vital Statistics System from 2002 to 2018, this study applied a Bayesian time series model to estimate the impacts of alcohol policy changes on overall and fi rearm-involved homicide and suicide rates. The analysis was performed in 2023 and 2024. Results: A 1 SD change in the Alcohol Policy Scale was associated with a 6% decline in homicide rates both overall (incident rate ratio=0.94; 95% credible interval = 0.89, 1.00) and for fi rearm homicides specifically fi cally (incident rate ratio=0.94, 95% CI=0.88, 1.01). There was no clear association of alcohol policy with suicides. The model predicts that a nationwide increase in alcohol restrictions equivalent to a shift from the 25thto th to 75th th percentile of the scale's ' s distribution would result in almost 1,200 fewer homicides annually. Conclusions: Increases in the restrictiveness of state-level alcohol policies are associated with reductions in homicides. More restrictive alcohol policy environments may offer an opportunity to reduce homicides. Am J Prev Med 2024;67(2):193-200. - 200. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Importance Causal associations between household firearm ownership rates (HFRs) and firearm mortality rates are not well understood. Objective To assess the population-level temporal sequencing of firearm death rates and HFRs. Design, Setting, and Participants This cohort study used autoregressive cross-lagged models to analyze HFRs, firearm suicide rates, and firearm homicide rates in the US from 1990 to 2018. The suicide analyses included 16 demographic subgroups of adults, defined by study year, state, sex, race and ethnicity, marital status, and urbanicity. The homicide analyses consisted of adult subgroups living in urban or rural areas. Data analysis was conducted from March to December 2023. Exposures Firearm mortality rates and HFRs. Main Outcomes and Measures Firearm homicide and suicide rates with HFRs as the exposure, and HFR with mortality as the exposure. Results A total of 10 416 observations of 16 demographic subgroups by state and 2-year periods were included in the suicide analyses, while 1302 observations from 2 demographic subgroups by state and 2-year period were included in the homicide analysis. At baseline, the mean (SD) rate per 100 000 population across strata was 7.46 (7.21) for firearm suicides and 3.32 (2.13) for firearm homicides. The mean (SD) baseline HFR was 36.9% (20.2%) for firearm suicides and 36.9% (14.8%) for firearm homicides. Higher HFR preceded increases in suicide rates: demographic strata with equal firearm suicide rates but which differ by 18.6 percentage points on HFR (1 SD) would be expected to have firearm suicide rates that diverged by 0.19 (95% CI, 0.15-0.23) deaths per 100 000 population per period. With these differences accumulated over 8 years, firearm suicide rates in subgroups with the highest decile HFR would be expected to have 1.93 (95% CI, 1.64-2.36) more suicides per 100 000 population than strata with lowest decile HFR, a difference of 25.7% of the overall firearm suicide rate in 2018 and 2019. Firearm suicide rates had a smaller magnitude of association with subsequent changes in HFR: strata with equal HFRs but which differ by 1 SD in firearm suicide rates had minimal subsequent change in HFRs (−0.02 [95% CI, −0.04 to 0.01] percentage points). A 1-SD difference in HFRs was associated with little difference in next-period overall firearm homicides rates (0.03 [95% CI, −0.02 to 0.08] per 100 000 population), but a 1-SD difference in homicide rates was associated with a decrease in HFR (−0.09 [95% CI, −0.16 to −0.04] percentage points). Conclusions and Relevance This cohort study found an association between high HFRs and subsequent increases in rates of firearm suicide. In contrast, higher firearm homicide rates preceded decreases in HFRs. By demonstrating the temporal sequencing of firearm ownership and mortality, this study may help to rule out some theories of why gun ownership and firearm mortality are associated at the population level.

Importance Measures of the proportion of individuals living in households with a firearm (HFR), over time, across states, and by demographic groups are needed to evaluate disparities in firearm violence and the effects of firearm policies. Objective To estimate HFR across states, years, and demographic groups in the US. Design, Setting, and Participants In this survey study, substate HFR totals from 1990 to 2018 were estimated using bayesian multilevel regression with poststratification to analyze survey data on HFR from the Behavioral Risk Factor Surveillance System and the General Social Survey. HFR was estimated for 16 substate demographic groups defined by gender, race, marital status, and urbanicity in each state and year. Exposures Survey responses indicating household firearm ownership were analyzed and compared with a common proxy for firearm ownership, the fraction of suicides completed with a firearm (FSS). Main Outcome and Measure HFR, FSS, and their correlations and differences. Results Among US adults in 2018, HFR was significantly higher among married, nonurban, non-Hispanic White and American Indian male individuals (65.0%; 95% credible interval [CI], 61.5%-68.7%) compared with their unmarried, urban, female counterparts from other racial and ethnic groups (7.3%; 95% CIs, 6.0%-9.2%). Marginal HFR rates for larger demographic groups also revealed important differences, with racial minority groups and urban dwellers having less than half the HFR of either White and American Indian (39.5%; 95% CI, 37.4%-42.9% vs 17.2%; 95% CI, 15.5%-19.9%) or nonurban populations (46.0%; 95% CI, 43.8%-49.5% vs 23.1%; 95% CI, 21.3%-26.2%). Population growth among groups less likely to own firearms, rather than changes in ownership within demographic groups, explains 30% of the 7 percentage point decline in HFR nationally from 1990 to 2018. Comparing HFR estimates with FSS revealed the expected high overall correlation across states (r = 0.84), but scaled FSS differed from HFR by as many as 20 percentage points for some states and demographic groups. Conclusions and Relevance This survey study of HFR providing detailed, publicly available HFR estimates highlights key disparities among individuals in households with firearms across states and demographic groups; it also identifies potential biases in the use of FSS as a proxy for firearm ownership rates. These findings are essential for researchers, policymakers, and public health experts looking to address geographic and demographic disparities in firearm violence.

Importance Despite high social and public health costs of firearm violence in the United States, the effects of many policies designed to reduce firearm mortality remain uncertain. Objective To estimate the individual and joint effect sizes of state firearm policies on firearm-related mortality. Design, Setting, and Participants In this comparative effectiveness study, bayesian methods were used to model panel data of annual, state-level mortality rates (1979-2019) for all US firearm decedents, with analyses conducted in October 2023. Exposures Six classes of firearms policies: background checks, minimum age, waiting periods, child access, concealed carry, and stand-your-ground laws. Main Outcome and Measures Primary outcomes (total firearm deaths, firearm homicide deaths, and firearm suicide deaths) were assessed using the National Vital Statistics System. Bayesian estimation was used to estimate the partial association of changes in firearms policies with subsequent changes in firearm mortality. Results The estimated effect sizes of individual policies 5 or more years after implementation were generally small in magnitude and had considerable uncertainty. The policy class with the highest probability of reducing firearm deaths was child-access prevention laws, estimated to reduce overall firearm mortality by 6% (80% credible interval [CrI], -2% to -9%). The policy class with the highest probability of increasing firearm deaths was stand-your-ground laws, estimated to increase firearm homicides by 6% (80% CrI, 0% to 13% increase). Estimates of association of implementing multiple firearm restrictions with subsequent changes in firearm mortality yielded larger effect sizes. Moving from the most permissive to most restrictive set of firearm policies was associated with an estimated 20% reduction in firearm deaths (80% CrI, 10% to 28% reduction), with a 0.99 probability of any reductions in firearm death rates. Conclusions and Relevance In this comparative effectiveness study of state firearm policies, the joint effect estimates of combinations of firearm laws were calculated, showing that restrictive firearm policies were associated with substantial reductions in firearm mortality. Although policymakers would benefit from knowing the effects of individual policies, the estimated changes in firearm mortality following implementation of individual policies were often small and uncertain.

The authors produced new estimates of the number of adults caregiving in the United States today; investigated how those caring for wounded, ill, and injured service members and veterans compare with those caring for civilians and with non-caregivers; and share insights on the potential consequences of caregiving on caregiversapos health, their economic security, and their families' well-being. They also propose recommendations to strengthen caregiver support. The information in this study is derived from two sources. RAND researchers administered the 2023 RAND Caregiving Survey. The final analytic sample size was 2,946 respondents, including 513 military and veteran caregivers, and, for comparison, 1,205 civilian caregivers and 1,228 non-caregivers. RAND researchers also administered the 2022 RAND Veterans Survey, a survey of 1,100 veterans residing in the United States. There are 14.3 million military and veteran caregivers, representing 5.5 percent of the U.S. adult population. There are an additional 91.3 million civilian caregivers (35.0 percent of U.S. adults) caring for wounded, ill, or injured civilian adults. Across all caregivers, most (78 to 81 percent) spend between one and 30 hours per week providing care. Under 10 percent spend less than one hour per week, and 11 to 16 percent spend 31 hours or more per week caregiving. The estimated aggregate economic value generated by military/veteran caregiving activities, which are largely uncompensated, ranges from $119 billion to $485 billion per year. Military/veteran caregivers incur an estimated $8,583 in annual out-of-pocket costs associated with their caregiving responsibilities. Military/veteran caregivers forgo an estimated $4,522 in annual household income.

Background Long-term prescription opioid use is a significant risk factor for opioid morbidity and mortality, and severe traumatic injury is an important initiation point for prescription opioid use. This study examines predictors of long-term prescription opioid use among a racially and ethnically diverse population of patients hospitalized for traumatic injury. Methods Study participants (N= 650) from two urban Level I trauma centers were enrolled. Baseline information on demographics, injury characteristics, self-reported pre-injury substance use and mental health, and personality characteristics and attitudes was collected through interviews during the initial hospitalization. Patients were interviewed again at 3 months and 12 months and asked about prescription opioid use in the prior 7 days. Multivariable logistic regressions assessed participants' baseline characteristics associated with opioid use at one or more follow-up interviews. Results Pre-injury use of prescription painkillers had the strongest association with prescription opioid use at follow-up (adjusted odds ratio: 3.10; 95% confidence interval: 1.86-5.17). Older age, health insurance coverage at baseline, length of hospitalization, higher current pain level, pre-injury post-traumatic stress disorder symptoms, and discharge to a location other than home were also associated with significantly higher odds of prescription opioid use at follow-up. Conclusions Providers could consider screening for past use of prescription pain relievers and post-traumatic stress disorder before hospital discharge to identify patients who might benefit from additional resources and support. However, providers should ensure that these patients' pain management needs are still being met and avoid abrupt discontinuation of prescription opioid use among those with a history of long-term use.

Background Despite growing evidence about how state-level firearm regulations affect overall rates of injury and death, little is known about whether potential harms or benefits of firearm laws are evenly distributed across demographic subgroups. In this systematic review, we synthesized available evidence on the extent to which firearm policies produce differential effects by race and ethnicity on injury, recreational or defensive gun use, and gun ownership or purchasing behaviors. Main body We searched 13 databases for English-language studies published between 1995 and February 28, 2023 that estimated a relationship between firearm policy in the USA and one of eight outcomes, included a comparison group, evaluated time series data, and provided estimated policy effects differentiated by race or ethnicity. We used pre-specified criteria to evaluate the quality of inference and causal effect identification. By policy and outcome, we compared policy effects across studies and across racial/ethnic groups using two different ways to express effect sizes: incidence rate ratios (IRRs) and rate differences. Of 182 studies that used quasi-experimental methods to evaluate firearm policy effects, only 15 estimated policy effects differentiated by race or ethnicity. These 15 eligible studies provided 57 separate policy effect comparisons across race/ethnicity, 51 of which evaluated interpersonal violence. In IRR terms, there was little consistent evidence that policies produced significantly different effects for different racial/ethnic groups. However, because of different baseline homicide rates, similar relative effects for some policies (e.g., universal background checks) translated into significantly greater absolute differences in homicide rates among Black compared to white victims. Conclusions The current literature does not support strong conclusions about whether state firearm policies differentially benefit or harm particular racial/ethnic groups. This largely reflects limited attention to these questions in the literature and challenges with detecting such effects given existing data availability and statistical power. Findings also emphasize the need for additional rigorous research that adopts a more explicit focus on testing for racial differences in firearm policy effects and that assesses the quality of race/ethnicity information in firearm injury and crime datasets.

INTRODUCTION:Homicides and suicides are the second- and third-leading causes of death among young people (aged 10-24) in the US. While a substantial share of these deaths involve alcohol, evidence is needed on whether specific alcohol policies, such as day-based sales restrictions, help prevent these deaths. METHODS:We constructed total and firearm-related homicide and suicide counts by state, year, and day-of-week from the Multiple Cause of Death Micro-data 1990-2019. Repeals of Sunday bans were taken from the Alcohol Policy Information System. Two-way fixed effects Poisson models with standard errors clustered at state-level and population offset control for state, year and day-of-the-week fixed effects and state time-varying covariates. RESULTS:Repealing Sunday bans is associated with an increase in homicides (IRR=1.125; 95% confidence interval [CI]:1.02-1.24) and firearm homicides (IRR=1.17; 95% CI:1.03-1.33). Analyses by day-of-the-week show significant associations with homicides not only on Sundays, but also other days, consistent with delays in death. There was no significant relationship for suicides. CONCLUSION:Restricting alcohol availability may prove a useful policy tool to reduce homicides, given that day-based restrictions are associated with changes in deaths rather than only shifting across days-of-the-week.

BackgroundChronic pain represents a substantial health burden and source of disability following traumatic injury. This study investigates factors associated with racial and ethnic disparities in chronic pain.MethodsProspective, longitudinal, panel study. Seriously injured patients were recruited from two trauma centres in the Northeastern and Southwestern USA. Data from medical records and individual surveys were collected in-hospital, and at 3-month and 12-month postinjury from a balanced cohort of non-Hispanic black, non-Hispanic white and Hispanic patients. We used linear regression to estimate the associations between race and ethnicity and 3-month and 12-month pain severity outcomes. We grouped all available cohort data on factors that theoretically influence the emergence of chronic pain after injury into five temporally ordered clusters and entered each cluster sequentially into regression models. These included: participant race and ethnicity, other demographic characteristics, preinjury health characteristics, acute injury characteristics and postinjury treatment.Results650 participants enrolled (Hispanic 25.6%; white 38.1%; black 33.4%). Black participants reported highest relative chronic pain severity. Injury-related factors at the time of acute hospitalisation (injury severity, mechanism, baseline pain and length of stay) were most strongly associated with racial and ethnic disparities in chronic pain outcomes. After controlling for all available explanatory factors, a substantial proportion of the racial and ethnic disparities in chronic pain outcomes remained.ConclusionRacial and ethnic disparities in chronic pain outcomes may be most influenced by differences in the characteristics of acute injuries, when compared with demographic characteristics and postacute treatment in the year after hospitalisation.

To better understand the circumstances surrounding sexual assault in the Army, RAND Arroyo Center researchers created descriptions of active-component soldiers' most serious sexual assault experiences using data from the 2016 and 2018 Workplace and Gender Relations Survey of Active Duty Members. In this study, researchers describe the most common types of behaviors that occurred, characteristics of alleged perpetrators, and times and places in which the experiences occurred. They also explore differences by gender, sexual orientation, and installation risk level. Nearly 90 percent of victims believed that the assault was committed for a sexual reason, and more than half indicated that the assault was meant to be abusive or humiliating. The typical perpetrator of victims' most serious sexual assault experiences was a male enlisted member of the military acting alone. Perpetrators were most often a military peer of the victim; perpetrators who were strangers to the victim were uncommon; and assaults by spouses, significant others, or family members were comparatively rare. Approximately two-thirds of victims' most serious experience of sexual assault occurred at a military installation. The authors found substantial differences by gender, especially in terms of the types of sexual assault behaviors victims experienced and in terms of the setting in which victims were sexually assaulted. The authors also found some evidence suggesting that sexual minorities-that is, individuals who identify with a sexual orientation other than heterosexual-may experience more-violent sexual assaults and more assaults that are meant to abuse, humiliate, haze, or bully, especially among men.