Alcohol, firearms, and adolescent gunshot injury risk

描述(申请人提供)：枪伤是10-19岁非洲裔美国男性死亡的主要原因，也是青少年死亡的第二大原因。大多数被枪杀的青少年是在袭击期间被枪杀的(60%)，每一次致命的枪击事件中，有7名青少年需要急诊科(ED)治疗非致命性枪击创伤。此外，每天有70多名青少年因非枪支武器造成的非致命攻击伤害而需要急诊治疗。然而，人们对青少年中枪支和其他武器造成的攻击性伤害的流行病学知之甚少。通过使用流行病学时空建模方法，我们开发并试行了一种创新的便携式技术，用于动态绘制青少年的活动图，从而能够非常准确地估计他们每分钟接触酒精和枪支的情况。为了确定枪伤风险，我们建议进行一项以人群为基础的病例对照研究。向费城两家市中心医院急诊室报告与袭击相关的枪伤的10-19岁青少年将与随机选择的10-19岁对照样本进行比较。作为第二个目标，表现为非枪击伤害的青少年将被登记为第二个病例组，并与相同样本的对照对象进行比较，以确定非枪击伤害的风险。每个病例和对照受试者将使用便携式、计算机化绘图技术进行访谈，以创建动态图形，该动态图形提供受试者在受伤当天(病例)或1-4天前随机指定的(对照)当天如何、何时、与谁一起以及在哪里度过他或她如何步行或以其他方式从一个位置步行到另一个位置以及从一个活动到另一个活动的时间的每一分钟的记录。每个受试者将被问及他或她当天使用酒精和枪支的情况，以及他或她周围的人当天如何使用酒精和枪支(例如，在街角饮酒的人；枪支留在家里)。我们将与叙述性数据一起链接到地图的次要数据将识别额外的曝光和混淆因素，包括街道、建筑和社区的特征。Logistic回归分析将调查饮酒和/或携带枪支的青少年，和/或其日常活动发生在酒精和/或枪支丰富的环境中，是否面临被枪击或在非枪支袭击中受伤的不同风险。这项研究将有助于确定青少年的日常活动是如何在时间和空间上受到限制的，从而确定特定的地点和时间，从而增加和减少攻击伤害的风险。

DESCRIPTION (provided by applicant): Gunshot injury is the leading cause of death in 10-19 year old African American males and the second leading cause of adolescent death overall. Most adolescents who are killed with guns are shot during assaults (60 percent) and for each gunshot assault that is fatal, 7 adolescents require emergency department (ED) treatment for non-fatal assaultive gunshot trauma. Additionally, each day more than 70 adolescents require ED treatment for non-fatal assaultive injuries inflicted with non-gun weapons. Nevertheless, little is known about the epidemiology of assaultive injury from guns and other weapons among adolescents. By using an epidemiological space-time modeling approach, we have developed and pilot-tested an innovative, portable technology for dynamically mapping the activities of adolescents thereby allowing very accurate estimation of their exposure to alcohol and firearms on a minute-to-minute basis. To determine gunshot injury risk, we propose conducting a population-based case-control study. Adolescents 10-19 years of age presenting to the ED of 2 inner-city Philadelphia hospitals for assault-related gunshot injuries will be compared with a randomly selected, population-based sample of control subjects 10-19 years old. As a secondary aim, adolescents presenting for non-gunshot assault injuries will be enrolled as a second case group and compared with the same sample of control subjects to determine non-gun injury risk. Each case and control subject will be interviewed using portable, computerized mapping technology to create a dynamic graphic that provides a minute-by-minute record of how, when, with whom, and where the subject spent time as he or she walked or otherwise traveled from location to location and from activity to activity on the day of the injury (cases) or 1-4 days earlier designated randomly (controls). Each subject will be asked about his or her use of alcohol and firearms that day, and about how other people around him or her used alcohol and firearms that day (e.g., people drinking alcohol on street corners; firearms kept at home). Secondary data we will link, along with the narrative data, to the map will identify additional exposure and confounding factors including characteristics of streets, buildings, and neighborhoods. Logistic regression analyses will investigate whether adolescents who consume alcohol and/or carry firearms, and/or whose daily activities occur in surroundings rich in alcohol and/or firearms, face a differential risk of being shot with a firearm or injured in a non-gun assault. This study will help to identify how adolescents are restricted in time and space by their daily activities, thereby identifying particular locations and times of enhanced, and reduced, assaultive injury risk.