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      Firearm violence in the USA: a frank discussion on an American public health crisis—The Kansas City Firearm Violence Symposium

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          Abstract

          Kansas City is a microcosm for USA. Although Kansas City shows a relatively diverse population, it is one that is segregated along the lines of race and income. This is an inequity that is common to all cities across the country. With this inequity comes unequal opportunity to survive and to thrive. Firearm violence is a core component of this societal inequity. In this article, we present the proceedings of the 2019 Kansas City Firearm Violence Symposium, where distinguished experts in trauma convened to share their experience, evidence and voices of gun violence—directly and indirectly. There were discussions on topics such as the human toll of gun violence, the role of structural violence in its perpetuation, the intersectional nature of race with both violence and medical care, and guidance on measures that could be taken to advocate for the reduction and elimination of gun violence. This was a symposium that started a country-wide conversation between academia, healthcare, survivors and the community on the most pressing public health crisis facing USA today.

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          Risk factors for femicide in abusive relationships: results from a multisite case control study.

          This 11-city study sought to identify risk factors for femicide in abusive relationships. Proxies of 220 intimate partner femicide victims identified from police or medical examiner records were interviewed, along with 343 abused control women. Preincident risk factors associated in multivariate analyses with increased risk of intimate partner femicide included perpetrator's access to a gun and previous threat with a weapon, perpetrator's stepchild in the home, and estrangement, especially from a controlling partner. Never living together and prior domestic violence arrest were associated with lowered risks. Significant incident factors included the victim having left for another partner and the perpetrator's use of a gun. Other significant bivariate-level risks included stalking, forced sex, and abuse during pregnancy. There are identifiable risk factors for intimate partner femicides.
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            Cultural Violence

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              Gun storage practices and risk of youth suicide and unintentional firearm injuries.

              Household firearms are associated with an elevated risk of firearm death to occupants in the home. Many organizations and health authorities advocate locking firearms and ammunition to prevent access to guns by children and adolescents. The association of these firearm storage practices with the reduction of firearm injury risk is unclear. To measure the association of specific household firearm storage practices (locking guns, locking ammunition, keeping guns unloaded) and the risk of unintentional and self-inflicted firearm injuries. Case-control study of firearms in events identified by medical examiner and coroner offices from 37 counties in Washington, Oregon, and Missouri, and 5 trauma centers in Seattle, Spokane, and Tacoma, Wash, and Kansas City, Mo. CASES AND CONTROLS: Case firearms were identified by involvement in an incident in which a child or adolescent younger than 20 years gained access to a firearm and shot himself/herself intentionally or unintentionally or shot another individual unintentionally. Firearm assaults and homicides were excluded. We used records from hospitals and medical examiners to ascertain these incidents. Using random-digit dial telephone sampling, control firearms were identified by identification of eligible households with at least 1 firearm and children living or visiting in the home. Controls were frequency matched by age group and county. The key exposures of interest in this study were: (1) whether the subject firearm was stored in a locked location or with an extrinsic lock; (2) whether the firearm was stored unloaded; (3) whether the firearm was stored both unloaded in a locked location; (4) whether the ammunition for the firearm was stored separately; and (5) whether the ammunition was stored in a locked location. Data regarding the storage status of case and control guns were collected by interview with respondents from the households of case and control firearms. We interviewed 106 respondents with case firearms and 480 with control firearms. Of the shootings associated with the case firearms, 81 were suicide attempts (95% fatal) and 25 were unintentional injuries (52% fatal). After adjustment for potentially confounding variables, guns from case households were less likely to be stored unloaded than control guns (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.16-0.56). Similarly, case guns were less likely to be stored locked (OR, 0.27; 95% CI, 0.17-0.45), stored separately from ammunition (OR, 0.45; 95% CI, 0.34-0.93), or to have ammunition that was locked (OR, 0.39; 95% CI, 0.23-0.66) than were control guns. These findings were consistent for both handguns and long guns and were also similar for both suicide attempts and unintentional injuries. The 4 practices of keeping a gun locked, unloaded, storing ammunition locked, and in a separate location are each associated with a protective effect and suggest a feasible strategy to reduce these types of injuries in homes with children and teenagers where guns are stored.
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                Author and article information

                Journal
                Trauma Surg Acute Care Open
                Trauma Surg Acute Care Open
                tsaco
                tsaco
                Trauma Surgery & Acute Care Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2397-5776
                2019
                10 December 2019
                : 4
                : 1
                : e000359
                Affiliations
                [1 ]University of Kansas Medical Center , Kansas City, Kansas, USA
                [2 ]departmentSurgery , University of Florida College of Medicine - Jacksonville , Jacksonville, Florida, USA
                [3 ]departmentDepartment of Surgery , University of Chicago Division of Biological Sciences , Chicago, Illinois, USA
                [4 ]departmentSurgery , The Johns Hopkins University , Baltimore, Maryland, USA
                [5 ]departmentUniversity of Kansas Medical Center, Department of Surgery , University of Kansas , Kansas City, KS, USA
                Author notes
                [Correspondence to ] Dr Tanya L Zakrison, Department of Surgery, University of Chicago Division of Biological Sciences, Chicago, IL 60637, USA; tzakrison@ 123456icloud.com
                Author information
                http://orcid.org/0000-0002-6536-3123
                http://orcid.org/0000-0001-6061-431X
                Article
                tsaco-2019-000359
                10.1136/tsaco-2019-000359
                6924760
                2b35f344-52db-412f-84e1-8b673868f62b
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 15 July 2019
                : 06 October 2019
                : 08 October 2019
                Categories
                Plenary Paper
                1506
                Custom metadata
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                press-release

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