Increases in adolescent firearm injuries were associated with school closures during COVID-19

• Type of Material: Article
• Authors: John N Bliton, Jamaica Hospital Medical Center; Jonathan Paul, WellStar Atlanta Medical Center; Alexis Smith, Emory University; Randall G Duran, Ross University; Richard Sola Jr, Morehouse School of Medicine; Sofia Chaudhary, Emory University; Kiesha Fraser Doh, Childrens Healthcare Atlanta; Deepika Koganti, Emory University; Goeto Dantes, Emory University; Roberto Hernandez C Irizarry, Grady Memorial Hospital; Janice M Bonsu, Grady Memorial Hospital; Tommy T Welch, Gwinnett Cty Publ Sch; Roland A Richard, Gwinnett Cty Publ Sch; Randi Smith, Emory University
• Language: English
• Date: 2023-08-01
• Publisher: ELSEVIER SCI LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Elsevier Ltd. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.injury.2023.05.055
• Title of Journal or Parent Work: INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED
• Volume: 54
• Issue: 8
• Start Page: 110824
• End Page: 110824
• Keywords: Violence; CHILDREN; HOMICIDE; Life Sciences & Biomedicine; COVID-19; Emergency Medicine; Injury prevention; UNITED-STATES; Surgery; Orthopedics; Adolescent firearm injuries; Critical Care Medicine; General & Internal Medicine; Science & Technology

Abstract

Background:: Mitigation measures, including school closures, were enacted to protect the public during the COVID-19 pandemic. However, the negative effects of mitigation measures are not fully known. Adolescents are uniquely vulnerable to policy changes since many depend on schools for physical, mental, and/or nutritional support. This study explores the statistical relationships between school closures and adolescent firearm injuries (AFI) during the pandemic. Methods:: Data were drawn from a collaborative registry of 4 trauma centers in Atlanta, GA (2 adult and 2 pediatric). Firearm injuries affecting adolescents aged 11–21 years from 1/1/2016 to 6/30/2021 were evaluated. Local economic and COVID data were obtained from the Bureau of Labor Statistics and the Georgia Department of Health. Linear models of AFI were created based on COVID cases, school closure, unemployment, and wage changes. Results:: There were 1,330 AFI at Atlanta trauma centers during the study period, 1,130 of whom resided in the 10 metro counties. A significant spike in injuries was observed during Spring 2020. A season-adjusted time series of AFI was found to be non- stationary (p = 0.60). After adjustment for unemployment, seasonal variation, wage changes, county baseline injury rate, and county-level COVID incidence, each additional day of unplanned school closure in Atlanta was associated with 0.69 (95% CI 0.34- 1.04, p < 0.001) additional AFIs across the city. Conclusion:: AFI increased during the COVID pandemic. This rise in violence is statistically attributable in part to school closures after adjustment for COVID cases, unemployment, and seasonal variation. These findings reinforce the need to consider the direct implications on public health and adolescent safety when implementing public policy.