American Journal of Preventive Medicine最新文献

{"title":"Sexual violence and unintended pregnancy in women with disabilities: An intersectional, cross-sectional study.","authors":"Frank S Li, Anne Valentine, J Dalton Stevens, Jessica Chaikof, Monika Mitra","doi":"10.1016/j.amepre.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.amepre.2025.04.011","url":null,"abstract":"<p><strong>Objective: </strong>To describe risk of unintended pregnancy among women with previous history of sexual violence by disability and race/ethnicity.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the 2011-2017 National Survey of Family Growth, a U.S. nationally representative survey. We classified women 18-44 years by combining disability status and racial/ethnic background and selected all pregnancies that occurred after a reported exposure to sexual violence. We used unadjusted and adjusted logistic regressions to examine differences in unintended pregnancy. All analyses were conducted in 2024 and 2025 using Stata 18 MP.</p><p><strong>Results: </strong>Amongst women with lifetime experience of sexual violence, pregnancies to disabled White (OR=1.35, p<0.05), Black (OR=2.94, p<0.001), or Hispanic (OR=1.81, p<0.01) women were more likely to be unintended than to nondisabled White women. Adjustment for sociodemographic covariates did not attenuate disparities, nor did further adjustment for risky prenatal health behaviors.</p><p><strong>Conclusions: </strong>Targeted efforts are needed to address the prevalence and consequences of sexual violence, including unintended pregnancy. Existing research finds that unintended pregnancies are associated with adverse health behaviors and outcomes. These findings thus underscore the importance of accessible services for racial/ethnic minority women with disabilities.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family-Based Interventions to Prevent Substance Use Among Youth: Community Guide Systematic Economic Review","authors":"Verughese Jacob PhD, MPH, MS ,&nbsp;Jeffrey A. Reynolds MPH ,&nbsp;Sajal K. Chattopadhyay PhD ,&nbsp;David P. Hopkins MD, MPH ,&nbsp;Cora Peterson PhD, MSc ,&nbsp;Bianca Tenney MPH, MA ,&nbsp;Nelia Nadal MPH ,&nbsp;Alison E. Cuellar PhD ,&nbsp;Lisa A. Prosser PhD, MS ,&nbsp;John M. Clymer BA ,&nbsp;Sarah A. Stoddard PhD, RN, CNP, FASHM, FAAN ,&nbsp;the Community Preventive Services Task Force","doi":"10.1016/j.amepre.2025.04.009","DOIUrl":"10.1016/j.amepre.2025.04.009","url":null,"abstract":"<div><h3>Introduction</h3><div>This paper presents a systematic review of evidence from economic evaluations of family-based interventions that was recommended by the Community Preventive Services Task Force to prevent substance use among youth.</div></div><div><h3>Methods</h3><div>The search covered studies published from inception of databases through October 2023 and was limited to those based in the U.S. and other high-income countries. This review reports results from peer-reviewed studies and government reports as separate sources of evidence. Analyses were conducted in June 2023 through September 2024. Monetary values are in 2023 U.S. dollars.</div></div><div><h3>Results</h3><div>The search yielded 11 peer-reviewed studies and 2 government reports: 1 from the Washington State Institute for Public Policy that evaluated 14 programs and 1 from the Substance Abuse and Mental Health Administration that evaluated 8 programs. The median intervention cost ranged from $655 to $1,672 per family and $677 to $753 per youth or participant across the 3 sources of evidence. The median benefit to cost ratio were 5.8, 3.9, and 8.9 from peer-reviewed studies, Washington State Institute for Public Policy, and Substance Abuse and Mental Health Administration, respectively, with all 3 estimates indicating that benefits exceed cost. Substance Abuse and Mental Health Administration’s report found some interventions to be cost saving and the others to have a median cost per quality-adjusted life years gained of $21,426.</div></div><div><h3>Discussion</h3><div>The Community Preventive Services Task Force determined that cost–benefit evidence across the 3 sources showed that societal benefits exceeded cost of family-based interventions to prevent substance use among youth. The Task Force determined that there were not enough studies to reach a conclusion about cost-effectiveness.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 1","pages":"Article 107639"},"PeriodicalIF":4.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redeveloping Low-Income Communities and Residents' Mental Health: Evidence From a Natural Experiment in Watts, Los Angeles","authors":"Jose J. Scott PhD, MPA ,&nbsp;Ashlesha Datar PhD ,&nbsp;Victoria Shier PhD, MPA ,&nbsp;Ying Liu PhD","doi":"10.1016/j.amepre.2025.04.001","DOIUrl":"10.1016/j.amepre.2025.04.001","url":null,"abstract":"<div><h3>Introduction</h3><div>The role of housing and the built and social environments is understudied as a social determinant of mental health. This study leverages a natural experiment created by the ongoing redevelopment of a public housing community to examine the effects of simultaneously improving the housing, built, and social environments on mental health for low-income, minoritized residents.</div></div><div><h3>Methods</h3><div>This study analyzed longitudinal data from adult participants in the Watts Neighborhood Health Study. The cohort study includes residents in the public housing community being redeveloped (treatment group) and those in two nearby public housing sites (comparison group) in Watts, Los Angeles. ANCOVA regression models were used to examine whether residents in the treatment group had better mental health scores at follow-up (2021–22) compared to residents in the comparison group, conditional on mental health scores at baseline (2018–19) and other covariates. The analyses leveraged plausibly exogenous variation within the treatment group in exposure to the redevelopment to examine whether mental health at follow-up varied differentially by proximity to the redeveloped areas.</div></div><div><h3>Results</h3><div>Analyses showed the treatment group experienced slightly fewer depressive symptoms than the comparison group at follow-up. They also revealed a non-linear relationship between proximity to redeveloped areas and residents’ mental health within the treatment group.</div></div><div><h3>Conclusions</h3><div>Comprehensive redevelopment of low-income minoritized communities is a complex process that entails uneven mental health impacts on residents in the short term. Strategies to help spread these benefits more evenly may be needed.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 1","pages":"Article 107631"},"PeriodicalIF":4.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State Earned Income Tax Credit and Food Security: Results Among Economically At-Risk Households With Children","authors":"Megan R. Winkler PhD, RN ,&nbsp;Rachel Clohan BS ,&nbsp;Kelli A. Komro PhD, MPH ,&nbsp;Melvin D. Livingston PhD ,&nbsp;Sara Markowitz PhD","doi":"10.1016/j.amepre.2025.04.007","DOIUrl":"10.1016/j.amepre.2025.04.007","url":null,"abstract":"<div><h3>Introduction</h3><div>The Earned Income Tax Credit is a key program to reducing U.S. child poverty. Approximately half of U.S. states have augmented the federal Earned Income Tax Credit, leading to wide variation in state Earned Income Tax Credit access and generosity. Yet, questions remain around the effectiveness of state tax credits in improving basic child needs, such as food security, and whether the policy can equitably narrow longstanding disparities. The purpose of this study was to evaluate the effects of the state Earned Income Tax Credit on food insecurity among economically at-risk U.S. households with children and explore differential effects across sociodemographic groups.</div></div><div><h3>Methods</h3><div>The authors used an intent-to-treat causal inference design and household-level data from all 50 U.S. states available from the Current Population Survey. The authors estimated the effect of state variation in Earned Income Tax Credit generosity on food insecurity from 2001 to 2022 among a sample of 153,683 households with children and limited parent educational attainment. Analyses were performed in 2024.</div></div><div><h3>Results</h3><div>Compared with households living in states without a refundable state Earned Income Tax Credit, those living in states with the most generous refundable tax credits experienced significant declines in food insecurity (0.25 percentage point reduction [95% CI= −0.42, −0.09]). In addition, beneficial reductions in food insecurity were observed to be larger for single-headed than for partnered households and for non-Hispanic Black than for non-Hispanic White households.</div></div><div><h3>Conclusions</h3><div>Findings indicate that state legislatures that elected to implement a more generous refundable state Earned Income Tax Credit have also improved childhood food security among households at high risk for economic hardship.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 1","pages":"Article 107637"},"PeriodicalIF":4.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143943079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood-Based Colorectal Cancer Screening: Implementation Into 2 Appalachian Primary Care Clinics","authors":"William B. Haynes Jr. PhD ,&nbsp;Mridula P. Talari MD ,&nbsp;Karen A. Elmore MD ,&nbsp;Rasmiyah M. Jastan MD ,&nbsp;Julia J.L. Resil MD, MPH","doi":"10.1016/j.amepre.2025.04.006","DOIUrl":"10.1016/j.amepre.2025.04.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Colorectal cancer is a serious health concern in the U.S. and worldwide and the third leading cause of cancer mortality. Appalachia ranks low in screening for colorectal cancer and correspondingly higher in incident and mortality rates than other regions of the U.S. This study aimed to determine whether offering a blood-based test to screen for colorectal cancer would result in increased rates of screening for colorectal cancer.</div></div><div><h3>Methods</h3><div>Colorectal cancer screening rates were measured in 2 primary care clinics over two 3-month phases. In Phase 1, physicians conducted colorectal cancer screening with standard-of-care options only (<em>n</em>=74). Phase 2 differed by offering blood-based test along with standard-of-care options (<em>n</em>=165). The study objective was to see whether offering a blood-based test would (1) increase the overall rate of screening and (2) prove to be a preferred method of screening compared with standard-of-care options. Data were gathered and evaluated in 2024.</div></div><div><h3>Results</h3><div>There was a large observed increase in overall completed screening rates when comparing Phase 1 (<em>n</em>=33) with Phase 2 (<em>n</em>=151). In addition, in Phase 2, the blood-based test option was a strong preference to standard of care (standard of care, <em>n</em>=29; blood-based test, <em>n</em>=134) with this sample group.</div></div><div><h3>Conclusions</h3><div>The availability of a blood-based test as one option for routine colorectal cancer screening in adults with average risk for colorectal cancer had a clear positive impact on overall screening rates, completion rates, and patient preference to standard-of-care options.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 1","pages":"Article 107636"},"PeriodicalIF":4.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifecourse Socioeconomic Status and High-Risk Pregnancy in Chinese Women: Evidence From Grandmothers, Mothers, and Their Children’s Health Study","authors":"Hui Wang MPH ,&nbsp;Yue Zhang BMed ,&nbsp;Yaguan Zhou BMed ,&nbsp;Weijie Ding MPH ,&nbsp;Xiaoqin Zhu BMed ,&nbsp;Xiaolin Xu PhD","doi":"10.1016/j.amepre.2025.04.004","DOIUrl":"10.1016/j.amepre.2025.04.004","url":null,"abstract":"<div><h3>Introduction</h3><div>The increasing proportion of women with high-risk pregnancy has been highlighted as an important public health challenge. This study examined the associations between maternal socioeconomic status during childhood, young adulthood, and married life and the risk of the spectrum of high-risk pregnancy in Chinese pregnant women.</div></div><div><h3>Methods</h3><div>This study used data from the Grandmothers, Mothers, and Their Children’s Health study, which was conducted in Huai’an city, China, from 2020 to 2021 and included 8,407 married pregnant women. High-risk pregnancy was defined according to the Five-Color Management framework by linking to the Maternity Information System. Maternal socioeconomic status across the life course was constructed using the educational levels of maternal parents, maternal family economic status at age 18 years (referring to parents’ economic status), maternal educational level, maternal occupation, husband’s educational level, and annual household income. Logistic regression models, the Shapley value decomposition, and the serial mediation model were used. Analyses were conducted in 2024.</div></div><div><h3>Results</h3><div>There were dose-response associations between socioeconomic status scores and high-risk pregnancy at each stage of maternal life, including childhood, young adulthood, and married life (<em>p</em> for trend&lt;0.05). Married life socioeconomic status accounted for 79.59% of the model’s explanatory power, followed by young adulthood (10.84%) and childhood socioeconomic status (9.57%). Compared with those with consistently high socioeconomic status, women with consistently low socioeconomic status had higher odds of developing high-risk pregnancy (OR=1.63, 95% CI=1.32, 2.01).</div></div><div><h3>Conclusions</h3><div>Women with lower socioeconomic status across their life-course, particularly those with consistently low socioeconomic status, have a higher risk of high-risk pregnancy. Married life socioeconomic status accounts for the largest portion of the explanatory power of the model. Reducing socioeconomic inequalities from a life-course perspective and promoting universal access to healthcare resources should be considered in the implementation of universal two-child and three-child policies in China.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 1","pages":"Article 107634"},"PeriodicalIF":4.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Secure Firearm Storage Among U.S. Gun Owners","authors":"James A. Densley DPhil ,&nbsp;David C. Pyrooz PhD ,&nbsp;Jillian K. Peterson PhD","doi":"10.1016/j.amepre.2025.04.005","DOIUrl":"10.1016/j.amepre.2025.04.005","url":null,"abstract":"<div><h3>Introduction</h3><div>This study examines the prevalence of secure firearm storage behaviors through direct and indirect measures, identifies associated factors, and provides insights for targeted public health interventions to reduce gun injury.</div></div><div><h3>Methods</h3><div>A cross-sectional survey of 10,000 respondents designed to be representative of U.S. adults was administered online in January 2024. Respondents self-reported firearm ownership and storage practices measured directly (locked and unloaded) and indirectly (<em>If you need your firearm in the middle of the night, approximately how long would it take you to have it ready to use?</em>). Multivariable logistic regression models determined demographic, socio-economic, and firearm-related correlates of secure storage.</div></div><div><h3>Results</h3><div>Approximately half of gun owners reported storing their firearms locked and unloaded, while two thirds reported having access in under 60 seconds. Secure storage was more common among women, individuals with children in the home, those who owned fewer firearms, and those whose primary firearm use was for hunting, sport, or collection. Unsecure storage was more prevalent among respondents who reported fears of being shot in various contexts, including at home, in their neighborhood, or at work. Certain demographic and contextual factors, notably, victimization history, political orientation, and the presence of child access prevention laws, were associated with secure storage according to one measure but not the other, highlighting differences in how these practices are measured.</div></div><div><h3>Conclusions</h3><div>Firearm storage behaviors are largely driven by perceptions of safety, highlighting the need for public health efforts that address fear and tailor messaging to groups less likely to store firearms securely.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 1","pages":"Article 107635"},"PeriodicalIF":4.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Cannabis Use for Medical Symptoms on Cannabis Use Disorder Symptoms: A 24-Month Follow-up Study","authors":"Julia Jashinski MSW ,&nbsp;Bryn Evohr BS ,&nbsp;Kevin Potter PhD ,&nbsp;Randi M. Schuster PhD ,&nbsp;A. Eden Evins MD, MPH ,&nbsp;Jodi M. Gilman PhD","doi":"10.1016/j.amepre.2025.04.008","DOIUrl":"10.1016/j.amepre.2025.04.008","url":null,"abstract":"","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 1","pages":"Article 107638"},"PeriodicalIF":4.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of School Fluoride Delivery Programs: A Community Guide Systematic Review","authors":"Susan O. Griffin PhD ,&nbsp;Mei Lin MD ,&nbsp;Christina R. Scherrer PhD ,&nbsp;Shillpa Naavaal MPH ,&nbsp;David P. Hopkins MD ,&nbsp;Anita A. Jones PhD ,&nbsp;Tammy Alexander MEd ,&nbsp;Virginia A. Black RN ,&nbsp;Elizabeth Clark RN ,&nbsp;Lori K. Cofano RDH ,&nbsp;Raul I. Garcia DMD ,&nbsp;Anna Goddard PhD ,&nbsp;Jane Grover DDS ,&nbsp;Susan M. Kansagra MD ,&nbsp;Thomas E. Kottke MD ,&nbsp;Elizabeth C. Lense DDS ,&nbsp;Tooka Zokaie MPH ,&nbsp;The Community Preventive Services Task Force","doi":"10.1016/j.amepre.2025.04.003","DOIUrl":"10.1016/j.amepre.2025.04.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Although preventable, dental caries remains highly prevalent. Many children do not receive preventive dental services routinely in clinical settings. This review examined the effectiveness of school (preschool through high school) fluoride varnish delivery programs in preventing caries.</div></div><div><h3>Methods</h3><div>Community Guide systematic review methods were followed. In 2024, databases were searched for studies published through December 2023 on school flouride varnish delivery program effectiveness in increasing fluoride varnish receipt and decreasing caries. Included studies had to be written in English, published in peer-reviewed journals, and conducted in upper-middle– or high-income countries. Data synthesis conducted in 2024 used median RR and interquartile interval (IQI) to summarize findings across studies.</div></div><div><h3>Results</h3><div>Of 31 included studies with 60,780 students, 25 were randomized controlled trials—20 with good quality of execution. Most studies were conducted in low socioeconomic status areas among students at elevated caries risk. School flouride varnish delivery programs reduced caries initiation by 32% (IQI: 21%, 37%) in permanent teeth (19 studies, 25,826 students) and by 25% (IQI: 4%, 37%) in primary teeth (12 studies, 4,304 students). Stratified assessments indicated findings were largely applicable to different settings, populations, and intervention characteristics. Two studies found school flouride varnish delivery programs significantly increased the number of annual flouride varnish applications and 2 found that school flouride varnish delivery program effectiveness was inversely related to socioeconomic status.</div></div><div><h3>Discussion</h3><div>About 30% of states report having no school flouride varnish delivery programs. Possible barriers to implementation include that Medicaid in some states only reimburses dental and medical professionals and does not reimburse non-dental providers for flouride varnish delivered to children older than age 6 years.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 1","pages":"Article 107633"},"PeriodicalIF":4.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing Intent of Firearm Injuries by Number of Bullet Wounds","authors":"Saskia R. Vos PhD, MPH,&nbsp;Steven A. Sumner MD, MSc,&nbsp;Katherine A. Fowler PhD,&nbsp;Janet M. Blair PhD, MPH,&nbsp;Daniel A. Bowen MPH","doi":"10.1016/j.amepre.2025.04.002","DOIUrl":"10.1016/j.amepre.2025.04.002","url":null,"abstract":"<div><h3>Introduction</h3><div>A complex and ongoing issue in firearm violence prevention research is correctly classifying injury intent (e.g., homicide, suicide, or unintentional). Emerging rule-based approaches to improve classification use the number of bullet wounds to infer intent of the injury when additional information is not available. Using the Centers for Disease Control and Prevention’s National Violent Death Reporting System (NVDRS), which captures detailed information on intent of firearm injuries from coroner/medical examiner reports, law enforcement reports, and death certificates, this study examined potential evidence to support intent determination based on the number of bullet wounds.</div></div><div><h3>Methods</h3><div>2003–2021 NVDRS data on fatal firearm injuries was analyzed in 2023. ANOVA was used to test statistical significance of differences in average number of bullet wounds by intent, and Tukey’s Honest Significant Difference Test was used to determine specific differences by intent.</div></div><div><h3>Results</h3><div>A total of 299,362 fatal firearm injury decedents were identified. The average number of bullet wounds significantly differed by intent: suicide, 1.02; homicide, 2.72; and unintentional injury, 1.01 (<em>p&lt;</em>0.01). Homicide decedents had a significantly higher average number of wounds than unintentional injury decedents and suicide decedents (ΔM homicide-unintentional injury [1.71; 95% CI=1.62, 1.79; <em>p</em>&lt;0.01] and ΔM homicide-suicide [1.70; 95% CI=1.68, 1.72; <em>p</em>&lt;0.01]).</div></div><div><h3>Conclusions</h3><div>The number of bullet wounds may be a useful indicator for classifying intent of firearm injuries, particularly for interpersonal assault, and when other supporting information is not available for medical coding. Accurate counts of firearm injuries by intent are critical for public health surveillance and prevention planning.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 1","pages":"Article 107632"},"PeriodicalIF":4.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}