Fred Rivara

University of Washington Seattle | UW · Department of Pediatrics

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...

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...

Background Injury is a leading contributor to the global disease burden in children and places children at risk for adverse and lasting impacts on their health-related quality of life (HRQoL) and development. This study aimed to identify key predictors of HRQoL following injury in childhood and adolescence. Methods Data from 2259 injury survivors...

BACKGROUND There is limited long-term data on the course of school-related problems and academic needs for youth with persistent post-concussive symptoms (PPCS). METHODS This was a randomized trial comparing collaborative care to usual care for 200 youth 11–18 years of age with PPCS. In this report, the main outcomes were academic functioning, GPA...

Background: While renal trauma management has shifted to conservative non-operative management, insufficient data exist to guide inter-hospital renal trauma transfer protocols. Secondary overtriage is defined as the potentially avoidable transfer of patients from a lower to a higher-level trauma center despite the lack of need for higher-level car...

Background We discuss barriers to recruitment, retention, and intervention delivery in a randomized controlled trial (RCT) of patients presenting with firearm injuries to a Level 1 trauma center. The intervention was adapted from the Critical Time Intervention and included a six-month period of support in the community after hospital discharge to a...

Objectives: To assess the prevalence and risk factors for emotional distress in youth with persistent post-concussive symptoms (PPCS) greater than one month. Methods: We used baseline data from an intervention study for youth with PPCS, utilizing Poisson regression to examine factors associated with exceeding clinical cut-points on measures of depr...

In the midst of the global COVID-19 pandemic, attention has drifted away from the endemic problem of firearm-related morbidity and mortality in the US. The Centers for Disease Control and Prevention reported in 2019, the most recent year for which data were available, that 39 707 people died of firearm-related injuries, of whom 19.8% were children...

The effects of violence exposure on the risk of self-harming behaviors of youth in low- and middle-income countries is not well-understood. Using household survey data from one nationally representative sample and one sample from conflict-affected areas, we examined violence exposure and self-harm among Colombian youth aged 13–24. Survey-weighted p...

Objectives Describe what costs and benefits parents across the socioeconomic spectrum weight most heavily when making decisions about sport participation for their children. Method Cross-sectional survey of a nationally representative online panel of parents of children between the ages of 5 and 18 (n = 1025, 52% response rate). Parents rated the...

Considering the recent sociopolitical and environmental stress in Haiti, from the COVID pandemic to repeated natural disasters, we aimed to identify risk and protective factors associated with childhood physical violence (CPV) after the 2010 earthquake. A population-based national survey was administered to 13–24-year-old Haitians in 2012. A three-...

Research summary. Extreme risk protection orders (ERPOs) allow police, family, and household members to file an order to temporarily remove firearms or prevent purchasing among individuals at high risk for harming themselves or others. Using inductive qualitative content analysis, we examined 241 ERPOs filed December 8, 2016 through May 10, 2019 in...

Federal funding for firearm-related research in the health sciences has incurred Congressional restrictions and executive actions. Little is known about the funding landscape for published scholarship in this field. This study’s aim was to characterize the number and sources of funding, including federal and non-federal sources, for firearm-related...

The Pediatric Collections: Sports Medicine Playbook will increase pediatric providers’ understanding of the injuries that young athletes may incur – including their history, treatment, and prevention. Each section includes a unique expert introduction and they cover such topics as the benefits of physical activity, injuries, and concerns including...

Background: Injury is a leading contributor to the global disease burden in children, affecting their health-related quality of life (HRQoL)-yet valid estimates of burden are absent. Methods: This study pooled longitudinal data from five cohort studies of pediatric injury survivors (5-17 years) at baseline, 1-, 4-, 6-, 12-, and 24- months (n = 2...

Objective While prior studies have found parental socioeconomic status (SES) affects the outcomes of pediatric traumatic brain injury (TBI), the longitudinal trajectory of this effect is not well understood. Methods This prospective cohort study included children 8–18 years of age admitted to six sites with a complicated mild (n = 123) or moderate...

Objectives: To evaluate which individual elements of health-related quality of life contribute most to decline in overall health-related quality of life status following pediatric critical care. Design: Retrospective cohort study. Setting: Seattle Children's Hospital. Patients: ICU patients age 1 month to 18 years admitted between December 2...

Background Unplanned hospital readmissions are associated with morbidity and high cost. Existing literature on readmission after trauma has focused on how injury characteristics are associated with readmission. We aimed to evaluate how psychosocial determinants of health and complications of hospitalization combined with injury characteristics affe...

Purpose: To determine differences among intimate partner homicides (IPH) by whether or not a firearm was used in and whether a protective order (PO) was filed prior to IPH. Method: We identified all incidents of IPH recorded in the National Violent Death Reporting System from 2003-2018, based on the relationship between victim and perpetrator. W...

Objectives: To evaluate the optimal timing of tracheostomy for injured adolescents. Design: Retrospective cohort study. Setting: Trauma facilities in the United States. Patients: Adolescents (age 12-17 yr) in the National Trauma Data Bank (2007-2016) who were ventilated for greater than 24 hours and survived to discharge. Interventions: No...

School security has increased over the years with an aim to improve student safety,¹,2 but students may experience greater criminalization.³ Of the more than 290 600 students referred to the police in 2015-2016, Black students represented more than twice their proportion of enrollment.

Importance: Enzyme-inducing antiseizure medications (eiASMs) have been hypothesized to be associated with long-term risks of cardiovascular disease. Objective: To quantify and model the putative hazard of cardiovascular disease secondary to eiASM use. Design, setting, and participants: This cohort study covered January 1990 to March 2019 (medi...

Background: Concussion is common, and up to 30% of youth develop persistent symptoms. Preliminary data suggests treatment with rehabilitative exercise is beneficial, but most programs require frequent in-person visits, which is challenging for youth in rural areas, and has been made more difficult for all youth during the COVID-19 pandemic. We have...

Our objective in this study was to evaluate how well proxy variables for firearm ownership used in county-level studies measure firearm ownership. We applied Bayesian spatial smoothing methods to calculate county-level estimates of household firearm ownership using Behavioral Risk Factor Surveillance System (BRFSS) data (2013-2018). We compared the...