ObjectiveRugby union (‘rugby’) is popular globally, with most of its participants being amateur. Concern regarding sport-related concussion (SRC) sustained during rugby is increasing. SRC occurs most frequently in the tackle, yet few interventions have aimed to mitigate this risk factor. This study investigated the influence of a lowered legal tackle height on SRC incidence in amateur rugby.DesignCross-sectional analytical study: 2018 (control—standard tackle height) and 2019 (intervention—lowered legal tackle height) seasons.SettingSouth African collegiate student rugby competition.ParticipantsBetween 800 and 900 male amateur student players (age: 20±1.6 years) in each year.InterventionMaximum legal tackle height lowered from line of the shoulder on the ball carrier to the line of the armpit.Outcome measuresNumber of overall (medical attention) and time-loss (≥1 day lost) injuries, head injuries and SRCs in 2018 and 2019 (dependent variables); events associated with injury incidents (independent variables).ResultsThere was no statistically significant difference in incidences of time-loss injuries (IRR: 0.79; 95% CI: 0.6 to 1.1; p=0.13), head injuries (IRR: 0.83; 95% CI: 0.5 to 1.3; p=0.42) and SRC (IRR: 0.69; 95% CI: 0.4 to 1.2; p=0.20). In 2018 and 2019, most time-loss head injuries (57%, n=43) and SRCs (55%, n=26) occurred during the tackle.ConclusionsDespite a trend towards reducing injuries, head injuries and SRC, lowering maximum legal tackle height to armpit level did not change SRC incidence in this amateur male rugby cohort. Most time-loss head injuries and SRCs occurred during the tackle. Further tackle-related interventions to reduce SRC incidence require investigation.

BackgroundIntimate partner violence (IPV) victims and perpetrators often report suicidal ideation, yet there is no comprehensive national dataset that allows for an assessment of the connection between IPV and suicide. The National Violent Death Reporting System (NVDRS) captures IPV circumstances for homicide-suicides (<2% of suicides), but not single suicides (suicide unconnected to other violent deaths; >98% of suicides).ObjectiveTo facilitate a more comprehensive understanding of the co-occurrence of IPV and suicide, we developed and validated a tool that detects mentions of IPV circumstances (yes/no) for single suicides in NVDRS death narratives.MethodsWe used 10 000 hand-labelled single suicide cases from NVDRS (2010–2018) to train (n=8500) and validate (n=1500) a classification model using supervised machine learning. We used natural language processing to extract relevant information from the death narratives within a concept normalisation framework. We tested numerous models and present performance metrics for the best approach.ResultsOur final model had robust sensitivity (0.70), specificity (0.98), precision (0.72) and kappa values (0.69). False positives mostly described other family violence. False negatives used vague and heterogeneous language to describe IPV, and often included abusive suicide threats.ImplicationsIt is possible to detect IPV circumstances among singles suicides in NVDRS, although vague language in death narratives limited our tool’s sensitivity. More attention to the role of IPV in suicide is merited both during the initial death investigation processes and subsequent NVDRS reporting. This tool can support future research to inform targeted prevention.

BackgroundThere are large discrepancies between official statistics of traffic injuries in African countries and estimates from the Global Burden of Disease (GBD) study and WHO’s Global Status Reports on Road Safety (GSRRS). We sought to assess the magnitude of the discrepancy in Ethiopia, its implications and how it can be addressed.MethodsWe systematically searched for nationally representative epidemiological data sources for road traffic injuries and vehicle ownership in Ethiopia and compared estimates with those from GBD and GSRRS.FindingsGBD and GSRRS estimates vary substantially across revisions and across projects. GSRRS-2018 estimates of deaths (27 326 in 2016) are more than three times GBD-2019 estimates (8718), and these estimates have non-overlapping uncertainty ranges. GSRRS estimates align well with the 2016 Demographic and Health Survey (DHS-2016; 27 838 deaths, 95th CI: 15 938 to 39 738). Official statistics are much lower (5118 deaths in 2018) than all estimates. GBD-2019 estimates of serious non-fatal injuries are consistent with DHS-2016 estimates (106 050 injuries, 95th CI: 81 728 to 130 372) and older estimates from the 2003 World Health Survey. Data from five surveys confirm that vehicle ownership levels in Ethiopia are much lower than in other countries in the region.InterpretationInclusion of data from national health surveys in GBD and GSRRS can help reduce discrepancies in estimates of deaths and support their use in highlighting under-reporting in official statistics and advocating for better prioritisation of road safety in the national policy agenda. GBD methods for estimating serious non-fatal injuries should be strengthened to allow monitoring progress towards Sustainable Development Goal target 3.6.

ObjectiveCellphone ubiquity has increased distracted pedestrian behaviour and contributed to growing pedestrian injury rates. A major barrier to large-scale implementation of prevention programmes is unavailable information on potential monetary benefits. We evaluated net economic societal benefits of StreetBit, a programme that reduces distracted pedestrian behaviour by sending warnings from intersection-installed Bluetooth beacons to distracted pedestrians’ smartphones.MethodsThree data sources were used as follows: (1) fatal, severe, non-severe pedestrian injury rates from Alabama’s electronic crash reporting system; (2) expected costs per fatal, severe, non-severe pedestrian injury—including medical cost, value of statistical life, work-loss cost, quality-of-life cost—from CDC and (3) prevalence of distracted walking from extant literature. We computed and compared estimated monetary costs of distracted walking in Alabama and monetary benefits from implementing StreetBit to reduce pedestrian injuries at intersections.ResultsOver 2019–2021, Alabama recorded an annual average of 31 fatal, 83 severe and 115 non-severe pedestrian injuries in intersections. Expected costs/injury were US$11 million, US$339 535 and US$93 877, respectively. The estimated distracted walking prevalence is 25%–40%, and StreetBit demonstrates 19.1% (95% CI 1.6% to 36.0%) reduction. These figures demonstrate potential annual cost savings from using interventions like StreetBit statewide ranging from US$18.1 to US$29 million. Potential costs range from US$3 208 600 (beacons at every-fourth urban intersection) to US$6 359 200 (every other intersection).ConclusionsEven under the most parsimonious scenario (25% distracted pedestrians; densest beacon placement), StreetBit yields US$11.8 million estimated net annual benefit to society. Existing data sources can be leveraged to predict net monetary benefits of distracted pedestrian interventions like StreetBit and facilitate large-scale intervention adoption.

This study aims to identify potential injury-related mortality disparities for American Indians/Alaskan Natives (AI/ANs) within the rural counties of one US state, Wisconsin. The Wisconsin Interactive Statistics on Health database was used to compare injury-related mortality for AI/ANs and whites in rural counties from 2016 to 2020. Both unintentional and intentional injuries were examined. This study found that AI/ANs were 62% more likely to die of an injury compared with whites in rural counties (relative risk (RR): 1.62; 95% CI: 1.41 to 1.86). When looking at injury-related mortality across various age groups, the 18–44-year-old age group had the largest injury-related mortality gap for AI/ANs compared with whites (RR: 2.85; 95% CI: 2.36 to 3.44). This study presents evidence that AI/ANs face significant injury-related mortality disparities compared with whites in rural counties.

BackgroundDog bite injuries cause over 100 000 paediatric emergency department visits annually. Our objective was to analyse associations between regional dog ownership laws and incidence of paediatric dog bites.MethodsThis observational study used an online search to locate local dog-related policies within Ohio cities. Data collected by Ohio Partners For Kids from 2011 through 2020 regarding claims for paediatric dog bite injuries were used to compare areas with and without located policies and the incidence of injury.ResultsOur cohort consisted of 6175 paediatric patients with dog bite injury encounters. A majority were white (79.1%), male (55.0%), 0–5 years old (39.2%) and did not require hospital admission (98.1%). Seventy-nine of 303 cities (26.1%) had city-specific policies related to dogs. Overall, the presence of dog-related policies was associated with lower incidence of dog bite injury claims (p=0.01). Specifically, metropolitan areas and the Central Ohio region had a significantly lower incidence when dog-related policies were present (324.85 per 100 000 children per year when present vs 398.56 when absent; p<0.05; 304.87 per 100 000 children per year when present vs 411.43 when absent; p<0.05).ConclusionsThe presence of city-specific dog-related policies is associated with lower incidence of paediatric dog bite injury claims, suggesting that local policy impacts this important public health issue. There are limited dog-related policies addressing dog bite prevention, with inconsistencies in breadth and depth. Creating consistent, practical requirements among policies with vigorous enforcement could ameliorate public health concerns from paediatric dog bite injuries.

ObjectiveAdverse childhood experiences (ACEs) are associated with increased risk of sustaining a traumatic brain injury (TBI). Alcohol use may play an important role in this relationship. This study examines whether binge drinking mediates the relationship between four ACEs and TBIs sustained in adulthood.MethodsUsing the National Longitudinal Survey of Youth, 1979 cohort, we conducted longitudinal mediation analyses (n=6317). Interviews occurred annually from 1979 to 1994 and biennially until 2016. We evaluated the direct and indirect effects of individual ACEs (ie, experiencing physical violence, low parental warmth, familial alcoholism and familial mental illness; reported retrospectively) and a cumulative ACEs score on mean level of binge drinking (calculated across waves) and having a TBI in adulthood. To establish temporality, we included binge drinking that was measured at age 18 or older and before any reported TBI.ResultsCumulative ACEs, familial alcoholism and physical abuse exposure were significantly associated with having a TBI through binge drinking, although this only explained a small part of the association between ACEs and TBI. Other ACEs were not significantly associated with binge drinking or TBI.ConclusionThe results indicate that while ACEs and adult TBI risk were significantly associated, lifetime binge drinking explains only a small part of the association. Future research could examine alternative social, biological and behavioural mechanisms along the pathway between ACEs and TBI. Determining this mechanism will allow public health practitioners to design and implement effective TBI prevention programmes for those at higher risk of injury due to ACE exposure.

In 2019, a presentation for a variety of stakeholders was arranged as part of the launch event for a publication documenting the subnational magnitude of road traffic injuries in India as estimated by the Global Burden of Disease Study.1 I did not use the term ‘road accident’ and explained to the audience the need to move away from that term because accidents do not happen, they are caused. All the questions and comments that followed the presentation used ‘road accident’. The same was explained by me in another meeting to a very different audience—researchers at a leading global vehicle manufacturer. After the presentation, the president of the company said that he hoped that I slipped and used ‘road accident’ at least once during the presentation or interaction, but I did not. He was …

ObjectivesDetermine whether Pre-Game Safety Huddles, a novel and low-resource approach to concussion education, increase the expected likelihood of concussion reporting for youth athletes.MethodsA cluster-randomised trial compared Safety Huddles to usual care. Safety Huddles bring together athletes and coaches from both teams before the start of each game for coaches to briefly affirm the importance of speaking up if a concussion is suspected. Participants were athletes from 22 competitive community-based American football and girls and boys soccer teams (ages 9–14), and randomisation into intervention or control occurred at the level of the bracket (group of teams that compete against each other during the regular season). The primary outcome was expected likelihood of reporting concussion symptoms to the coach, measured via validated athlete survey at the beginning and end of the season.ResultsOf 343 eligible participants, 339 (99%) completed baseline surveys and 303 (88%) completed surveys at season end. The mean (SD) age was 11.4 (1.1) years, 26% were female soccer athletes, 27% were male soccer athletes and 47% were football athletes. In adjusted analyses accounting for baseline values and clustering by sport and team via random effects, expected likelihood of concussion reporting at the end of the season was significantly higher in the intervention group compared to controls (mean difference=0.49, 95% CI 0.11 to 0.88; Cohen’s d=0.35).Conclusions and relevancePre-Game Safety Huddles increased the expected likelihood of athletes reporting concussion symptoms. While further study is warranted, sport organisations should consider this approach a promising low-resource option for improving concussion safety in their setting.Trial registration numberNCT04099329.

BackgroundMexico City approved new road safety policies in 2015, which included lower speed limits and higher fines for traffic offences. In 2019, economic fines were replaced by a point penalty system among other changes. This study evaluates these policies on road traffic collisions, injuries and deaths.MethodsCollisions data came from insurance collision claims (January 2015 to December 2019) and road traffic deaths from vital registrations (January 2013 to December 2019). We conducted an interrupted time series analysis for each outcome using negative binomial regression models with an offset of insured vehicles (collisions) or total population (deaths). Then, we classified the 16 municipalities in the city into enforcement and no-enforcement groups based on presence or absence of automated traffic enforcement devices and conducted a controlled interrupted time series analysis.ResultsThe 2015 road safety policies had no effect on total collisions and collisions resulting in injury but were associated with a 0.2% (95% CI −0.3 to 0.0) decline in the mortality trend. The 2019 policies had no effect on total collisions but were associated with a 1.5% increase in the trend of collisions resulting in injuries and with a 2.7% (95% CI 1.0 to 4.5) increase in the mortality trend. Postpolicy trends in enforcement versus no-enforcement municipalities were not significantly different.ConclusionPolicies that included high economic penalties for speeding and dangerous behaviours were effective in decreasing traffic mortality while removing economic penalties and replacing them with a point penalty system were associated with an increase in collisions, resulting in injury and mortality.

IntroductionThe purpose was to examine the association between concussion history and academic standing among high school students, and whether the association varies by sex, school grade and race/ethnicity.MethodsData from the 2019 Youth Risk Behaviour Survey were used for our cross-sectional study. Exposure was self-reported history of concussions in the past 12 months. Outcome was self-reported academic standing in the past 12 months. Poisson regression was used to analyse the exposure–outcome association, and whether there were differences by our stratifying variables.ResultsHaving a history of concussion in the past 12 months was significantly associated with a higher risk of poor academic standing during the same period, and the association varied by race/ethnicity.DiscussionYouth with a history of concussion may be at risk for poorer academic standing, indicating to the importance of prevention. Future studies are needed to examine the interaction of race/ethnicity on the presented association.

BackgroundSerious car seat installation errors occur at high rates in infants and children. These errors significantly increase the risk of child injury in a motor vehicle crash, and few interventions have addressed the challenge longitudinally.MethodsThis was a pilot randomised controlled feasibility trial of virtual car seat safety checks for caregivers of newborns recruited from an urban newborn nursery. The control (enhanced usual care (EUC)) group received an in-person car seat check as a newborn and virtual check at 9 months. The intervention group received two additional virtual checks at 3 and 6 months. Installation and infant positioning errors were documented and corrected by a child passenger safety technician (CPST). We measured feasibility and acceptability by tracking caregiver and CPST challenges, and caregiver retention. Group differences were tested for statistical significance using χ2 or Fisher’s exact test for categorical variables, and two sample t-tests for continuous variables.Results33 caregivers were randomised to the EUC and 28 to the intervention group. Virtual checks were feasible, with variable participation levels at each quarter. Wi-Fi and app challenges noted in 30%. There was satisfaction with the virtual car seat checks. At baseline, car seat installation and infant positioning errors occurred at equal frequency, and at 9 months the intervention group had a significantly lower mean proportion than the EUC group in all categories of errors. In summary, virtual seat checks are feasible and the optimal timing of repeat checks requires additional study. A larger study is needed to further evaluate the effect of longitudinal virtual checks on errors.

ObjectiveTo estimate the effect of a handgun purchase waiting period repeal on handgun and firearm suicides in Wisconsin.MethodsData for outcome and predictor variables were obtained for the 1999–2020 study period. Synthetic controls were used to assess the impact of Wisconsin’s waiting period repeal on mean-centred suicide rates. Placebo tests, difference-in-differences regression and augmented synthetic controls supplemented the synthetic control analyses.ResultsPostrepeal suicides were more likely to involve handguns than those in the 5 years immediately preceding the repeal (χ² (1, N=8269) = 49.25, p<0.001). The waiting period repeal resulted in an estimated annual increase of 1.1 handgun suicides per 100 000, or roughly 65 handgun suicide deaths per year. Estimates from difference-in-differences regression and augmented synthetic control analyses indicated similar treatment effects. Relative to the synthetic control, firearm suicides increased 6.5% following the repeal.ConclusionThe waiting period repeal in Wisconsin was associated with increases in both handgun and firearm suicides. The findings suggest that waiting periods may be effective means restriction policies to reduce suicide. Additionally, the synthetic control’s ability to closely approximate preintervention handgun suicide trends despite a limited donor pool has implications for future policy analyses.

Introduction Non-fatal shooting rates vary tremendously within cities in the USA. Factors related to structural racism (both historical and contemporary) could help explain differences in non-fatal shooting rates at the neighbourhood level. Most research assessing the relationship between structural racism and firearm violence only includes one dimension of structural racism. Our study uses an intersectional approach to examine how the interaction of two forms of structural racism is associated with spatial non-fatal shooting disparities in Baltimore, Maryland.Methods We present three additive interaction measures to describe the relationship between historical redlining and contemporary racialized economic segregation on neighbourhood-level non-fatal shootings.Results Our findings revealed that sustained disadvantage census tracts (tracts that experience contemporary socioeconomic disadvantage and were historically redlined) have the highest burden of non-fatal shootings. Sustained disadvantage tracts had on average 24 more non-fatal shootings a year per 10 000 residents compared with similarly populated sustained advantage tracts (tracts that experience contemporary socioeconomic advantage and were not historically redlined). Moreover, we found that between 2015 and 2019, the interaction between redlining and racialized economic segregation explained over one-third of non-fatal shootings (approximately 650 shootings) in sustained disadvantage tracts.Conclusion These findings suggest that the intersection of historical and contemporary structural racism is a fundamental cause of firearm violence inequities in Baltimore. Intersectionality can advance injury prevention research and practice by (1) serving as an analytical tool to expose inequities in injury-related outcomes and (2) informing the development and implementation of injury prevention interventions and policies that prioritise health equity and racial justice.

PurposeWe evaluated the impact of Senate Bill 489 passed in May 2017, allowing the sale and use of fireworks in Iowa 1 June to 8 July and 10 December to 3 January, on hospital presentations for firework injuries in the state. To identify the public health implications of this law, we conducted a detailed subanalysis of hospital presentations to the two level I trauma centres.MethodsHospital presentations for firework injuries from 1 June 2014 to 31 July 2019 were identified using the Iowa Hospital Admission database and registries and medical records of Iowa’s two level 1 trauma centres. Trauma centres’ data were reviewed to obtain demographics, injury information and hospital course. Prefirework and postfirework legalisation state data were compared using negative binomial regression analysis. Trauma centre data detailing injuries were compared using χ2 and Mann-Whitney U tests as appropriate.ResultsEmergency department (ED) visits and hospital admissions for firework injuries increased in Iowa post-legalisation (B-estimate=0.598±0.073, p<0.001 and B-estimate=0.612±0.322, p=0.058, respectively). ED visits increased postlegalisation in July (73.6% vs 64.5%; p=0.008), reflecting an increase in paediatric admissions (81.8% vs 62.5%; p=0.006). Trauma centres’ data showed similar trends. The most common injury site across both study periods was the hands (48.5%), followed by the eyes (34.3%) and face (28.3%). Amputations increased from 0 prelegalisation to 16.2% postlegalisation.ConclusionFirework legalisation led to an increase in the number of admissions and more severe injuries.

In 1999, the Centers for Disease Control and Prevention proclaimed the reduction in motor vehicle fatalities to be one of the great public health achievements of the 20th century. That motor vehicle success story has had enormous intellectual impact on the injury prevention field, providing many guiding lessons. Can we learn any lessons from what has happened to motor vehicle safety in the 21st century? A key lesson may come from the fact that the great injury achievement of reducing the motor vehicle death rate did not stop in 2000—it continued. We believe that is largely due to the 20th century creation of the conditions that promote continuous declines in injury. By contrast, in the firearms area, these conditions do not exist, and rates of death have not fallen, but have increased. As the idea of continuous quality improvement has become a staple in medicine, we should similarly have a focus on how to continuously reduce injuries. An important lesson from the 21st century motor vehicle success story for the injury prevention field is that we should put more strategic emphasis on creating the conditions that will lead to continuous reductions in injuries. But first we need a much better understanding of what those conditions are.

It is an incredible honour for me to have become the President of SAVIR in April of 2022; a society of professionals who are committed to advancing violence and injury research, practice and education. I am also humbled by the faith colleagues have shown in me to lead this great association. In this editorial, I will share my reflections and SAVIR’s priorities in the years ahead. With support from the US CDC, injury research centre directors across the country started the National Association of Injury Control Research Centers (NAICRC) in 1990s. Several years later, NAICRC was changed to SAVIR in order to be more inclusive of injury centres not supported by CDC and public health practitioners who might not have been engaged in research but were practicing injury prevention. Over the years, many distinguished scholars and leaders not only trained and mentored countless young researchers and professionals, but also put in tremendous effort to develop and grow the violence and injury research and prevention field.1 2 SAVIR has evolved to become a leading academic society for violence prevention and injury control research, due to the commitment, energy and great effort of many distinguished scholars and leaders. It is inspiring to read the seminal research, challenges and practice of those pioneers who have been making significant contribution to our field over the past three decades.2 Their efforts in establishing the first issue of Injury Prevention in 1995 met many challenges but through determination, perseverance, and leadership, Injury Prevention is now SAVIR’s …

BackgroundSuicide deaths have been increasing for the past 20 years in the USA resulting in 45 979 deaths in 2020, a 29% increase since 1999. Lack of data linkage between entities with potential to implement large suicide prevention initiatives (health insurers, health institutions and corrections) is a barrier to developing an integrated framework for suicide prevention.ObjectivesData linkage between death records and several large administrative datasets to (1) estimate associations between risk factors and suicide outcomes, (2) develop predictive algorithms and (3) establish long-term data linkage workflow to ensure ongoing suicide surveillance.MethodsWe will combine six data sources from North Carolina, the 10th most populous state in the USA, from 2006 onward, including death certificate records, violent deaths reporting system, large private health insurance claims data, Medicaid claims data, University of North Carolina electronic health records and data on justice involved individuals released from incarceration. We will determine the incidence of death from suicide, suicide attempts and ideation in the four subpopulations to establish benchmarks. We will use a nested case–control design with incidence density-matched population-based controls to (1) identify short-term and long-term risk factors associated with suicide attempts and mortality and (2) develop machine learning-based predictive algorithms to identify individuals at risk of suicide deaths.DiscussionWe will address gaps from prior studies by establishing an in-depth linked suicide surveillance system integrating multiple large, comprehensive databases that permit establishment of benchmarks, identification of predictors, evaluation of prevention efforts and establishment of long-term surveillance workflow protocols.

BackgroundGun violence restraining orders (GVROs), implemented in California in 2016, temporarily prohibit individuals at high risk of violence from purchasing or possessing firearms and ammunition. We sought to describe the circumstances giving rise to GVROs issued 2016–2018, provide details about the GVRO process and quantify mortality outcomes for individuals subject to these orders (‘respondents’).MethodsFor this cross-sectional description of GVRO respondents, 2016–2018, we abstracted case details from court files and used LexisNexis to link respondents to mortality data through August 2020.ResultsWe abstracted information for 201 respondents with accessible court records. Respondents were mostly white (61.2%) and men (93.5%). Fifty-four per cent of cases involved potential harm to others alone, 15.3% involved potential harm to self alone and 25.2% involved both. Mass shooting threats occurred in 28.7% of cases. Ninety-six and one half per cent of petitioners were law enforcement officers and one-in-three cases resulted in arrest on order service. One-year orders after a hearing (following 21-day emergency/temporary orders) were issued in 53.5% of cases. Most (84.2%) respondents owned at least one firearm, and firearms were removed in 55.9% of cases. Of the 379 respondents matched by LexisNexis, 7 (1.8%) died after the GVRO was issued: one from a self-inflicted firearm injury that was itself the reason for the GVRO and the others from causes unrelated to violence.ConclusionsGVROs were used most often by law enforcement officers to prevent firearm assault/homicide and post-GVRO firearm fatalities among respondents were rare. Future studies should investigate additional respondent outcomes and potential sources of heterogeneity.

BackgroundMental health problems ranging from depression to more severe acts such as self-harm or suicidal behaviours are a serious problem among adolescents and young adults. Exposure to violence during the life of young people can increase mental health issues for youth. This study examines the relationship between exposure to violence and mental health issues among youth using a nationally representative study in Malawi.MethodsWe analysed data from the nationally representative Violence Against Children Survey from Malawi (2013) to quantify the association between exposures to violence (physical, sexual and emotional) and their relationship with mental distress, self-harm behaviours and suicidal ideation and attempts among youth aged 13–24 years. We evaluated the association of exposures to violence against children with reported mental health conditions among women and men. We used ordinal logistic regression models with appropriate survey weights to assess exposures to violence and the three outcomes of interest.ResultsChildren and youth aged 13–24 years exposed to violence in childhood reported higher levels of adverse mental health effects, including mental distress, self-harm behaviours and suicidal ideation and attempts. The odds of reporting these outcomes increased as the number of violence types increased.ConclusionsUnderstanding the risks based on different combinations of exposures to violence in Malawi can help identify populations at higher risk and optimise violence prevention strategies.

IntroductionMillions of children witness violence and are victims of violence each year. Previous research suggests that this is a risk factor for perpetrating violence. There is a paucity of studies that examine factors that protect violence-exposed youth from perpetrating violence.MethodsThis study used a panel design to measure the effects of exposure to violence on the perpetration of violence. It examined the protective effects of social support and school social capital on the risk of exposure to violence, using multivariate logistic regression modelling. The sample was weighted to reflect a national population.ResultsThe median age of the sample was 15. When considering risk factors only, those who ‘saw someone shoot or stab another person’ were at 4.77 times (95% CI 3.19 to 7.13) greater risk for perpetrating interpersonal violence. In the full model (risk and protective factors, (N=8375)), those with lower school social capital were at 2.43 (95% CI 1.15 to 5.15) to 2.91 (95% CI 1.02 to 8.29) times greater risk of perpetrating violence compared with those with the highest school social capital; adding the protective factors into the model reduced the odds of perpetrating violence from 4.77 times to 3.47 times (95% CI 1.97 to 6.11) (p<0.001).ConclusionOn a national level, the protective effects of school social capital could translate to a substantial reduction of violence. School-wide policies and programmes that reach all adolescents in a school and promote social capital should be pursued as a strategy to prevent the perpetration of interpersonal violence.

BackgroundAlcohol and other drug (AOD) use is a key preventable risk factor for serious injuries. Prevention strategies to date have largely focused on transport injuries, despite AOD use being a significant risk factor for other injury causes, including falls. This systematic review aimed to report the prevalence of AOD use in patients presenting to hospital for fall-related injuries.MethodsThis systematic review includes studies published in English after the year 2010 that objectively measured the prevalence of AOD use in patients presenting to hospital for a fall-related injury. Screening, data extraction and risk of bias assessments were completed by two independent reviewers. Data were presented using narrative synthesis and, where appropriate, meta-analyses.ResultsA total of 12 707 records were screened. Full texts were retrieved for 2042 records, of which 29 were included. Four studies reported the combined prevalence of any alcohol and/or drug use, generating a pooled prevalence estimate of 37% (95% CI 25% to 49%). Twenty-two records reported on the prevalence of acute alcohol use alone and nine reported specifically on the prevalence of drugs other than alcohol, with prevalence ranging from 2% to 57% and 7% to 46%, respectively. The variation in prevalence estimates likely resulted from differences in toxicology testing methods across studies.ConclusionsAOD exposure was common in hospitalised fall-related injuries. However, research addressing prevalence across different types of falls and the use of drugs other than alcohol was limited. Future research should address these areas to improve our understanding of which populations should be targeted in AOD and injury prevention strategies .PROSPERO registration numberCRD42020188746.

ObjectiveThis study investigated the application of the Children’s Safety Network (CSN) Framework for Quality Improvement and Innovation in Child Safety through the Child Safety Learning Collaborative (CSLC).MethodsThe CSN Framework was used by 26 state/jurisdiction teams that participated in cohort 1 of the CSLC, from November 2018 to April 2020. The aim was to strengthen child safety systems and the workforce to spread child safety evidence-based and evidence-informed strategies and programmes for children and adolescents ages <1–19 years.ProceduresParticipating teams’ child safety system development, workforce development, engagement in the CSLC, challenges encountered and overall satisfaction with the CSLC were assessed through ongoing CSLC participation records and an end-of-cohort survey (survey response rate: 73.1%).ResultsTeams showed an average change of 2.4-fold increase in the spread of evidence-based and evidence-informed child safety strategies and programmes, indicating improvement in child safety systems. Knowledge development on CSLC tools and strategies was reported by 77.8% of teams, with 55.5% reporting CSLC tools and strategies contributed to workforce development. Over two-thirds (70.6%) reported being satisfied or very satisfied with the CSLC, but identified some challenges, including staff turnover and the need to strengthen partnerships. All teams demonstrated engagement in the CSLC, based on participation in a virtual meeting, learning session or a monthly report submission.ConclusionsDespite challenges, teams continued to participate in the CSLC, recognising the importance of collaborative learning. The CSN Framework is helpful for state/jurisdiction teams to improve child safety systems and develop their workforce.

ObjectiveResearch surrounding firearm ownership is often contextualised within the perspectives of older white men. We expand this description using the perceptions of a diverse group of firearm-owning stakeholders.MethodsWe conducted semistructured interviews from October 2020 to May 2021 with Colorado/Washington State stakeholders representing (1) firearm ranges/retailers; (2) law enforcement agencies or (3) relevant state/national firearm organisations. Data were analysed using standard qualitative techniques and included 25 participants, representing varied sociocultural groups including racial and ethnic minorities, political minorities and sexual minorities.ResultsParticipants for this analysis were of different self-identified sociocultural groups including racial and ethnic minorities (African American, Hispanic and Asian), political minorities (liberal) and sexual minorities, defined as Lesbian, Gay, Bisexual, and Transgender (LGBT). Perspectives on firearm ownership included an idea of gun culture as a component of (1) personal identity, (2) an expression of full citizenship and (3) necessary for self-protection. A strong subtheme was the intersection of minority group and firearm owner identities, creating a need for divergent social communities because of ideas on traditional gun culture. These communities are a safe place for individuals belonging to minority groups to escape negative external and internal group associations with firearms.ConclusionPerspectives on firearms and firearm ownership in the secondary analysis were heterogeneous and related to personal experiences, external and internal group pressures that influence individual behaviour. Understanding the breadth of perspectives on firearm ownership is imperative to engaging individuals for risk reduction. This study adds to the literature by expanding an understanding of the motivation for firearm ownership among diverse communities.