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. 2023 Aug;54(8):110824.
doi: 10.1016/j.injury.2023.05.055. Epub 2023 Jun 7.

Increases in adolescent firearm injuries were associated with school closures during COVID-19

John N Bliton  1 , Jonathan Paul  2 , Alexis D Smith  3 , Randall G Duran  4 , Richard Sola Jr  5 , Sofia Chaudhary  6 , Kiesha Fraser Doh  6 , Deepika Koganti  7 , Goeto Dantes  8 , Roberto C Hernandez Irizarry  7 , Janice M Bonsu  9 , Tommy T Welch  10 , Roland A Richard  10 , Randi N Smith  11
Affiliations

Increases in adolescent firearm injuries were associated with school closures during COVID-19

John N Bliton et al. Injury. 2023 Aug.

Abstract

Background: Mitigation measures, including school closures, were enacted to protect the public during the COVID-19 pandemic. However, the negative effects of mitigation measures are not fully known. Adolescents are uniquely vulnerable to policy changes since many depend on schools for physical, mental, and/or nutritional support. This study explores the statistical relationships between school closures and adolescent firearm injuries (AFI) during the pandemic.

Methods: Data were drawn from a collaborative registry of 4 trauma centers in Atlanta, GA (2 adult and 2 pediatric). Firearm injuries affecting adolescents aged 11-21 years from 1/1/2016 to 6/30/2021 were evaluated. Local economic and COVID data were obtained from the Bureau of Labor Statistics and the Georgia Department of Health. Linear models of AFI were created based on COVID cases, school closure, unemployment, and wage changes.

Results: There were 1,330 AFI at Atlanta trauma centers during the study period, 1,130 of whom resided in the 10 metro counties. A significant spike in injuries was observed during Spring 2020. A season-adjusted time series of AFI was found to be non- stationary (p = 0.60). After adjustment for unemployment, seasonal variation, wage changes, county baseline injury rate, and county-level COVID incidence, each additional day of unplanned school closure in Atlanta was associated with 0.69 (95% CI 0.34- 1.04, p < 0.001) additional AFIs across the city.

Conclusion: AFI increased during the COVID pandemic. This rise in violence is statistically attributable in part to school closures after adjustment for COVID cases, unemployment, and seasonal variation. These findings reinforce the need to consider the direct implications on public health and adolescent safety when implementing public policy.

Keywords: Adolescent firearm injuries; COVID-19; Injury prevention; Violence.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1:
Fig. 1
Time series. A: Injuries and COVID-19 Incidence. The monthly data is displayed according to the left Y axis, and the weekly data according to the right Y axis. B: Seasonal variation (by month) and school closure. Covariates. C: Economic covariates. Wage changes are standardized to a yearly rate and averaged over 3 months.
Fig 2:
Fig. 2
Unadjusted mean differences vs pre-COVID baseline rates under various conditions. This is based on weekly data and is standardized to district-level adolescent populations.
Fig 3:
Fig. 3
R2 contributions. This is based on Atlanta-wide, monthly data. The shared contribution of school policy and COVID cases is calculated by observing the difference in R2 after removing both from the model.
Fig 4:
Fig. 4
Model fit. This model is based on Atlanta-wide, monthly data.
See this image and copyright information in PMC

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