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Article ; Online: Factors That Protect Children From Community Violence: Applying the INSPIRE Model to a Sample of South African Children.

Falconer, N Suzanne / Casale, Marisa / Kuo, Caroline / Nyberg, Beverly J / Hillis, Susan D / Cluver, Lucie Dale

2020 Volume 36, Issue 23-24, Page(s) 11602–11629

Abstract: Community violence is a prevalent form of interpersonal violence in South Africa for children living in low-income areas. Trauma arising from violence exposure is of concern in contexts where access to treatment is often unattainable. As simultaneous ... ...

Abstract	Community violence is a prevalent form of interpersonal violence in South Africa for children living in low-income areas. Trauma arising from violence exposure is of concern in contexts where access to treatment is often unattainable. As simultaneous multisectoral strategies show higher potential to counter interpersonal violence than single interventions, the World Health Organization with partners created INSPIRE. INSPIRE takes an integrated approach coordinated across formal and informal settings of civil and private society. Responding to research paucity on methods that counter community violence in LMIC settings, this study employed a cross-sectional correlational design consisting of a sample of 2,477 children aged 10 to 17 years from the Young Carers 2009-2010 study conducted in a low-income, HIV-endemic province of South Africa highly affected by community violence. Multiple logistic regressions assessed individual and dose associations between four INSPIRE-based violence prevention strategies-positive parenting, basic necessities, formal social support, and school structural support-and direct and indirect community violence outcomes. Three strategies had significant associations with community violence outcomes: necessities (direct
MeSH term(s)	Child ; Cross-Sectional Studies ; Exposure to Violence ; Humans ; Longitudinal Studies ; Poverty ; South Africa ; Violence/prevention & control
Language	English
Publishing date	2020-01-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2028900-5
ISSN	1552-6518 ; 0886-2605
ISSN (online)	1552-6518
ISSN	0886-2605
DOI	10.1177/0886260519898425
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The enduring impact of violence against children.

Hillis, Susan D / Mercy, James A / Saul, Janet R

Psychology, health & medicine

2017 Volume 22, Issue 4, Page(s) 393–405

Abstract: More than one billion children - half of all children in the world - are exposed to violence every year. The violence children are exposed to includes both direct experiences of physical, sexual, and emotional abuse, as well as indirectly witnessing ... ...

Abstract	More than one billion children - half of all children in the world - are exposed to violence every year. The violence children are exposed to includes both direct experiences of physical, sexual, and emotional abuse, as well as indirectly witnessing violence in their homes, schools, and communities. What these various forms of violence share, based on a review of the literature, is their enduring potential for life-long consequences. These consequences include increases in the risks of injury, HIV, sexually transmitted infections, mental health problems, reproductive health problems, and non-communicable diseases, including cardiovascular disease, cancer, chronic lung disease, and diabetes. Studies addressing biologic underpinnings of such consequences demonstrate that violence-associated toxic stress may cause damage to the nervous, endocrine, circulatory, musculo-skeletal, reproductive, respiratory, and immune systems. Furthermore, rigorous economic evaluations suggest that costs associated with the consequences of violence against children exceed $120 billion in the U.S. and account for up to 3.5% of the GDP in sub-regions of East Asia. The expanding literature confirming the mechanisms of consequences and the associated costs of violence against children has been accompanied by growing evidence on effective approaches to prevention. Moreover, the expanding evidence on prevention has been accompanied by a growing determination on the part of global leaders to accelerate action. Thus, as part of the Post-2015 Sustainable Development agenda, the UN has issued a call-to-action: to eliminate violence against children. This unprecedented UN call may foster new investments, to fuel new progress for protecting children around the world from violence and its preventable consequences.
Language	English
Publishing date	2017-04
Publishing country	England
Document type	Journal Article
ZDB-ID	1477841-5
ISSN	1465-3966 ; 1354-8506
ISSN (online)	1465-3966
ISSN	1354-8506
DOI	10.1080/13548506.2016.1153679
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Article ; Online: Childhood Violence Is Associated with Forced Sexual Initiation Among Girls and Young Women in Malawi: A Cross-Sectional Survey.

Swedo, Elizabeth A / Sumner, Steven A / Msungama, Wezi / Massetti, Greta M / Kalanda, McKnight / Saul, Janet / Auld, Andrew F / Hillis, Susan D

The Journal of pediatrics

2019 Volume 208, Page(s) 265–272.e1

Abstract: Objective: To describe associations between childhood violence and forced sexual initiation in young Malawian females.: Study design: We analyzed data from 595 women and girls who were 13-24 years old who ever had sex and participated in Malawi's ... ...

Abstract	Objective: To describe associations between childhood violence and forced sexual initiation in young Malawian females. Study design: We analyzed data from 595 women and girls who were 13-24 years old who ever had sex and participated in Malawi's 2013 Violence Against Children Survey, a nationally representative household survey. We estimated the overall prevalence of forced sexual initiation and identified subgroups with highest prevalences. Using logistic regression, we examined childhood violence and other independent predictors of forced sexual initiation. Results: The overall prevalence of forced sexual initiation was 38.9% among Malawian girls and young women who ever had sex. More than one-half of those aged 13-17 years at time of survey (52.0%), unmarried (64.6%), or experiencing emotional violence in childhood (56.9%) reported forced sexual initiation. After adjustment, independent predictors of forced sexual initiation included being unmarried (aOR, 3.54; 95% CI, 1.22-10.27) and any emotional violence (aOR, 2.47; 95% CI, 1.45-4.24). Those experiencing emotional violence alone (aOR, 3.04; 95% CI: 1.01-9.12), emotional violence in combination with physical or nonpenetrative sexual violence (aOR, 2.50; 95% CI, 1.23-5.09), and emotional violence in combination with physical and nonpenetrative sexual violence (aOR, 2.61; 95% CI, 1.20-5.67) had an increased independent odds of forced sexual initiation. Conclusions: Experiences of forced sexual initiation are common among Malawian females. Emotional violence is strongly associated with forced sexual initiation, alone and in combination with other forms of childhood violence. The relationship between emotional violence and forced sexual initiation highlights the importance of comprehensive strategies to prevent childhood violence.
MeSH term(s)	Adolescent ; Cross-Sectional Studies ; Family Characteristics ; Female ; Humans ; Intimate Partner Violence/statistics & numerical data ; Malawi/epidemiology ; Prevalence ; Rape/statistics & numerical data ; Sex Offenses/statistics & numerical data ; Sexual Behavior/statistics & numerical data ; Surveys and Questionnaires ; Violence/statistics & numerical data ; Young Adult
Language	English
Publishing date	2019-02-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2018.12.066
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Article ; Online: Adolescent Opioid Misuse Attributable to Adverse Childhood Experiences.

Swedo, Elizabeth A / Sumner, Steven A / de Fijter, Sietske / Werhan, Luke / Norris, Kirkland / Beauregard, Jennifer L / Montgomery, Martha P / Rose, Erica B / Hillis, Susan D / Massetti, Greta M

The Journal of pediatrics

2020 Volume 224, Page(s) 102–109.e3

Abstract: Objectives: To estimate the proportion of opioid misuse attributable to adverse childhood experiences (ACEs) among adolescents.: Study design: A cross-sectional survey was administered to 10 546 seventh-to twelfth-grade students in northeastern Ohio ... ...

Abstract	Objectives: To estimate the proportion of opioid misuse attributable to adverse childhood experiences (ACEs) among adolescents. Study design: A cross-sectional survey was administered to 10 546 seventh-to twelfth-grade students in northeastern Ohio in Spring 2018. Study measures included self-reported lifetime exposure to 10 ACEs and past 30-day use of nonmedical prescription opioid or heroin. Using generalized estimating equations, we evaluated associations between recent opioid misuse, individual ACEs, and cumulative number of ACEs. We calculated population attributable fractions to determine the proportion of adolescents' recent opioid misuse attributable to ACEs. Results: Nearly 1 in 50 adolescents reported opioid misuse within 30 days (1.9%); approximately 60% of youth experienced ≥1 ACE; 10.2% experienced ≥5 ACEs. Cumulative ACE exposure demonstrated a significant graded relationship with opioid misuse. Compared with youth with zero ACEs, youth with 1 ACE (aOR 1.9, 95% CI, 0.9-3.9), 2 ACEs (aOR, 3.8; 95% CI, 1.9-7.9), 3 ACEs (aOR, 3.7; 95% CI, 2.2-6.5), 4 ACEs (aOR, 5.8; 95% CI, 3.1-11.2), and ≥5 ACEs (aOR, 15.3; 95% CI, 8.8-26.6) had higher odds of recent opioid misuse. The population attributable fraction of recent opioid misuse associated with experiencing ≥1 ACE was 71.6% (95% CI, 59.8-83.5). Conclusions: There was a significant graded relationship between number of ACEs and recent opioid misuse among adolescents. More than 70% of recent adolescent opioid misuse in our study population was attributable to ACEs. Efforts to decrease opioid misuse could include programmatic, policy, and clinical practice interventions to prevent and mitigate the negative effects of ACEs.
MeSH term(s)	Adolescent ; Adverse Childhood Experiences/psychology ; Adverse Childhood Experiences/statistics & numerical data ; Causality ; Cohort Studies ; Cross-Sectional Studies ; Female ; Humans ; Male ; Ohio/epidemiology ; Opioid-Related Disorders/epidemiology ; Opioid-Related Disorders/psychology
Language	English
Publishing date	2020-05-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2020.05.001
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Article ; Online: Associations Between Social Media and Suicidal Behaviors During a Youth Suicide Cluster in Ohio.

Swedo, Elizabeth A / Beauregard, Jennifer L / de Fijter, Sietske / Werhan, Luke / Norris, Kirkland / Montgomery, Martha P / Rose, Erica B / David-Ferdon, Corinne / Massetti, Greta M / Hillis, Susan D / Sumner, Steven A

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

2020 Volume 68, Issue 2, Page(s) 308–316

Abstract: Purpose: Youth suicide clusters may be exacerbated by suicide contagion-the spread of suicidal behaviors. Factors promoting suicide contagion are poorly understood, particularly in the advent of social media. Using cross-sectional data from an ongoing ... ...

Abstract	Purpose: Youth suicide clusters may be exacerbated by suicide contagion-the spread of suicidal behaviors. Factors promoting suicide contagion are poorly understood, particularly in the advent of social media. Using cross-sectional data from an ongoing youth suicide cluster in Ohio, this study examines associations between suicide cluster-related social media and suicidal behaviors. Methods: We surveyed 7th- to 12th-grade students in northeastern Ohio during a 2017-2018 suicide cluster to assess the prevalence of suicidal ideation (SI), suicide attempts (SAs), and associations with potential contagion-promoting factors such as suicide cluster-related social media, vigils, memorials, news articles, and watching the Netflix series 13 Reasons Why before or during the cluster. Generalized estimating equations examined associations between potential contagion-promoting factors and SI/SA, adjusting for nonmodifiable risk factors. Subgroup analyses examined whether associations between cluster-related factors and SI/SA during the cluster varied by previous history of SI/SA. Results: Among participating students, 9.0% (876/9,733) reported SI and 4.9% attempted suicide (481/9,733) during the suicide cluster. Among students who posted suicide cluster-related content to social media, 22.9% (267/1,167) reported SI and 15.0% (175/1,167) attempted suicide during the suicide cluster. Posting suicide cluster-related content was associated with both SI (adjusted odds ratio 1.7, 95% confidence interval 1.4-2.0) and SA during the cluster (adjusted odds ratio 1.7, 95% confidence interval 1.2-2.5). In subgroup analyses, seeing suicide cluster-related posts was uniquely associated with increased odds of SI and SA during the cluster among students with no previous history of SI/SA. Conclusions: Exposure to suicide cluster-related social media is associated with both SI and SA during a suicide cluster. Suicide interventions could benefit from efforts to mitigate potential negative effects of social media and promote prevention messages.
MeSH term(s)	Adolescent ; Cross-Sectional Studies ; Humans ; Ohio/epidemiology ; Risk Factors ; Social Media ; Suicidal Ideation ; Suicide, Attempted
Language	English
Publishing date	2020-07-07
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1063374-1
ISSN	1879-1972 ; 1054-139X
ISSN (online)	1879-1972
ISSN	1054-139X
DOI	10.1016/j.jadohealth.2020.05.049
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Article ; Online: COVID-19-Associated Orphanhood and Caregiver Death in the United States.

Hillis, Susan D / Blenkinsop, Alexandra / Villaveces, Andrés / Annor, Francis B / Liburd, Leandris / Massetti, Greta M / Demissie, Zewditu / Mercy, James A / Nelson Iii, Charles A / Cluver, Lucie / Flaxman, Seth / Sherr, Lorraine / Donnelly, Christl A / Ratmann, Oliver / Unwin, H Juliette T

Pediatrics

2021 Volume 148, Issue 6

Abstract: Background: Most coronavirus disease 2019 (COVID-19) deaths occur among adults, not children, and attention has focused on mitigating COVID-19 burden among adults. However, a tragic consequence of adult deaths is that high numbers of children might lose ...

Abstract	Background: Most coronavirus disease 2019 (COVID-19) deaths occur among adults, not children, and attention has focused on mitigating COVID-19 burden among adults. However, a tragic consequence of adult deaths is that high numbers of children might lose their parents and caregivers to COVID-19-associated deaths. Methods: We quantified COVID-19-associated caregiver loss and orphanhood in the United States and for each state using fertility and excess and COVID-19 mortality data. We assessed burden and rates of COVID-19-associated orphanhood and deaths of custodial and coresiding grandparents, overall and by race and ethnicity. We further examined variations in COVID-19-associated orphanhood by race and ethnicity for each state. Results: We found that from April 1, 2020, through June 30, 2021, >140 000 children in the United States experienced the death of a parent or grandparent caregiver. The risk of such loss was 1.1 to 4.5 times higher among children of racial and ethnic minority groups compared with non-Hispanic White children. The highest burden of COVID-19-associated death of parents and caregivers occurred in Southern border states for Hispanic children, in Southeastern states for Black children, and in states with tribal areas for American Indian and/or Alaska Native populations. Conclusions: We found substantial disparities in distributions of COVID-19-associated death of parents and caregivers across racial and ethnic groups. Children losing caregivers to COVID-19 need care and safe, stable, and nurturing families with economic support, quality child care, and evidence-based parenting support programs. There is an urgent need to mount an evidence-based comprehensive response focused on those children at greatest risk in the states most affected.
Language	English
Publishing date	2021-10-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2021-053760
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Article ; Online: Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study.

Hillis, Susan D / Unwin, H Juliette T / Chen, Yu / Cluver, Lucie / Sherr, Lorraine / Goldman, Philip S / Ratmann, Oliver / Donnelly, Christl A / Bhatt, Samir / Villaveces, Andrés / Butchart, Alexander / Bachman, Gretchen / Rawlings, Laura / Green, Phil / Nelson, Charles A / Flaxman, Seth

Lancet (London, England)

2021 Volume 398, Issue 10298, Page(s) 391–402

Abstract: Background: The COVID-19 pandemic priorities have focused on prevention, detection, and response. Beyond morbidity and mortality, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face ... ...

Abstract	Background: The COVID-19 pandemic priorities have focused on prevention, detection, and response. Beyond morbidity and mortality, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, and institutionalisation. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation. Methods: We used mortality and fertility data to model minimum estimates and rates of COVID-19-associated deaths of primary or secondary caregivers for children younger than 18 years in 21 countries. We considered parents and custodial grandparents as primary caregivers, and co-residing grandparents or older kin (aged 60-84 years) as secondary caregivers. To avoid overcounting, we adjusted for possible clustering of deaths using an estimated secondary attack rate and age-specific infection-fatality ratios for SARS-CoV-2. We used these estimates to model global extrapolations for the number of children who have experienced COVID-19-associated deaths of primary and secondary caregivers. Findings: Globally, from March 1, 2020, to April 30, 2021, we estimate 1 134 000 children (95% credible interval 884 000-1 185 000) experienced the death of primary caregivers, including at least one parent or custodial grandparent. 1 562 000 children (1 299 000-1 683 000) experienced the death of at least one primary or secondary caregiver. Countries in our study set with primary caregiver death rates of at least one per 1000 children included Peru (10·2 per 1000 children), South Africa (5·1), Mexico (3·5), Brazil (2·4), Colombia (2·3), Iran (1·7), the USA (1·5), Argentina (1·1), and Russia (1·0). Numbers of children orphaned exceeded numbers of deaths among those aged 15-50 years. Between two and five times more children had deceased fathers than deceased mothers. Interpretation: Orphanhood and caregiver deaths are a hidden pandemic resulting from COVID-19-associated deaths. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families to nurture children bereft of caregivers and help to ensure that institutionalisation is avoided. These data show the need for an additional pillar of our response: prevent, detect, respond, and care for children. Funding: UK Research and Innovation (Global Challenges Research Fund, Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, US National Institutes of Health, and Imperial College London.
MeSH term(s)	Adolescent ; Adult ; Aged ; COVID-19/mortality ; Caregivers/supply & distribution ; Child ; Child, Orphaned/statistics & numerical data ; Female ; Global Health ; Humans ; Male ; Middle Aged ; Models, Statistical ; Young Adult
Language	English
Publishing date	2021-07-21
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(21)01253-8
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Article ; Online: Violence in the United States: Status, Challenges, and Opportunities.

Sumner, Steven A / Mercy, James A / Dahlberg, Linda L / Hillis, Susan D / Klevens, Joanne / Houry, Debra

JAMA

2015 Volume 314, Issue 5, Page(s) 478–488

Abstract: Importance: Interpersonal violence, which includes child abuse and neglect, youth violence, intimate partner violence, sexual violence, and elder abuse, affects millions of US residents each year. However, surveillance systems, programs, and policies to ...

Abstract	Importance: Interpersonal violence, which includes child abuse and neglect, youth violence, intimate partner violence, sexual violence, and elder abuse, affects millions of US residents each year. However, surveillance systems, programs, and policies to address violence often lack broad, cross-sector collaboration, and there is limited awareness of effective strategies to prevent violence. Objectives: To describe the burden of interpersonal violence in the United States, explore challenges to violence prevention efforts and to identify prevention opportunities. Data sources: We reviewed data from health and law enforcement surveillance systems including the National Vital Statistics System, the Federal Bureau of Investigation's Uniform Crime Reports, the US Justice Department's National Crime Victimization Survey, the National Survey of Children's Exposure to Violence, the National Child Abuse and Neglect Data System, the National Intimate Partner and Sexual Violence Survey, the Youth Risk Behavior Surveillance System, and the National Electronic Injury Surveillance System-All Injury Program. Results: Homicide rates have decreased from a peak of 10.7 per 100,000 persons in 1980 to 5.1 per 100,000 in 2013. Aggravated assault rates have decreased from a peak of 442 per 100,000 in 1992 to 242 per 100,000 in 2012. Nevertheless, annually, there are more than 16,000 homicides and 1.6 million nonfatal assault injuries requiring treatment in emergency departments. More than 12 million adults experience intimate partner violence annually and more than 10 million children younger than 18 years experience some form of maltreatment from a caregiver, ranging from neglect to sexual abuse, but only a small percentage of these violent incidents are reported to law enforcement, health care clinicians, or child protective agencies. Moreover, exposure to violence increases vulnerability to a broad range of mental and physical health problems over the life course; for example, meta-analyses indicate that exposure to physical abuse in childhood is associated with a 54% increased odds of depressive disorder, a 78% increased odds of sexually transmitted illness or risky sexual behavior, and a 32% increased odds of obesity. Rates of violence vary by age, geographic location, sex, and race/ethnicity, and significant disparities exist. Homicide is the leading cause of death for non-Hispanic blacks from age 1 through 44 years, whereas it is the fifth most common cause of death among non-Hispanic whites in this age range. Additionally, efforts to understand, prevent, and respond to interpersonal violence have often neglected the degree to which many forms of violence are interconnected at the individual level, across relationships and communities, and even intergenerationally. The most effective violence prevention strategies include parent and family-focused programs, early childhood education, school-based programs, therapeutic or counseling interventions, and public policy. For example, a systematic review of early childhood home visitation programs found a 38.9% reduction in episodes of child maltreatment in intervention participants compared with control participants. Conclusions and relevance: Progress has been made in reducing US rates of interpersonal violence even though a significant burden remains. Multiple strategies exist to improve violence prevention efforts, and health care providers are an important part of this solution.
MeSH term(s)	Adolescent ; Adult ; Aged ; Child ; Child Abuse/prevention & control ; Child Abuse/statistics & numerical data ; Data Collection ; Female ; Homicide/statistics & numerical data ; Humans ; Male ; Middle Aged ; Population Surveillance ; Retrospective Studies ; Risk Factors ; Sex Offenses/prevention & control ; Sex Offenses/statistics & numerical data ; Spouse Abuse/prevention & control ; Spouse Abuse/statistics & numerical data ; United States/epidemiology ; Violence/prevention & control ; Violence/statistics & numerical data
Language	English
Publishing date	2015-08-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2015.8371
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Article ; Online: Decline in HIV seroprevalence in street youth 2006-2012, St. Petersburg, Russia: moving toward an AIDS-free generation.

Kornilova, Marina S / Batluk, Julia V / Yorick, Roman V / Baughman, Andrew L / Hillis, Susan D / Vitek, Charles R

International journal of STD & AIDS

2017 Volume 28, Issue 4, Page(s) 345–356

Abstract: A 2006 survey of street youth at pre-mapped street youth locations in St. Petersburg, Russia, found extremely high HIV seroprevalence (37.4%) among 313 street youth aged 15-19 years of age, strongly associated with injection drug use, which was reported ... ...

Abstract	A 2006 survey of street youth at pre-mapped street youth locations in St. Petersburg, Russia, found extremely high HIV seroprevalence (37.4%) among 313 street youth aged 15-19 years of age, strongly associated with injection drug use, which was reported by 50.6% of participants. In response, multi-sectoral social support and prevention measures were instituted. In 2012, we conducted a follow-up survey of 15- to 19-year-old street youth using the same study procedures as in 2006. Of 311 participants, 45 (14.5%) reported injection drug use; 31 participants (10.0%, 95% confidence interval, 6.0%-16.2%) were HIV-seropositive . Predictors independently associated with HIV seropositivity included injection drug use (adjusted prevalence ratio 53.1) and transactional sex (adjusted prevalence ratio 1.3). None of the 178 participants aged 15-17 years were HIV-positive. Thirty of 31 (96.8%) HIV-seropositive individuals reported injection drug use. Street youth in St Petersburg had a 73% decrease in HIV seroprevalence from 2006 to 2012, primarily due to decreased initiation of injection drug use. This marked reduction in the HIV epidemic among street youth occurred after implementation of extensive support programs and socio-economic improvements.
Language	English
Publishing date	2017-03
Publishing country	England
Document type	Journal Article
ZDB-ID	1018089-8
ISSN	1758-1052 ; 0956-4624
ISSN (online)	1758-1052
ISSN	0956-4624
DOI	10.1177/0956462416649275
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Article ; Online: Use of Naloxone by Emergency Medical Services during Opioid Drug Overdose Resuscitation Efforts.

Sumner, Steven Allan / Mercado-Crespo, Melissa C / Spelke, M Bridget / Paulozzi, Leonard / Sugerman, David E / Hillis, Susan D / Stanley, Christina

Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors

2016 Volume 20, Issue 2, Page(s) 220–225

Abstract: Naloxone administration is an important component of resuscitation attempts by emergency medical services (EMS) for opioid drug overdoses. However, EMS providers must first recognize the possibility of opioid overdose in clinical encounters. As part of a ...

Abstract	Naloxone administration is an important component of resuscitation attempts by emergency medical services (EMS) for opioid drug overdoses. However, EMS providers must first recognize the possibility of opioid overdose in clinical encounters. As part of a public health response to an outbreak of opioid overdoses in Rhode Island, we examined missed opportunities for naloxone administration and factors potentially influencing EMS providers' decision to administer naloxone. We reviewed medical examiner files on all individuals who died of an opioid-related drug overdose in Rhode Island from January 1, 2012 through March 31, 2014, underwent attempted resuscitation by EMS providers, and had records available to assess for naloxone administration. We evaluated whether these individuals received naloxone as part of their resuscitation efforts and compared patient and scene characteristics of those who received naloxone to those who did not receive naloxone via chi-square, t-test, and logistic regression analyses. One hundred and twenty-four individuals who underwent attempted EMS resuscitation died due to opioid overdose. Naloxone was administered during EMS resuscitation attempts in 82 (66.1%) of cases. Females were nearly three-fold as likely not to receive naloxone as males (OR 2.9; 95% CI 1.2-7.0; p-value 0.02). Additionally, patients without signs of potential drug abuse also had a greater than three-fold odds of not receiving naloxone (OR 3.3; 95% CI 1.2-9.2; p-value 0.02). Older individuals, particularly those over age 50, were more likely not to receive naloxone than victims younger than age 30 (OR 4.8; 95% CI 1.3-17.4; p-value 0.02). Women, older individuals, and those patients without clear signs of illicit drug abuse, were less likely to receive naloxone in EMS resuscitation attempts. Heightened clinical suspicion for opioid overdose is important given the recent increase in overdoses among patients due to prescription opioids.
MeSH term(s)	Adult ; Cross-Sectional Studies ; Drug Overdose/drug therapy ; Emergency Medical Services/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Naloxone/therapeutic use ; Narcotic Antagonists/therapeutic use ; Opioid-Related Disorders/drug therapy ; Resuscitation
Chemical Substances	Narcotic Antagonists ; Naloxone (36B82AMQ7N)
Language	English
Publishing date	2016
Publishing country	England
Document type	Journal Article
ZDB-ID	1461751-1
ISSN	1545-0066 ; 1090-3127
ISSN (online)	1545-0066
ISSN	1090-3127
DOI	10.3109/10903127.2015.1076096
Database	MEDical Literature Analysis and Retrieval System OnLINE

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