Harvard Injury Control Research Center

Boston, MA, United States

Harvard Injury Control Research Center

Boston, MA, United States
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Wolfson J.A.,University of Michigan | Azrael D.,Harvard Injury Control Research Center | Miller M.,Harvard Injury Control Research Center | Miller M.,Northeastern University
American Journal of Public Health | Year: 2017

Objectives. To estimate US public opinion, overall and by gun ownership status, about the public places where legal gun owners should be allowed to carry firearms. Methods. We fielded an online survey among 3949 adults, including an oversample of gun owners and veterans, in April 2015. We used cross-tabulations with survey weights to generate nationally representative estimates. Results. Fewer than 1 in 3 US adults supported gun carrying in any of the specified venues. Support for carrying in public was consistently higher among gun owners than among non-gun owners. Overall, support for carrying in public was lowest for schools (19%; 95% confidence interval [CI] = 16.7, 21.1), bars (18%; 95% CI = 15.9, 20.6), and sports stadiums (17%; 95% CI = 15.0, 19.5). Conclusions. Most Americans, including most gun owners, support restricting public places legal gun owners can carry firearms. These views contrast sharply with the current trend in state legislatures of expanding where, how, and by whom guns can be carried in public. Recent state laws and proposed federal legislation that would force states to honor out-of-state concealed carry permits are out of step with American public opinion.


Miller M.,Harvard Injury Control Research Center | Azrael D.,Harvard Injury Control Research Center | Barber C.,Harvard Injury Control Research Center
Annual Review of Public Health | Year: 2012

Suicide mortality varies widely across age, sex, race, and geography, far more than does mortality from the leading causes of natural death. Unlike the tight correlation between cancer mortality and the incidence of cancer, suicide mortality is only modestly correlated with the incidence of suicidal acts and other established risk factors for suicidal behavior, such as major psychiatric disorders. An implication of this modest correlation is that the proportion of all suicidal acts that prove fatal (the case fatality ratio) must account for a substantial portion of the (nonrandom) variation observed in suicide mortality. In the United States, the case fatality ratio is strongly related to the availability of household firearms. Findings from ecologic and individual-level studies conducted over the past two decades illustrate the importance of accounting for the availability of highly lethal suicide methods in efforts to understand (and ultimately reduce) disparities in suicide mortality across populations. © 2012 by Annual Reviews. All rights reserved.


Barber C.,Harvard Injury Control Research Center | Hemenway D.,Harvard Injury Control Research Center
Accident Analysis and Prevention | Year: 2011

We examined the accuracy of data on unintentional firearm fatalities in the United States. We began with data from the National Violent Death Reporting System (NVDRS) and examined every firearm death reported as an accident by any NVDRS data source - the NVDRS abstracter, the State Vital Statistics Registry (i.e.; the ICD-10 Underlying Cause of Death code and manner of death from the death certificate), the medical examiner or coroner report, and the police Supplementary Homicide Report. After carefully reading the information from all sources, we then classified each case as either unintentional or intentional using NVDRS definitions. Comparing our classification with that of the NVDRS abstracter, we conclude that NVDRS data accurately report unintentional firearm deaths (sensitivity 98%; positive predictive value [PPV] 99%). We then compared our classification with that of the State Vital Statistics Registry based on the ICD-10 Underlying Cause of Death code and found great inaccuracy (sensitivity 62%; PPV 58%). Thirty-eight percent of true cases were missed and 42% of reported cases were false positives. As has been previously reported in the literature, over half of unintentional shootings that were inflicted by another person were classified as homicides, not accidents. This is a particular problem for the data on young victims. What was unexpected, however, was the opposite problem: we found many unambiguous suicides and homicides that were reported as accidents. We believe this is due to the ICD-10 coding practice of assigning injury deaths to the "accident" category when manner of death is "pending" or left blank. Finally, at the state-level, we compared our overall results for each state and year with the official National Vital Statistics System count (reported on CDC's WONDER website). We found evidence of even greater over-reporting of unintentional firearm deaths there. In answer to the question, "Are there too many or too few unintentional firearm deaths in official mortality data?" the best answer is, "Both." Many true accidents are missed, while many suicides and homicides are mistakenly reported as accidents. By contrast, the NVDRS applies a case definition for unintentional firearm deaths with consistency and accuracy. © 2010 Elsevier Ltd All rights reserved.


Hemenway D.,Harvard Injury Control Research Center
Injury Prevention | Year: 2013

Three common beliefs that are impediments to injury prevention are: (1) the optimistic belief that nothing bad is going to happen, especially to me ('it will never happen to me'); (2) the fatalistic belief that, if something bad does happen, nothing could have been done to prevent it ('accidents happen'); and (3) the moralistic belief that if the injury happens to someone else (eg, you), you probably deserved it-so do not blame me or expect that I should have done anything to help prevent it ('blaming the victim'). On-line blogs and comments are used to illustrate these beliefs. Counter-arguments are discussed.


Betz M.E.,University of Colorado at Denver | Barber C.,Harvard Injury Control Research Center | Miller M.,Harvard Injury Control Research Center
Suicide and Life-Threatening Behavior | Year: 2011

The association between home firearms and the likelihood and nature of suicidal thoughts and plans was examined using the Second Injury Control and Risk Survey, a 2001-2003 representative telephone survey of U.S. households. Of 9,483 respondents, 7.4% reported past-year suicidal thoughts, 21.3% with a plan. Similar proportions of those with and without a home firearm reported suicidal thoughts, plans, and attempts. Among respondents with suicidal plans, the odds of reporting a plan involving a firearm were over seven times greater among those with firearms at home, compared with those without firearms at home. The results suggest people with home firearms may not be more likely to be suicidal, but when suicidal they may be more likely to plan suicide by firearm. © 2011 The American Association of Suicidology.


Miller M.,Harvard Injury Control Research Center | Warren M.,Harvard Injury Control Research Center | Hemenway D.,Harvard Injury Control Research Center | Azrael D.,Harvard Injury Control Research Center
Injury Prevention | Year: 2015

On an average day in the USA more than 100 Americans die by suicide—half use firearms. Suicide rates overall and by firearms are higher, on average, in states where household firearm ownership is more common. In general this means in states where a greater proportion of the population lives in rural areas. The current ecological study focuses on the relation between measures of household firearm prevalence and suicide mortality in urban areas (metropolitan statistical areas and divisions) using survey-based measures of firearm ownership. Suicide rates (1999–2010) for metropolitan statistical areas that are comprised of large US cities come from death certificate records; rates of household firearm ownership come from the 2002 and 2004 Behavioural Risk Factor Surveillance System. Higher rates of firearm ownership are strongly associated with higher rates of overall suicide and firearm suicide, but not with non-firearm suicide. Stratification by gender, age and race did not materially affect the association between firearms and suicide. This study provides evidence consistent with previous case–control work and extends evidence from previous state- and region-level ecological studies that firearms in the home impose suicide risk above and beyond baseline. © 2015 BMJ Publishing Group. All rights reserved.


Hemenway D.,Harvard Injury Control Research Center
American journal of public health | Year: 2011

We sought to provide additional information about the characteristics of adolescents who were most likely to cause unintentional injury to other people. In 2008, as part of a randomized survey of high-school students in the Boston Public School system, more than 1800 respondents answered questions about unintentionally causing an injury to someone else in the past year. More than 20% of boys and 13% of girls reported unintentionally injuring another person in the past year. Being male, exercising, participating in organized activities, and having carried a knife were risk factors for unintentionally causing an injury during sports. Using illegal drugs, having friends who are a bad influence, and having carried a knife were risk factors for unintentionally causing an injury not associated with sports. Unintentionally injuring another person is a fairly common event for high-school students. Characteristics differ between adolescents who unintentionally injure others during sports versus those who unintentionally injure others during nonsports activities. Many of the risk factors for causing unintentional injury unrelated to sports are similar to those for intentionally causing injury.


Barber C.W.,Harvard Injury Control Research Center | Miller M.J.,Harvard Injury Control Research Center
American Journal of Preventive Medicine | Year: 2014

Reducing the availability of highly lethal and commonly used suicide methods has been associated with declines in suicide rates of as much as 30%-50% in other countries. The theory and evidence underlying means restriction is outlined. Most evidence of its efficacy comes from population-level interventions and natural experiments. In the U.S., where 51% of suicides are completed with firearms and household firearm ownership is common and likely to remain so, reducing a suicidal person's access to firearms will usually be accomplished not by fiat or other legislative initiative but rather by appealing to individual decision, for example, by counseling at-risk people and their families to temporarily store household firearms away from home or otherwise making household firearms inaccessible to the at-risk person until they have recovered. Providers, gatekeepers, and gun owner groups are important partners in this work. Research is needed in a number of areas: communications research to identify effective messages and messengers for "lethal means counseling," clinical trials to identify effective interventions, translational research to ensure broad uptake of these interventions across clinical and community settings, and foundational research to better understand method choice and substitution. Approaches to suicide methods other than firearms are discussed. Means restriction is one of the few empirically based strategies to substantially reduce the number of suicide deaths. © 2014 American Journal of Preventive Medicine.


Richardson E.G.,University of California at Los Angeles | Hemenway D.,Harvard Injury Control Research Center
Journal of Trauma - Injury, Infection and Critical Care | Year: 2011

Background: Violent death is a major public health problem in the United States and throughout the world. Methods: A cross-sectional analysis of the World Health Organization Mortality Database analyzes homicides and suicides (both disaggregated as firearm related and non-firearm related) and unintentional and undetermined firearm deaths from 23 populous high-income Organization for Economic Co-Operation and Development countries that provided data to the World Health Organization for 2003. Results: The US homicide rates were 6.9 times higher than rates in the other high-income countries, driven by firearm homicide rates that were 19.5 times higher. For 15-year olds to 24-year olds, firearm homicide rates in the United States were 42.7 times higher than in the other countries. For US males, firearm homicide rates were 22.0 times higher, and for US females, firearm homicide rates were 11.4 times higher. The US firearm suicide rates were 5.8 times higher than in the other countries, though overall suicide rates were 30% lower. The US unintentional firearm deaths were 5.2 times higher than in the other countries. Among these 23 countries, 80% of all firearm deaths occurred in the United States, 86% of women killed by firearms were US women, and 87% of all children aged 0 to 14 killed by firearms were US children. Conclusions: The United States has far higher rates of firearm deaths-firearm homicides, firearm suicides, and unintentional firearm deaths compared with other high-income countries. The US overall suicide rate is not out of line with these countries, but the United States is an outlier in terms of our overall homicide rate. Copyright © 2011 by Lippincott Williams &Wilkins.


News Article | April 15, 2016
Site: news.yahoo.com

Road rage may have played a role in the shooting death of former NFL player Will Smith in New Orleans over the weekend, police have said. Whether or not road rage is implicated, the incident highlights the real threat of what seem to be driver tantrums. And, according to scientists, freak-outs on the road can be considered a mental disorder, or at the very least, may stem from brain abnormalities. "I would be surprised if the person who killed Smith didn't have an anger problem," University of Chicago psychiatry professor Dr. Emil Coccaro told Live Science, referring to the driver who rear-ended Smith's car. [Hypersex to Hoarding: 7 New Psychological Disorders] After the collision, the two men pulled over and exchanged words, during which time the other driver pulled out a handgun and shot both Smith and his wife, injuring her and killing Smith at the scene, according to a release by the New Orleans Police Department. Police are investigating the possibility that road rage, among other potential causes, was a factor in the shooting, according to the Washington Post. Coccaro and other psychologists consider road rage a manifestation of a psychiatric disorder called intermittent explosive disorder (IED), which is essentially a problem of "recurrent, problematic, aggressive, impulsive outbursts," Coccaro said. Though scientists can't say what proportion of road rage is related to IED, road rage is one type of outburst that people with IED have, he said. More specifically, according to the current (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders, IED can involve either frequent, low-intensity outbursts or less frequent but more destructive ones (three or more episodes within the course of a year that to lead to destruction of property or bodily harm). Most people with IED, however, experience both kinds of outbursts, Coccaro said. What's the line between an angry outburst while driving and a psychiatric disorder? In addition to the two types of outbursts, IED is associated with aggression that is disproportionate to the situation; it isn't premeditated; and it's not related to substance abuse or another mental disorder, Coccaro said. Additionally, the outbursts "have to get [the person with IED] into trouble. They have to cause them distress, or they have to get them into difficulty with others, either in their relationships or at work. Typically, it's with relationships," Coccaro said. [Understanding the 10 Most Destructive Human Behaviors] People with IED often "have trouble understanding what's happening in their interactions with other people, particularly when those interactions are ambivalent," Coccaro said. They are more likely to misinterpret people's actions as threats and respond with aggression. Interpersonal interactions tend to trigger outbursts in people with IED, he said. As for why some people have "shorter fuses" than others, that boils down to biology, Coccaro said. People with IED tend to have higher levels of proteins that are linked to inflammation, according to a 2013 study led by Coccaro and published in the journal JAMA Psychiatry. It's unknown if inflammation leads to aggression, though animal research suggests that it might, Coccaro said. Brain abnormalities also factor into aggression, he said. In people with aggression problems like IED, "the frontal areas of the brain function less well, and they're the brakes of the system," said Coccaro. The accelerator in this aggression system would be the lower areas of the brain, such as the amygdala, he added. "That tends to be hyper-responsive to threat stimuli." Research has shown that people with IED tend to have less gray matter in the cortical limbic regions — their "brakes" are less well-endowed, Coccaro said. Coccaro noted that the kinds of correlations he has observed among aggression and other factors also hold for people who do not have IED. In other words, the same correlations, say between gray matter levels and aggression, are seen when people have less intense outbursts that wouldn't be considered IED. Rather, IED is aggression at a level deemed clinically significant. "When you get up to high levels of aggression, it becomes its own disorder," Coccaro said. Sometimes an accident can result in an abnormally aggressive driver. For instance, people who have had a traumatic brain injury (TBI) are about four times as likely to engage in driver aggression as those who have not experienced such an injury, according to a study of Ontario adult drivers published last year in the journal Accident Analysis and Prevention. According to the same study, TBI survivors were also more likely to have been involved in vehicle collisions. [The Odds of Dying] "When we look at the large proportion of adult drivers with a history of traumatic brain injury" — about 17 percent in the Ontario study — "it's very possible that these individuals may account for a great proportion of [or] burden of all traffic-safety problems," said study author Gabriela Ilie, now a faculty member at Dalhousie University, in Nova Scotia. External factors also play a role. Motorists who drive with guns in the car are significantly more likely to engage in aggressive driving behavior (such as making obscene gestures or aggressively following another vehicle), according to two studies led by the Harvard Injury Control Research Center of the university's School of Public Health. "We don't know whether having a gun in the car changes people's behavior, or if they tended to be more aggressive to start with," David Hemenway, director of the center and a co-author on both studies, told Live Science.  "What we would like is that people driving around with guns were the most calm and least aggressive motorists," he said. "The opposite seems to be the case." "Add to that the fact that violent behavior with a gun is much more likely to prove lethal than violent behavior without a gun, [and] what we can say is that Will Smith stood a much better chance of being alive today if the rageful encounter on the road did not involve a gun," added center co-director and study author Dr. Matthew Miller. To clear the roads of such harmful tantrums, Coccaro suggested paying some heed to the actual perpetrators. "People get very concerned about victims of violence. They have no concern for the perpetrators of violence, because they're just seen as bad people," Coccaro said. "If we don't do something to understand and help the people who are more aggressive than the rest of us, we're still going to have victims." Current treatments that help people with IED include serotonin modulators, such as selective serotonin re-uptake inhibitors (anti-anxiety drugs), which could raise the emotional threshold for an outburst. Cognitive behavioral therapy might also help people better control their reactions in potentially triggering situations, Coccaro said. Copyright 2016 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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