Introduction The 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. Methods National 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. Results From 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 Practice During 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.

Naloxone administration is an important component of resuscitation attempts by emergency medical services (EMS) for opioid drug overdoses. However, EMS providers must first recognize the possibility of opioid overdose in clinical encounters. As part of a public health response to an outbreak of opioid overdoses in Rhode Island, we examined missed opportunities for naloxone administration and factors potentially influencing EMS providers’ decision to administer naloxone. We reviewed medical examiner files on all individuals who died of an opioid-related drug overdose in Rhode Island from January 1, 2012 through March 31, 2014, underwent attempted resuscitation by EMS providers, and had records available to assess for naloxone administration. We evaluated whether these individuals received naloxone as part of their resuscitation efforts and compared patient and scene characteristics of those who received naloxone to those who did not receive naloxone via chi-square, t-test, and logistic regression analyses. One hundred and twenty-four individuals who underwent attempted EMS resuscitation died due to opioid overdose. Naloxone was administered during EMS resuscitation attempts in 82 (66.1%) of cases. Females were nearly three-fold as likely not to receive naloxone as males (OR 2.9; 95% CI 1.2–7.0; p-value 0.02). Additionally, patients without signs of potential drug abuse also had a greater than three-fold odds of not receiving nalox-one (OR 3.3; 95% CI 1.2–9.2; p-value 0.02). Older individuals, particularly those over age 50, were more likely not to receive naloxone than victims younger than age 30 (OR 4.8; 95% CI 1.3–17.4; p-value 0.02). Women, older individuals, and those patients without clear signs of illicit drug abuse, were less likely to receive naloxone in EMS resuscitation attempts. Heightened clinical suspicion for opioid overdose is important given the recent increase in overdoses among patients due to prescription opioids.

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Background Influenza vaccination is recommended annually for all persons 6 months and older. Reports of increased influenza-related morbidity and mortality during the 2013–2014 influenza season raised concerns about low adult influenza immunization rates in Puerto Rico. In order to inform public health actions to increase vaccination rates, we surveyed adults in Puerto Rico regarding influenza vaccination-related attitudes and barriers. Methods A random-digit-dialing telephone survey (50% landline: 50% cellphone) regarding influenza vaccination, attitudes, practices and barriers was conducted November 19–25, 2013 among adults in Puerto Rico. Survey results were weighted to reflect sampling design and adjustments for non-response. Results Among 439 surveyed, 229 completed the survey with a 52% response rate. Respondents’ median age was 55 years; 18% reported receiving 2013–2014 influenza vaccination. Among 180 unvaccinated respondents, 38% reported barriers associated with limited access to vaccination, 24% reported they did not want or need influenza vaccination, and 20% reported safety concerns. Vaccinated respondents were more likely to know if they were recommended for influenza vaccination, to report greater perceived risk of influenza illness, and to report being less concerned about influenza vaccine safety (p-value < 0.05). Of the 175 respondents who saw a healthcare provider (HCP) since July 1, 2013, 38% reported their HCP recommended influenza vaccination and 17% were offered vaccination. Vaccination rates were higher among adults who received a recommendation and/or offer of influenza vaccination (43% vs. 14%; p-value < 0.01). Conclusions Failure of HCP to recommend and/or offer influenza vaccination and patient attitudes (low perceived risk of influenza virus infection) may have contributed to low vaccination rates during the 2013–2014 season. HCP and public health practitioners should strongly recommend influenza vaccination and provide vaccinations during clinical encounters or refer patients for vaccination.

Youth violence is a critical public health problem across races/ethnicities in the United States. Although the differential association between substance use and physical aggression has been empirically proven, no tests have assessed the moderating effects of sociocultural differences in such associations. The purpose of this study is to test the moderating impact of race/ethnicity-as an indicator of sociocultural differences--on the associations between substance use and adolescent aggression, by conducting a validity assessment of a physical aggression measure for high school students with emphasis on Hispanics and other minorities. A cross-sectional, secondary data analysis of the 2007 national Youth Risk Behavior Survey, with a representative sample of all U.S. high school students, was conducted. Contingency table and chi-square test evaluated the statistical relationship between substance use (alcohol, marijuana, either, or both) and self-reports of physical aggression, race/ethnicity, age, and sex of the respondent. Three logistic regression analyses assessed the effect of race/ethnicity on the likelihood of reporting physical aggression by overall substance use and type of substance use. Statistical significant associations were found between physical aggression and alcohol and/or marijuana use. The self-report of substance use (marijuana or alcohol) and alcohol use significantly increased the likelihood of physical aggression across races/ethnicities, highest among racial/ethnic minorities (Blacks > Hispanic > Others > Whites). The differential impact of substance use on physical aggression was confirmed, and such impact was moderated by the sociocultural context (race/ethnicity) of the adolescent. In-depth validity assessments are needed to confirm this study's predictive validity findings.

Intimate partner violence (IPV) places children at risk for maltreatment (CM). It is critical for both IPV and CM professionals to assess the possibility of the co-occurrence of both of these types of family violence, whose risk factors are nearly identical. However, little is known about the attitudes and perceptions of child welfare (CW), IPV, child protection, or other related professionals when serving families where both of these circumstances may occur. This study examined the perceptions of service providers in Hillsborough County, Florida on the co-occurrence of CM and IPV. Findings demonstrate the inequitable knowledge, training, and perceived ability to deal with the co-occurrence of IPV and CM among professionals from different employment areas. These discrepancies serve as opportunities for different agencies to collaborate in reducing knowledge gaps and increasing respondent's capacity to effectively identify and intervene with victims.

Key Points Question Are online risk factors measured using real-world online activity data associated with youth suicide-related behavior? Findings In this case-control study of 227 youths, having a severe suicide/self-harm alert in a school-based online safety monitoring program was associated with multiple online risk factors (including cyberbullying, violence, drug-related content, hate speech, profanity, sexual content, depression, and low-severity self-harm content). However, the greatest risk was found among youth having multiple types of online risk factors. Meaning This case-control study provides information that may help guide youth suicide prevention activities related to online risk factors.

Although a non-gender-specific problem, intimate partner violence (IPV) disproportionately affects women on welfare, with an estimated prevalence two to three times larger than the national prevalence rates of IPV for all women. This article examines the effects of IPV on women leaving welfare for employment in a purposive sample of 411 women in Florida who participated or were actively participating in the 2000–2002 Work and Gain Economic Self-Sufficiency (WAGES) program. Data on sociodemographic characteristics, their IPV experiences, and mediating factors (i.e., social support, employer support, physical and mental health, parenting stress, and employment success) were collected via quantitative telephone interviews. Logistic regression analyses found that employment success among welfare-recipient women who are currently in a relationship is best predicted by a short-term impact of having experienced IPV before the past 12 months (OR = 2.17). Linear regression analyses found that having suitable housing predicted lower parenting stress (F = 3.20, p ≤ .05) and better physical health (F = 4.30, p ≤ .05) and social support (F = 1.90, p ≤ .001) outcomes. In addition, suffering from IPV within the past 12 months predicted worse mental health (F = −7.74, p ≤ .001) and lower parenting stress outcomes (F = −3.99, p ≤ .001). This study contributes to understanding the complexity of mediating factors affecting IPV’s impact on employment success of women leaving welfare.