Fred Rivara

• University of Washington

Background High-quality early childhood education may buffer against social and structural drivers of interpersonal violence. Methods: We examined the association of Head Start—a large-scale early childhood education program for low-income children, launched in 1965 as part of the War on Poverty—with handgun carrying, serious fighting, and assault...

BACKGROUND AND OBJECTIVES Nonfatal assault injuries have significant consequences for adolescent health, but trends in health care use after such injuries are poorly understood. We analyzed locations of medical care, examined temporal trends in health care and victim service use, and explored variations by injury type among adolescent violent injur...

Introduction George Floyd’s death in 2020 galvanised large protests around the country, including the emergence of the Capitol Hill Autonomous Zone (CHAZ) in Seattle, Washington, a non-policed, organised protest region that may have differing injury risks than other regions. We sought to quantitatively describe characteristics of injuries related t...

Background School shooting events and lockdowns have increased in the United States, raising concerns about their impact on youth mental health. Method This study assessed the association between school lockdowns and changes in youth mental health in 10,049 children who participated in the Adolescent Brain and Cognitive Development study. The expo...

Background: A significant portion of youth sustain a concussion every year, with around 30% experiencing persistent post-concussion symptoms (PPCS). Research has shown exercising just below the exertion level that provokes symptoms can lead to more rapid recovery. However, youth often struggle to adhere to exercise recommendations following concus...

Importance Domestic violence (DV; including intimate partner and family violence) is associated with heightened lethality risks, yet limited research has comprehensively assessed the connection between DV and fatal violence considering both homicides and suicides. Understanding the fatal consequences of DV can point to missed opportunities to suppo...

This cross-sectional study examines suicide mortality rates among Asian American youths and young adults overall and by ethnic subgroup from 2018 to 2021.

Objectives. To assess differences in contextual factors by intent among pediatric firearm injury patients and determine factors associated with data missingness. Methods. We retrospectively queried the American College of Surgeons Firearm Study database (March 1, 2021–February 28, 2022) for patients aged 18 years or younger. We stratified preinjury...

BACKGROUND Schools are important contexts for preventing sexual violence (SV) among adolescents. Evaluating whether programming is effective requires surveying youth about SV experiences. However, school communities often have concerns about asking students, particularly those in middle school, about these experiences. This study sought to understa...

Objective Describe how sports medicine clinicians support decision making about sport participation after concussion recovery with adolescent patients and their parents. Specific areas of inquiry related to how clinicians framed the decision, what factors they considered in how they approached the decision process, and how they navigated discordanc...

Background Many youth in the USA have access to a loaded and unlocked firearm in their home. Discussions between adult family members have the potential to positively influence firearm storage. Purpose Work with firearm-owning parents to develop and obtain preliminary data about the efficacy of a family-centered decision support tool about firearm...

Objectives To determine factors associated with health-related quality of life (HRQL) decline among pediatric acute respiratory distress syndrome (PARDS) survivors. Design Retrospective cohort study. Setting Academic children’s hospital. Patients Three hundred fifteen children 1 month to 18 years old with an unplanned PICU admission from Decembe...

Introduction: While the U.S. has high quality data on firearm-related deaths, less information is available on those who arrive at trauma centers alive, especially those discharged from the emergency department. This study sought to describe characteristics of patients arriving to trauma centers alive following a firearm injury, postulating that s...

Background: Pediatric emergency departments (ED) are where many families receive post-concussion medical care and thus an important context for helping parents build skills to support their child after discharge. Objective: Develop a strategy for increasing parent provision of emotional and instrumental support to their child after discharge and...

Background In the USA, firearms are commonly involved in many incidents of serious interpersonal harm. Federal law prohibits the purchase and possession of firearms by certain high-risk groups including those with prior felony or domestic violence misdemeanor convictions. Evidence supports the effectiveness of these prohibitions, but little is know...

Extreme risk protection orders (ERPO) seek to temporarily reduce access to firearms for individuals at imminent risk of harming themselves and/or others. Clinicians, including physicians, nurse practitioners, and social workers regularly assess circumstances related to patients’ risk of firearm-related harm in the context of providing routine and a...

Background: Early transfer to specialized centers improves trauma and burn outcomes, however, overtriage can result in unnecessary burdens to patients, providers, and health systems. Our institution developed novel burn triage pathways in 2016 to improve resource allocation. We evaluated the implementation of these pathways, analyzing trends in ad...

Perpetrators of domestic violence (DV) may be a population at elevated risk of suicide. Domestic violence protection orders (DVPOs) can include the removal of firearms from the individual subjected to the order (i.e., the respondent) to protect the victim-survivor. While removal of firearms in a DVPO is designed to protect the victim-survivor; it m...

Firearm deaths continue to be a major public health problem, but the number of non-fatal firearm injuries and the characteristics of patients and injuries is not well known. The American College of Surgeons Committee on Trauma, with support from the National Collaborative on Gun Violence Research, leveraged an existing data system to capture lethal...

Importance Firearm violence is a leading cause of death in the US. There is broad public agreement that individuals at high risk of perpetrating violence should not be allowed to purchase or possess firearms. The National Instant Criminal Background Check System (NICS) is a national system intended to stop firearm purchases or possession by prohibi...

This quality improvement study assesses heterogeneity in state rules regarding reporting of mental health conditions to the National Instant Criminal Background Check System when individuals seek to acquire firearms.

Background: Regionalized care for burn-injured patients requires accurate triage. In 2016, we implemented a tele-triage system for acute burn consultations. We evaluated resource utilization following implementation, hypothesizing that this system would reduce short stay admissions and prioritize inpatient care for those with higher burn severity....

Background: Firearms are commonly used in the United States to perpetrate serious interpersonal harm. Individuals with a criminal record are at elevated risk of perpetrating violence, particularly with a firearm. Accordingly, federal law prohibits the purchase and possession of firearms by certain high-risk groups including those with prior felony...

Objectives To determine factors associated with bedside family presence in the PICU and to understand how individual factors interact as barriers to family presence. Design Mixed methods study. Setting Tertiary children’s hospital PICU. Subjects Five hundred twenty-three children of less than 18 years enrolled in the Seattle Children’s Hospital...

Treatment of youth concussion during the acute phase continues to evolve, and this has led to the emergence of guidelines to direct care. While symptoms after concussion typically resolve in 14-28 days, a portion (~20%) of adolescents endorse persistent post-concussive symptoms (PPCS) beyond normal resolution. This report outlines a study implement...

Issue addressed: Drowning is one of the leading causes of unintentional deaths among children and adolescents globally. Adult supervision is one method to decrease the risk of drowning among youth. Methods: We sought to assess the acceptability of a Water Watcher toolkit among children's caregivers. The toolkit consists of a badge-to designate t...

Objectives: To examine how youth and their caregivers' mental health risk factors for suicide are associated with youth firearm access inside and outside the home. Methods: This study examines a cross-section of the Adolescent Brain and Cognitive Development Social Development study data collected from 2016 to 2021. The sample included 2277 chil...

Background: Community-level factors can profoundly impact children's health, including the risk of violent injury. This study's objective was to understand the relationship between the Childhood Opportunity Index and pediatric firearm injury owing to interpersonal violence compared with a motor vehicle crash. Methods: All pediatric patients (<18...

The General Anxiety Disorder 7-Item (GAD-7) scale is commonly used in primary care as a self-report measure of general anxiety symptoms with adult populations. There is little psychometric research on this measure with adolescent populations, particularly those with persistent post-concussive symptoms (PPCS). This study examined the psychometrics p...

Extreme risk protection orders (ERPOs), which allow for the temporary restriction of firearm access for individuals at substantial risk of harming themselves and/or others, are a promising policy tool to address increasing rates of firearm-related suicide, homicide, and mass shootings. Social workers frequently assess clients at risk of firearm-rel...

Assessing parent readiness to support post-concussion management requires valid and reliable measures. Thus, the objective of this study was to develop and conduct preliminary tests of reliability and validity of survey measures of parent concussion management knowledge and self-efficacy. Additionally, we tested the hypothesis that among parents of...

This cross-sectional study assesses non–self-inflicted firearm-related deaths occurring at inpatient or outpatient facilities, hospice care, nursing homes, home, or other settings from 1999 to 2021.

Background Temporary, voluntary storage of firearms away from the home is a recommended option for individuals with risk of suicide, but it may also be used in other situations (e.g., long trips). Prior work has explored the availability of storage options and the views of storage locations. Little is known about out-of-home storage practices among...

Online maps showing locations for voluntary, temporary firearm storage are a novel approach in suicide and injury prevention. A study team from two states with maps (Colorado and Washington) interviewed leaders from six additional states with maps and six without. Key considerations for map creation were: trust and partnerships; legal issues; fundi...

School‐shootings can enormously impact U.S. gun policy, but very little is known about the community mental health impact of school‐shootings. We used difference‐in‐differences and event study analyses to compare stress‐related ED visits in zip‐codes within 5 miles (exposed) and in zip‐codes 10–15 miles from (control) school‐shootings before and af...

Importance: Although peer review is an important component of publication for new research, the viability of this process has been questioned, particularly with the added stressors of the COVID-19 pandemic. Objective: To characterize rates of peer reviewer acceptance of invitations to review manuscripts, reviewer turnaround times, and editor-ass...

Objective: Firearms are highly lethal when used for suicide and are used more frequently as a suicide method by persons of older age. Individuals with terminal illness are at high risk for suicide, yet little research has explored how firearms may be used for self-harm in this population. The authors sought to understand the patterns of psychiatri...

Collaborative care is a multicomponent intervention delivered by frontline social work, nursing, and physician providers to address patients’ physical, emotional, and social needs. We argued that collaborative care may particularly benefit patients with a violent victimization history because it practices three principles of trauma-informed care: p...

Background Temporary, voluntary storage of firearms away from the home during times of risk is a recommended strategy for suicide prevention. Law enforcement agencies (LEAs) are often suggested as storage sites, and online maps in Colorado and Washington display LEAs willing to consider storage. Questions remain about the experiences and views of L...

Background: Tracheostomy placement is much more common in adults than children following severe trauma. We evaluated whether tracheostomy rates and outcomes differ for pediatric patients treated at trauma centers that primarily care for children versus adults. Methods: We conducted a retrospective cohort study of patients <18 years in the Nation...

Concussions can impact cognitive processes necessary for driving. Young adults, a group who are more likely to engage in risky behaviors, have limited driving experience and a higher rate of motor vehicle collisions; they may be at higher risk for driving impairment after concussion. There are no clear guidelines for return to driving following a c...

This study measured implicit and explicit racial bias about women and handguns and addressed important perceptions and stereotypes about gun competence and victimization that vary based on race and gender. We administered a national survey to 1,000 US adults using a new Race–Women–Handguns Implicit Association Test (IAT). Survey weighting was used...

This Viewpoint discusses violence-related US public health concerns and suggests creating a federal Office of National Violence Prevention to develop a comprehensive, coordinated, and sustained effort to address all aspects of violence in the US.

Objectives Determine whether Pre-Game Safety Huddles, a novel and low-resource approach to concussion education, increase the expected likelihood of concussion reporting for youth athletes. Methods A cluster-randomised trial compared Safety Huddles to usual care. Safety Huddles bring together athletes and coaches from both teams before the start o...

Purpose In addition to firearm-related intimate partner homicides, approximately 4.5 million adults in the US are threatened or harmed with a firearm by their intimate partner. It is unknown how many children are exposed to firearm-related IPV specifically, but an estimated 8–15 million children are exposed to parental IPV each year in the US. We s...

Purpose Describe use of drowning prevention strategies among diverse adolescents. Methods We analyzed 47,051 responses to 2012–2018 Washington statewide surveys of 8th–12th grade students, regarding formal swimming lessons, comfort in deep water (a measure of perceived water competency), and life jacket use in small watercraft. Using survey-weight...

Background and objective Athletics is the leading cause of pediatric concussion, and depression is a major comorbidity associated with concussion in the pediatric population. Prior studies have described the risk of depression after concussion in high school-, collegiate-, and elite-level athletes, but there is scarce data on younger athletes. Inte...

Background Many youths in the United States have access to an unlocked firearm in their home, and accidental discharge of unlocked firearms is a prevalent cause of pediatric injury and death. Discussions between adult family members have the potential to positively influence firearm storage practices. Purpose In families with two parenting adults,...

Family- and neighborhood-level poverty are associated with youth violence. Economic policies may address this risk factor by reducing parental stress and increasing opportunities. The federal Earned Income Tax Credit (EITC) is the largest cash transfer program in the US providing support to low-income working families. Many states have additional E...

Out-of-home storage of personal firearms is one recommended option for individuals at risk of suicide, and statewide online maps of storage locations have been created in multiple states, including Colorado and Washington. We sought to examine both the extent to which firearm retailers and ranges offer temporary, voluntary firearm storage and the p...

Firearm violence is a major threat to global public health and safety. Several individual, family, peer, community, and societal risk and protective factors determine or modify the risk of firearm violence. Specifically, there is a strong relationship between poverty, income inequality, and firearm violence; as such, interventions that influence up...

Extreme Risk Protection Orders (ERPOs) temporarily restrict access to firearms if an individual is deemed a significant risk of harm to themselves or others. Some states allow clinicians to initiate ERPO petitions for their patients and a new Justice Department model statute recommends clinicians should be eligible petitioners. Washington clinician...

Concussion education is widely mandated and largely ineffective. Recent consensus guidance on concussion education asserts the importance of (1) theory-driven programming that targets the team as a system and (2) working with end users throughout the development process, and considering issues such as feasibility, acceptability, and sustainability....

OBJECTIVES Poverty and low income are associated with increased risk for child maltreatment. The Earned Income Tax Credit (EITC) and Child Tax Credit (CTC) are among the largest antipoverty programs in the United States. We estimated associations between income transfer payments via the EITC and CTC and child maltreatment reports in the period shor...

Objective: Extreme risk protection orders (ERPOs) are civil orders designed to temporarily restrict access to firearms when people are at substantial risk of harm to themselves or others. A minority of ERPOs in the United States have been filed by civilians, with most filed by law enforcement. The authors examined barriers and facilitators to the...

Background: In its 2016 report on trauma care, the National Academies of Sciences, Engineering, and Medicine called for the establishment of a National Trauma Research Action Plan (NTRAP) to strengthen and guide future trauma research. To address this recommendation, the Department of Defense funded the Coalition for National Trauma Research to ge...

Background Subthreshold exercise, defined as aerobic exercise below the level that causes symptoms, has been utilized as a treatment for youth with persistent postconcussive symptoms (PPCS), but there is currently little evidence to guide use. In addition, prior studies of exercise for PPCS have all required multiple in-person visits. We developed...

Objective: Research 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. Methods: We conducted semistructured interviews from October 2020 to May 2021 with Colorado/Washington State stakeholders represe...

Background: Pain may be a modifiable risk factor for lower health-related quality of life after pediatric critical illness. Aim: To evaluate the association between severe pain experienced in the (pediatrc intensive care unit) and postdischarge health-related quality of life. Methods: This was a retrospective cohort study. Children aged 1 mont...

Research suggests that assault-related injuries known by the police significantly differ from those known by healthcare providers, but the magnitude and nature of these differences are poorly understood. To address this gap, our study examined the empirical differences between assault-related injuries reported to police and treated by healthcare pr...

Background: Existing studies have found a low prevalence of multiple organ dysfunction syndrome (MODS) in pediatric trauma patients, typically applying adult criteria to single-center pediatric cohorts. We used pediatric criteria to determine the prevalence, risk factors, and outcomes of MODS among critically injured children in a national PICU da...

Background: In 2016, the National Academies of Sciences, Engineering, and Medicine trauma report recommended a National Trauma Research Action Plan (NTRAP) to "strengthen trauma research and ensure that the resources available for this research are commensurate with the importance of injury and the potential for improvement in patient outcomes." W...

Statement of Purpose To support suicide prevention efforts, Colorado and Washington have online maps of locations willing to consider requests for voluntary, temporary firearm storage – including firearm retailers/ranges. With an increase in firearm sales and suicide risk factors during the COVID-19 pandemic, we sought to examine whether the pandem...

Statement of Purpose To assess the acceptability of a ‘Water Watcher’ safety toolkit among children’s caregivers. Methods/Approach We conducted online and in-person semi-structured interviews of 16 adults residing in Washington State and providing supervision to a child at least 20 hours per week. Participants were presented with the ‘Water Watche...

Statement of Purpose Extreme Risk Protection Orders (ERPO) are civil court orders that allow for the temporary restriction of firearm possession for individuals at substantial risk of harming themselves or others. Currently Washington clinicians can 1). counsel a patient or patient’s family to file a petition, or 2). contact law enforcement to file...

Statement of Purpose The study objectives were to determine the driving characteristics and driving behavior of young drivers after concussion compared to non-injured controls. Methods/Approach Young drivers 16–24 years of age with a valid driving license and access to a vehicle were recruited following emergency department care for concussion in...

Background: Post-concussion return-to-learn (RTL) guidelines include implementation of school accommodations. Yet, little is known about physician recommendations for school accommodations and their impact, particularly among youth experiencing persistent post-concussive symptoms (PPCS). Objective: We examined the association between physician r...

Objective: Few clinical trials of posttraumatic interventions have utilized symptom trajectory modeling to explore heterogeneity of treatment responses. The goal of this investigation was to conduct a secondary analysis of a randomized clinical trial of stepped collaborative care for adolescents with sports and recreational related concussion and p...

Background: Reducing firearm access during times of risk is a key component of suicide prevention, including the person at risk voluntarily, temporarily storing firearms outside the home. However, this approach relies on the participation of storage providers (ranges/retailers and law enforcement agencies (LEAs)). Our objective was to describe sta...

Background: Uncontrolled bleeding is the leading preventable cause of death after injury. Stop the Bleed (STB) is a bleeding control training with proposed expansion into schools. However, the attitudes of guardians, specifically those with past trauma/injury, towards expanding STB into schools are unknown. Methods: A cross-sectional survey eval...

Introduction: Increasing suicide rates across the United States are disproportionate among populations most impacted by mass incarceration. We sought to determine if incarceration is associated with risk of suicide and firearm suicide after release from prison. Methods: Using a population-based Washington cohort from Department of Corrections an...

About 30% of single mothers in the US live at or below the poverty line. Poverty is associated with higher risk of depression and substance use. We investigated associations between state earned income tax credit (EITC) policies and reported depressive symptoms and alcohol misuse among birthing parents who responded to Pregnancy Risk Assessment Mon...

Introduction Research is equivocal about how the social relationship between victims and offenders is linked to the emotional, social, and physical consequences of violence. This study examines the association of victim–offender relationship with the adverse outcomes reported by injured and uninjured victims of violence. Methods The study analyzed...