Association between Firearm Laws and Homicide in Urban Counties

Laws related to the sale, use, and carrying of firearms have been associated with differences in firearm homicide rates at the state level. Right-to-carry (RTC) and stand your ground (SYG) laws are associated with increases in firearm homicide; permit-to-purchase (PTP) laws and those prohibiting individuals convicted of violent misdemeanors (VM) have been associated with decreases in firearm homicide. Evidence for the effect of comprehensive background checks (CBC) not tied to PTP is inconclusive. Because firearm homicide tends to concentrate in urban areas, this study was designed to test the effects of firearm laws on homicide in large, urban U.S. counties. We conducted a longitudinal study using an interrupted time series design to evaluate the effect of firearm laws on homicide in large, urban U.S. counties from 1984 to 2015 (N?=?136). We used mixed effects Poisson regression models with random intercepts for counties and year fixed effects to account for national trends. Models also included county and state characteristics associated with violence. Homicide was stratified by firearm versus all other methods to test for specificity of the laws’ effects. PTP laws were associated with a 14% reduction in firearm homicide in large, urban counties (IRR?=?0.86, 95% CI 0.82–0.90). CBC-only, SYG, RTC, and VM laws were all associated with increases in firearm homicide. None of the laws were associated with differences in non-firearm homicide rates. These findings are consistent with prior research at the state level showing PTP laws are associated with decreased firearm homicide. Testing the effects of PTP laws specifically in large, urban counties strengthens available evidence by isolating the effects in the geographic locations in which firearm homicides concentrate.     

Subsequent Cancer Risk of Women Receiving Hysterosalpingography: A Nationwide Population-Based Retrospective Cohort Study

The objective of this study was to estimate the subsequent cancer risk of women after receiving hysterosalpingography (HSG) by conducting a nationwide retrospective cohort study. We identified a study cohort of 4,371 patients who had had a HSG examination and a comparison cohort of 17,484 women without HSG examination between 1998 and 2005. Both cohorts were followed up with until the end of 2010 to measure the incidence of cancer. The risk of developing cancer for patients with HSG was assessed using the Cox proportional hazard model. In the multivariate analyses, the HSG cohort did not have a significantly greater risk of cancer (Hazard Ratio [HR] = 1.02, 95% CI = 0.79–1.31) than the non-HSG cohort. The HR was highest for genital cancer (HR = 1.32, 95% CI = 0.77–2.25), followed by urinary system cancer (HR = 1.11, 95% CI = 0.23–5.40), and abdominal cancer not involving the GU system (HR = 1.04, 95% CI = 0.53–2.03), all of which were non-significant elevations. The cancer incidence rates, especially that for urinary system cancer, were increased in the HSG cohort, but the increase in cancer incidence was small and not statistically significant.     

Factors Associated with State Variations in Homicide, Suicide, and Unintentional Firearm Deaths

This study examined the relationship of 16 variables with homicide, suicide, and unintentional firearm deaths. This cross-sectional analysis, using adjusted partial correlation coefficients, found that state-level firearm homicide rates significantly varied by the prevalence of firearms and by percent of the population which was African American. Whereas, state-level variations in firearm suicide mortality significantly varied by firearm prevalence, per capita alcohol consumption, percent of the population which was African American, and level of urbanization. None of the variables were significantly (p < or = .05) related to state-level variations in unintentional firearm mortality. Furthermore, state gun laws had only a limited effect on firearm-related homicide deaths. Although the current study cannot determine causation, firearm mortality in its various forms is most commonly related to the prevalence of firearms and the percent of the population that is African American.     

Health Outcomes of Immigrants in Nursing Homes: A Population-Based Retrospective Cohort Study in Ontario,Canada

ObjectiveOlder adults account for a significant portion of Canadian immigrants, yet characteristics and health outcomes of older immigrants in nursing homes have not been studied. We aimed to describe the prevalence of immigrants living in nursing homes, their characteristics, and their hospitalization and mortality rates compared to long-term residents in the first year of entry to nursing homes.DesignPopulation-based, retrospective cohort study using linked health administrative databases.Setting and ParticipantsWe assessed all incident admissions into publicly funded nursing homes in Ontario between April 2013 and March 2016. Immigrants were defined as those who arrived in Canada after 1985; long-term residents are those who arrived before 1985 or are Canadian-born.MethodsThe primary outcome was all-cause hospitalization and mortality rates within 1 year of nursing home entry. Nested Cox proportional hazards models were estimated to explore the associations of facility, demographic, and clinical characteristics to the primary outcomes.ResultsImmigrants comprised 4.4% of residents in Ontario's nursing homes, compared to 13.9% in the general population. The majority were from East and Southeast Asia (52.2%), and more than half (53.9%) had no competency in either official language on arrival in Canada. At the time of nursing home entry, immigrants were younger than long-term residents but had greater functional and cognitive impairments. Immigrants had a lower rate of mortality [hazard ratio 0.58, 95% confidence interval (CI) 0.51, 0.68; P < .001] but were more likely to be hospitalized (hazard ratio 1.14, 95% CI 1.06, 1.23; P < .001). Adjusting for language ability, the effect of immigrant status on hospitalization was not statistically significant.Conclusions and ImplicationsDespite greater functional and cognitive impairments, immigrants in nursing homes had lower mortality than long-term residents, potentially reflecting the “healthy immigrant effect.” Inability to speak English was associated with increased risk of hospitalization, highlighting the need for strategies to overcome communication barriers.     

Network Exposure and Homicide Victimization in an African American Community

Objectives. We estimated the association of an individual’s exposure to homicide in a social network and the risk of individual homicide victimization across a high-crime African American community.Methods. Combining 5 years of homicide and police records, we analyzed a network of 3718 high-risk individuals that was created by instances of co-offending. We used logistic regression to model the odds of being a gunshot homicide victim by individual characteristics, network position, and indirect exposure to homicide.Results. Forty-one percent of all gun homicides occurred within a network component containing less than 4% of the neighborhood’s population. Network-level indicators reduced the association between individual risk factors and homicide victimization and improved the overall prediction of individual victimization. Network exposure to homicide was strongly associated with victimization: the closer one is to a homicide victim, the greater the risk of victimization. Regression models show that exposure diminished with social distance: each social tie removed from a homicide victim decreased one’s odds of being a homicide victim by 57%.Conclusions. Risk of homicide in urban areas is even more highly concentrated than previously thought. We found that most of the risk of gun violence was concentrated in networks of identifiable individuals. Understanding these networks may improve prediction of individual homicide victimization within disadvantaged communities.More than 10 000 people are killed by firearms each year, and another 40 000 are hospitalized or treated for gunshot injuries.1 Homicide victimization, however, is not evenly distributed across populations or places. Young people are more likely to be murdered than the elderly, African Americans are more likely to be murdered than whites, men are more likely to be murdered than women, gang members are more likely to be murdered than non-gang members, and individuals living in socially and economically disadvantaged neighborhoods are more likely to be murdered than individuals living in more advantaged neighborhoods.2–7Yet, despite decades of research into why certain characteristics and behaviors place individuals at greater risk for homicide, the social and health sciences have not fared as well in explaining why specific individuals within high-risk populations become victims of homicide. Although we know that risk factors such as age, race, gender, gang membership, and living in a poor neighborhood increase one’s risk of being a homicide victim, we cannot explain why a specific young African American male gang member in a high crime neighborhood becomes a murder victim while another young man with the identical risk factors does not. In this article, we argue that one’s position in a distinctive type of risky social network—a co-offending network—and exposure to violence in that network is essential to understanding individual victimization within high-risk populations.Understanding the topographies of risky networks and individuals’ placement within them illuminates analyses of violent victimization in at least 2 important ways. First, a network approach can offer new insight into the uneven distribution of homicide within high-risk communities. Like other social and health behaviors,8–12 homicides cluster within networks.13 Additionally, such networks tend to be fairly homogenous with respect to traditional individual-level risk factors. For example, a recent study of a high-crime community in Boston found that 85% of all gunshot injuries occurred entirely within a network of 763 young minority men (< 2% of the community population), a third of whom were gang members and a third of whom had previous police contact.13 In much the same way, geographic exposure to neighborhood violence is associated with a range of negative outcomes such as posttraumatic stress disorder, depression, and decreased cognitive functioning.14–18 But, like other risk factors, the spatial exposure to homicide in many high crime communities might be quite uniform. In the present study, for example, 40% of the individuals in the sample lived within 350 feet from where a homicide occurred, and 75% lived within roughly 1 city block (690 feet) from where a homicide occurred (see supplemental material, available as a supplement to the online version of this article at http://www.ajph.org). A network approach suggests that victimization is not simply a function of spatial proximity or of individual risk factors such as age, race, gender, or gang affiliation, but also of how people are connected, the structure of the overall network, the types of behaviors occurring in the network, and an individual’s position in the overall structure.Second, social network analysis extends the analysis of violent victimization by providing a means to quantify and measure more precisely the behaviors that are the proximate determinants of homicidal encounters. In most instances, risk factors act as proxies for more dynamic processes, situational dynamics, and risky behaviors. For example, gang membership—typically treated as a binary indicator where one is or is not a gang member—is frequently shown to increase one’s odds of being a victim or perpetrator of a violent crime.3,7,19,20 Yet, qualitative and ethnographic work demonstrates that gang participation is fluid and often changes within the situational contexts of particular interactions.21–23 The true effect of being a gang member is not about a binary label, but about whom one hangs around with, the structure of the network, and group processes within the gang. Network analysis can directly model such processes and structures.The present study investigates how exposure to homicide in one’s network contributes to one’s own probability of victimization. Rather than rely only on risk factors, this study directly measures the contours of a risky network in a high-crime African American community in Chicago, Illinois. The focus is on social distance to a victim—how many handshakes removed one is from a homicide victim in their network. Our hypothesis is that there is a strong association between one’s own risky behaviors (in this study, co-offending arrest) and the risky behavior of one’s associates. The stronger that association—the socially closer one is to a homicide victim—the greater the influence on one’s own victimization. In this sense, homicide is socially contagious, and associating with people engaged in risky behaviors—like carrying a firearm and engaging in criminal activities—increases the probability of victimization. Like needle sharing or unprotected sex in the spread of HIV,24–26 co-offending exposes an individual to situations, behaviors, and people that elevate the probability of homicide victimization. Although we are unable to ascertain the precise mechanisms of transmission in the case of homicide, we maintain that such transmission is heightened as individuals engage in risky behaviors such as, in this case, co-offending.     

Vital Signs: Changes in Firearm Homicide and Suicide Rates — United States, 2019–2020

IntroductionThe majority of homicides (79%) and suicides (53%) in the United States involved a firearm in 2020. High firearm homicide and suicide rates and corresponding inequities by race and ethnicity and poverty level represent important public health concerns. This study examined changes in firearm homicide and firearm suicide rates coinciding with the emergence of the COVID-19 pandemic in 2020.MethodsNational vital statistics and population data were integrated with urbanization and poverty measures at the county level. Population-based firearm homicide and suicide rates were examined by age, sex, race and ethnicity, geographic area, level of urbanization, and level of poverty.ResultsFrom 2019 to 2020, the overall firearm homicide rate increased 34.6%, from 4.6 to 6.1 per 100,000 persons. The largest increases occurred among non-Hispanic Black or African American males aged 10–44 years and non-Hispanic American Indian or Alaska Native (AI/AN) males aged 25–44 years. Rates of firearm homicide were lowest and increased least at the lowest poverty level and were higher and showed larger increases at higher poverty levels. The overall firearm suicide rate remained relatively unchanged from 2019 to 2020 (7.9 to 8.1); however, in some populations, including AI/AN males aged 10–44 years, rates did increase.Conclusions and Implications for Public Health PracticeDuring the COVID-19 pandemic, the firearm homicide rate in the United States reached its highest level since 1994, with substantial increases among several population subgroups. These increases have widened disparities in rates by race and ethnicity and poverty level. Several increases in firearm suicide rates were also observed. Implementation of comprehensive strategies employing proven approaches that address underlying economic, physical, and social conditions contributing to the risks for violence and suicide is urgently needed to reduce these rates and disparities.     

Coffee Consumption and Prostate Cancer Aggressiveness Among African and Caucasian Americans in a Population-Based Study

This study evaluated the relationship between caffeinated and decaffeinated coffee and prostate cancer (CaP) aggressiveness using data from a population-based incident CaP study within the North Carolina-Louisiana Prostate Cancer Project (PCaP). Classification of CaP aggressiveness at diagnosis was based on clinical criteria for 1,049 African-American (AA) and 1,083 Caucasian-American (CA) research subjects. Coffee consumption was measured using a modified NCI Dietary History Questionnaire. No significant associations were found between CaP aggressiveness and consumption of either caffeinated or decaffeinated coffee. The OR for high aggressive CaP among consumers of more than 4 cups per day was 0.92 (95%CI = 0.61, 1.39), compared to non-coffee-drinkers. Results stratified by race found no significant associations and no noticeable trends in either AAs (P for trend = 0. 62) or CAs (P for trend = 0.42). In contrast to a recent report on a select population that has less complete information on CaP aggressiveness suggesting that coffee prevents aggressive CaP, this rapid case ascertainment population-based study, in a biracial population with differing risks of CaP did not demonstrate a protective relationship between high coffee consumption and risk of high aggressive CaP.     

Etiology of Low-Birthweight Birth: A Population-Based Study

Background. Preterm and low-birthweight births remain the major correlates of infant mortality in the United States. The recognition that these births result from varying proximal etiologies is essential to the development of preventive strategies specific to each etiologic group. Methods. Using vital statistics data tapes provided by the North Carolina Center for Health and Environmental Statistics, mothers in 20 counties who delivered infants with birthweights between 1 pound and 5 pounds, 8 ounces were identified. Maternal hospital records of 4,754 women were reviewed for data about prenatal and intrapartal events. Two perinatologists classified births into four proximal etiology groups: term-lowbirthweight, medically indicated preterm birth, preterm premature rupture of membranes, and idiopathic preterm birth. Information from birth certificate and hospital records was merged to provide an expanded data set. Results. Race, age, education, and marital status are associated with different patterns of proximal etiology. Rates were higher for all etiologies in black women and in young women; however, the absolute number of LBW births was highest among white women. Idiopathic preterm birth was highest in black women and decreased as age increased; medical indications for preterm birth increased with increasing age. Conclusions. Classification of LBW births by etiologic group provides insights of value to both clinicians and researchers. Studies in which LBW and/or preterm birth are the outcome variables will be enhanced by identifying etiology. Multiple preventive strategies should address varying etiologic groups.     

Screening Mammography and Late-Stage Breast Cancer: A Population-Based Study

BACKGROUND: Among 50- to 69-year-old women, randomized clinical trials show breast cancer mortality reductions from screening mammography. However, few studies examine the long-term health effects and outcomes from screening mammography in community practice. The purpose of this study was to evaluate one approach for determining the effectiveness of screening mammography, as it is practiced in community settings, and to measure the prevalence of prior screening mammography among women with incident breast cancer. METHODS: This study was a population-based survey of the general community. Participants were 406 women with breast cancer diagnosed in 1993. The main outcome measure was breast cancer, late stage at diagnosis or fatal within 2 to 3 years of diagnosis. RESULTS: Sixty-four (57.7%) of 111 women with late-stage and 123 (42.1%) of 292 women with early-stage breast cancer did not have a screening mammogram in the 4 calendar years (1989-1992) before diagnosis. Relative to women with early-stage breast cancer, mammography nonuse in 1989-1992 was significantly more frequent among women with late-stage breast cancer (age-adjusted odds ratio 2.3, 95% confidence interval 1.3-4.3). Prior mammography was particularly infrequent among 42 women with breast cancer incident in 1993 and fatal before January 1996. CONCLUSIONS: Prior mammography among women with late-stage or fatal breast cancer was relatively infrequent. Late-stage or fatal breast cancer lacking prior mammography constitutes a missed public health opportunity. Also, this population-based study showed the expected association between prior mammography and late-stage or fatal breast cancer. These results are consistent with the effective practice of mammography in a community setting. The results illustrate and validate a public health approach that uses prior mammography histories among women with incident breast cancer to evaluate mammography penetration and quality in defined communities.     

Sex Differences in Home Care Performance: A Population-Based Study

BackgroundHome care services play an integral role in promoting independence, reducing hospital admission and readmission rates, and preventing or delaying nursing home admission among older adults. Despite important sex differences in functional status and use of services by recipients of home care, differences in home care performance measures by sex have not been examined.ObjectiveTo assess sex differences in the quality of publicly funded home care services in Ontario, Canada.MethodsValidated, publicly reported home care quality indicators derived from the Resident Assessment Instrument for Home Care using the 2009 and 2010 Home Care Reporting System database were assessed for 119,795 Ontario home care clients aged 65 years and older. Unadjusted and risk-adjusted sex differences in performance were examined provincially and by health region.ResultsIn unadjusted analyses, there were sex differences in health outcomes on all indicators examined (decline or failure to improve in activities of daily living, cognitive decline, depressive symptoms, and pain control). After risk adjustment, differences were minimal. For example, in unadjusted analyses, 23.1% of women and 18.7% of men reported poorly controlled pain. After risk adjustment, 21.2% of women and 21.6% of men reported poorly controlled pain, with a difference of −0.4% (95% CI, −0.4% to −0.3%). Across health regions risk adjustment eliminated sex differences. There was 1.3-fold to 2.6-fold variation in performance on indicators across health regions.ConclusionsAfter risk adjustment, no important sex differences in home care quality indicators were identified. Sizable regional variations observed indicate potential to improve home care outcomes for both women and men. Sex differences in unadjusted analyses demonstrate the value of examining both unadjusted and adjusted outcomes and suggest sex-specific strategies will likely be needed to improve home care quality.     

近5年医疗投诉及纠纷回顾性研究——以云南省某三甲专科医院为例

目的通过对云南省某三级甲等专科医院近5年医疗投诉及纠纷案例进行调查研究,分析医疗投诉及纠纷产生的原因,为减少医疗投诉及纠纷的发生和提高医院管理效率提供参考。方法查阅相关档案及管理制度,并收集医院医疗投诉及纠纷发生年度、涉及科室,投诉事由、解决方式和赔偿情况等资料,对样本医院2013—2017年的287例医疗投诉及纠纷案例进行对比分析。结果样本医院在近5年间,医疗投诉及纠纷发生原因多样化,科室分化明显,多集中在外科;发生率呈逐年增加趋势,但通过协商解决的案例逐年增多,且医疗纠纷赔偿中以未赔偿为主;处理途径逐渐趋向规范化、赔偿人次比逐年降低。结论加强医患沟通,改善服务态度,强化业务学习,规范诊疗行为,培养纠纷危机意识,健全纠纷处理处罚机制是防范医疗投诉及纠纷的重要措施。     

Plasma Carotenoids and Prostate Cancer: A Population-Based Case-Control Study in Arkansas

Carotenoids possess antioxidant properties and thus may protect against prostate cancer. Epidemiological studies of dietary carotenoids and this malignancy were inconsistent, partially due to dietary assessment error. In this study, we aimed to investigate the relation between plasma concentrations of carotenoids and the risk of prostate cancer in a population-based case-control study in Arkansas. Cases (n = 193) were men with prostate cancer diagnosed in 3 major hospitals, and controls (n = 197) were matched to cases by age, race, and county of residence. After adjustment for confounders, plasma levels of lycopene, lutein/zeaxanthin, and β -cryptoxanthin were inversely associated with prostate cancer risk. Subjects in the highest quartile of plasma lycopene (513.7 μ g/l) had a 55% lower risk of prostate cancer than those in the lowest quartile (140.5 μ g/l; P trend = 0.042). No apparent association was observed for plasma α -carotene and β -carotene. Further adjustment for the other 4 carotenoids did not materially alter the risk estimates for plasma lycopene, lutein/zeaxanthin, and β -cryptoxanthin but appeared to result in an elevated risk with high levels of plasma α -carotene and β -carotene. The results of all analyses did not vary substantially by age, race, and smoking status. This study added to the emerging evidence that high circulating levels of lycopene, lutein/zeaxanthin, and β -cryptoxanthin are associated with a low risk of prostate cancer.     

School Injury Among Ottawa-Area Children: A Population-Based Study

BACKGROUND:  Injuries are the leading cause of death among Canadian children and are responsible for a substantial proportion of hospitalizations and emergency department visits. This investigation sought to identify the factors associated with the likelihood of sustaining an injury at school among Ottawa-area children.
METHODS:  Children presenting to Ottawa-area hospitals and urgent care clinics from January to December 2002 (n = 24,074) were included for analysis. The frequency of school injuries by sex, age group, type of injury, and hospitalization was analyzed. Multivariate logistic regression was used to assess the factors associated with sustaining an injury at school. The school activities most associated with injury and the most frequent types of school injuries were assessed.
RESULTS:  A total of 4287 Ottawa-area children were injured at school in 2002, representing 18% of all injuries. Children aged 5-9 years and 10-14 years were more likely to have school injuries than older children (aged 15-19 years) (OR = 3.07, 95% CI = 2.77-3.40 and OR = 3.10, 95% CI = 2.83-3.37, respectively). The most frequently encountered school injuries were fractures (n = 1132) and musculoskeletal injury (n = 907). The most frequent mechanisms of school injuries were "playing" (n = 1004) and "informal sports" (n = 1503).
CONCLUSIONS:  Many children get hurt at school, particularly during informal recreation activities. Environmental modification and increased supervision are strategies that may reduce school injuries.     

Migration Status, Work Conditions and Health Utilization of Female Sex Workers in Three South African Cities

Intersections between migration and sex work are underexplored in southern Africa, a region with high internal and cross-border population mobility, and HIV prevalence. Sex work often constitutes an important livelihood activity for migrant women. In 2010, sex workers trained as interviewers conducted cross-sectional surveys with 1,653 female sex workers in Johannesburg (Hillbrow and Sandton), Rustenburg and Cape Town. Most (85.3 %) sex workers were migrants (1396/1636): 39.0 % (638/1636) internal and 46.3 % (758/1636) cross-border. Cross-border migrants had higher education levels, predominately worked part-time, mainly at indoor venues, and earned more per client than other groups. They, however, had 41 % lower health service contact (adjusted odds ratio = 0.59; 95 % confidence interval = 0.40–0.86) and less frequent condom use than non-migrants. Police interaction was similar. Cross-border migrants appear more tenacious in certain aspects of sex work, but require increased health service contact. Migrant-sensitive, sex work-specific health care and health education are needed.     

Epidemiology of Infertility: A Population-Based Study in Babol,Iran

The aim of researchers in the present study was to determine the prevalence of infertility and self-reported cause of infertility in Babol, Iran and then identify the factors associated with infertility. A retrospective epidemiologic study was conducted of characteristics of urban and rural women related to infertility. A total of 1,140 women aged 20–45 years were selected using cluster sampling. Of these 1,140 women, 59 (5.2%) (CI 4.2, 6.2) were voluntarily childless. Of the remaining 1,081 women, 913 (84.5%) (CI 82.5, 86.5) reported no difficulties in having children, and the remaining 168 (15.5%) (CI 13.5, 17.5) experienced difficulty conceiving at some stage in their lives. The prevalence of ever having primary infertility was 4.3% (CI 2.3, 6.3). The most frequently self-reported causes of infertility in this study were ovulation problems (39.2%). Infertile women were significantly more likely to have a higher age at marriage (p = 0.001), lower education (p = 0.006), higher body mass index (p = 0.0001), long-term health problems (p = 0.0001), a partner who smoked (p = 0.029), and past history of tubal or ectopic pregnancy (p = 0.002). These risk factors may help inform reproductive health clinics and primary healthcare centers about factors associated with infertility.