Higher trust in public health agencies during COVID-19 driven more by beliefs that agencies led with clear, science-based recommendations and provided protective resources, than by beliefs that agencies controlled outbreak

Lower trust driven by concerns about external influence and conflicting recommendations

Peer-Reviewed Publication

HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH

Boston, MA—In the first nationally representative survey of U.S. adults on reasons for trust in federal, state, and local public health agencies’ information during the COVID-19 pandemic, researchers at Harvard T.H. Chan School of Public Health and colleagues found that the Centers for Disease Control and Prevention (CDC) was highly trusted for information by more than one-third of U.S. adults, whereas state and local health departments were highly trusted by about one-quarter. An additional 37-51% of adults trusted these public health agencies somewhat, and <10% reported no trust at all in these agencies for health information.

High levels of trust were not primarily due to people believing agencies had “done a good job” controlling the spread of COVID-19, but rather to public beliefs that agencies communicated clear, science-based recommendations and provided protective resources, such as tests and vaccines. The survey found that lower levels of trust were primarily related to beliefs that health recommendations were influenced by politics or corporations, or were conflicting.

“Trust in public health agencies is crucial for enabling effective policies that save lives during emergencies,” said lead author Dr. Gillian SteelFisher, principal research scientist in the Department of Health Policy and Management and director of global polling at the Harvard Opinion Research Program. “Emergency programs have been underfunded for decades, but these data make clear how important it is to ensure public health agencies have appropriate stockpiles, have authority to make decisions based on scientific information, and have a stronger communication infrastructure.”

The survey’s findings will be published March 6, 2023, in the March issue of Health Affairs, a themed issue focused on public health lessons learned during the COVID-19 pandemic in the U.S. The survey was conducted in February 2022 among a nationally representative sample of 4,208 U.S. adults.

The researchers also found significant differences in reasons that the public trusts federal, state, and local public health agencies. Public trust in the CDC was related primarily to beliefs in their scientific expertise, whereas trust in state and local public health agencies was more related to their provision of direct, compassionate care.

In addition, the study found key differences in the primary reasons why adults had lower levels of trust. Among those who reported trusting public health agencies “somewhat” concerns were focused on conflicting recommendations and the perception of political influence. By comparison, those who reported trusting agencies “not very much” or “not at all” raised many more concerns, including agencies’ recommendations going “too far” and limited trust in government generally.

The researchers used the results to suggest takeaways to inform public health leaders in COVID-19 and future emergencies. They suggested a need to enhance policies around stockpiles of protective resources such as masks; to support a robust communication infrastructure in which public health agencies are given clear authority to disseminate science-based recommendations; and to engage trusted partners, such as clinicians and religious leaders, to amplify agency communications. Such measures would allow public health agencies to develop strategies to more effectively engage different segments of the public who have varying levels of trust, the researchers said.

Other Harvard Chan School co-authors included Dr. Mary Findling and Hannah Caporello.

The study was conducted through a cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the Association of State and Territorial Health Officials, who subcontracted to the Harvard T. H. Chan School of Public Health.

“Trust in US Federal, State, and Local Public Health Agencies During COVID-19: Responses and Policy Implications,” Gillian K. Steelfisher, Mary G. Findling, Hannah L. Caporello, Keri M. Lubell, Kathleen G. Vidoloff Melville, Lindsay Lane, Alyssa A. Boyea, Thomas J. Schafer, Eran N. Ben-Porath, Health Affairs, March 6, 2023, doi: 10.1377/hlthaff.2022.01204

Visit the Harvard Chan School website for the latest news, press releases, and multimedia offerings.

###

Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.

---

JOURNAL

Health Affairs

DOI

10.1377/hlthaff.2022.01204 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Trust In US Federal, State, And Local Public Health Agencies During COVID-19: Responses And Policy Implications

ARTICLE PUBLICATION DATE

6-Mar-2023

Commentary outlines steps to strengthen U.S. laboratory system and pandemic preparedness

Peer-Reviewed Publication

WEILL CORNELL MEDICINE

Weaknesses in the United States laboratory system, which were illuminated during the COVID-19 pandemic, underscore a need for policy changes to improve the country’s infectious disease response, according to a new analysis by a Weill Cornell Medicine investigator.

The analysis, published Mar. 6 in the March issue of Health Affairs, was co-authored by Dr. Jay Varma, professor of population health sciences and medicine at Weill Cornell Medicine, Dr. Jill Taylor of the Association of Public Health Laboratories, and Dr. Joshua Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health. The authors suggest government and private institutions collaborate to implement systemic changes to improve the monitoring and tracking of highly transmissible diseases.

“The laboratory system in the U.S. is a patchwork of different organizations inside and outside of the government that have to work together in a seamless way to ensure that the American people have the highest quality diagnostic testing and that public health organizations receive data in a clear and quick way to take immediate action,” said lead author Dr. Varma, who is also a director of the Cornell Center for Pandemic Prevention and Response.

Laboratory testing helps identify disease in a population, determine how a disease may evolve, detect outbreaks and assess the impact of disease control measures like vaccination. With inefficient test execution and faulty test design during the COVID-19 pandemic, the Centers for Disease Control and Prevention’s (CDC) “stepwise” approach to developing tests was too slow and insufficient to match the pace of the highly transmissible virus – setting up the institution to be a “single point of failure” when monitoring disease spread, writes the authors. These problems arose again during the 2022 outbreak of Mpox, with the nation facing medical supply shortages and delayed test results due to the lack of clarity and coordination between many different sources reporting public health data.

To address these limitations, the authors acknowledged the need for federal financial investment and provided estimated costs of improving staffing, equipment, infrastructure, and creating secure data systems for the U.S. health system over the next ten years. The authors also suggested internal improvements in CDC structure and operations, and having the institution collaborate with public and private labs to create a “national road map” defining roles and responsibilities for all involved at each stage of a disease outbreak as it evolves. Specifically, the CDC can work with the Food and Drug Administration (FDA) to create a regulatory pathway for at-home tests and with the National Institutes of Health (NIH) to coordinate a national database for standardized clinical information.

“The CDC needs to be legally empowered and sufficiently funded to serve as the leading government agency to implement public health strategy,” said Dr. Varma. “The people who can really ensure that happens are elected officials.”

In establishing public-private partnerships, the U.S. laboratory system can improve the reliability and efficacy of current disease tracking methods. Furthermore, the authors encourage expanding the Strategic National Stockpile and increasing access to testing resources, especially early in an outbreak – key investments to prepare the United States for the next pandemic.

“What is critical here is making sure the government, media and the public have the real-time information about the nature of an infectious disease,” explained Dr. Varma. “Making these policy changes will not only improve the quality of testing and reporting and the speed of developing new tests, but also have an impact on rebuilding the confidence in public health.”

Many Weill Cornell Medicine physicians and scientists maintain relationships and collaborate with external organizations to foster scientific innovation and provide expert guidance. The institution makes these disclosures public to ensure transparency. For this information, see profile for Dr. Varma. 

---

JOURNAL

Health Affairs

How to prevent concussions in football? Better helmets

UC engineers say the backs of players’ heads are especially vulnerable

Peer-Reviewed Publication

UNIVERSITY OF CINCINNATI

 

IMAGE: UC BIOMEDICAL ENGINEERING STUDENT CHRISTOPHER BOLES USES A MODAL HAMMER TO STRIKE A DUMMY HEAD CONTAINING ACCELEROMETERS. BY COMPARING THE FORCE THE DUMMY REGISTERS WITH AND WITHOUT A HELMET, RESEARCHERS CAN SEE WHICH HELMETS PROVIDE BETTER PROTECTION FROM POTENTIAL CONCUSSIONS. view more 

CREDIT: ANDREW HIGLEY

Football helmets made by four leading manufacturers showed vulnerabilities in tests designed to better understand player concussions, according to a new study.

University of Cincinnati engineers put popular football helmets made by leading brands through impact testing and found that no single design demonstrated superior reduction of potential concussion incidence or consistent energy absorption at every part of the helmet.

Concussions from football are a health concern across all age groups from youth sports to professional leagues.

The NFL saw a dramatic increase in concussions during the 2022 season. Concussions were up 18% over the previous season, including high-profile players such as Cincinnati Bengals’ receiver Tee Higgins.

“We’re not trying to get kids to stop playing football,” said Eric Nauman, a professor of biomedical engineering in UC’s College of Engineering and Applied Science. “We just want them to be able to play without suffering long-term consequences.”

The study was published in the Journal of Biomechanical Engineering.

The study was led by Nauman’s former students Kevin McIver and Patrick Lee along with UC’s Sean Bucherl.

Researchers tested three helmets from each of nine models made by four companies.

“We came up with a test on our own based on some military projects we’ve done,” Nauman said. “We can quantify exactly how much of the impact gets attenuated by the helmet.”

They measured the mass of each helmet, an important consideration in determining how much force is applied during a hard tackle or impact with the ground.

Each helmet was fit per manufacturer’s instructions onto a dummy similar to the kind used in automotive crash testing. The dummy contains sensors called accelerometers that measure how fast the head moves upon impact.

Using an instrument called a modal hammer that contains sophisticated sensors to measure applied force accurately, researchers delivered 20 blows by hand at seven impact points around the dummy’s bare head and its head while wearing each of the 27 helmets.

By measuring force applied to the dummy with and without the helmets, researchers were able to single out the strengths of each helmet design at each impact point. All four brands scored highest in minimizing impact in at least one of the impact points measured.

Helmets were able to mitigate between 52% and 83% of the translational acceleration — or change in velocity — researchers measured in the hammer strikes. The back of the helmets fared worst in testing, reducing less than half the rotational acceleration of hammer strikes.

“None of the helmets was uniformly good or uniformly bad, except on the back of the helmet where they were all uniformly bad,” Nauman said. “We didn’t expect the helmets would be so bad in that one place.”

Several well-known NFL players, including Miami Dolphins quarterback Tua Tagovailoa, sustained concussions when the back of their head hit the turf.

Researchers noted that lab tests alone are insufficient in determining what level of mitigation provides the best protection for particular athletes. They suggested field-based impact tracking in combination with lab tests could be more useful in future assessments.

Once the force ranges are better characterized, the shell and padding can be designed to maximize energy absorption and reduce the majority of unrestricted or sudden head movements, researchers said.

Nauman said helmet padding that provides more absorption from impacts might offer better protection from concussions than a more rigid type. Likewise, he said some of the more flexible helmet shells improved energy absorption from the repetitive hits typical of football.

“There are a lot of ways to fix it,” Nauman said. “The helmets are generally designed to withstand the maximum possible impact. But that’s a 99th percentile type of hit. If you can design a helmet to protect players from the smaller, more typical hits, that would be ideal.”

Nauman said even modest design changes could have profound benefits for players.

“I don’t care as much about the NFL. Our audience is mostly high school or under — the 98 percent of players who don’t play after high school,” Nauman said. “If we can keep them safer through high school, that would be great.”

UC BIOMEDICAL ENGINEERING STUDENT SHENGMING HU USES A MODAL HAMMER TO STRIKE A DUMMY HEAD CONTAINING ACCELEROMETERS. BY COMPARING THE FORCE THE DUMMY REGISTERS WITH AND WITHOUT A HELMET, RESEARCHERS CAN SEE WHICH HELMETS PROVIDE BETTER PROTECTION FROM POTENTIAL CONCUSSIONS.

CREDIT

Andrew Higley

---

JOURNAL

Journal of Biomedical Engineering

DOI

10.1115/1.4056653 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Design Considerations for the Attenuation of Translational and Rotational Accelerations in American Football Helmet

COI STATEMENT

Gregory D. Myer has consulted with commercial entities to support application to the US Food and Drug Administration but has no financial interest in the commercialization of the products. Dr. Myer’s institution receives current and ongoing grant funding from National Institutes of Health/NIAMS and has received industry sponsored research funding related to brain injury prevention and assessment with Q30 Innovations, LLC, and ElMinda, Ltd. Dr. Myer receives author royalties from Human Kinetics and Wolters Kluwer. Dr. Myer is an inventor of biofeedback technologies designed to enhance rehabilitation and prevent injuries and receives licensing royalties. The remaining authors have no conflict of interest regarding the data presented in this publication.

Does more money correlate with greater happiness?

 

Reconciling previously contradictory results, researchers from Penn and Princeton find a steady association between larger incomes and greater happiness for most people but a rise and plateau for an unhappy minority.

Peer-Reviewed Publication

UNIVERSITY OF PENNSYLVANIA

Are people who earn more money happier in daily life? Though it seems like a straightforward question, research had previously returned contradictory findings, leaving uncertainty about its answer.

Foundational work published in 2010 from Princeton University’s Daniel Kahneman and Angus Deaton had found that day-to-day happiness rose as annual income increased, but above $75,000 it leveled off and happiness plateaued. In contrast, work published in 2021 from the University of Pennsylvania’s Matthew Killingsworth found that happiness rose steadily with income well beyond $75,000, without evidence of a plateau.

To reconcile the differences, the two paired up in what’s known as an adversarial collaboration, joining forces with Penn Integrates Knowledge University Professor Barbara Mellers as arbiter. In a new Proceedings of the National Academy of Sciences paper, the trio shows that, on average, larger incomes are associated with ever-increasing levels of happiness. Zoom in, however, and the relationship becomes more complex, revealing that within that overall trend, an unhappy cohort within each income group shows a sharp rise in happiness up to $100,000 annually and then plateaus.

“In the simplest terms, this suggests that for most people larger incomes are associated with greater happiness,” says Killingsworth, a senior fellow at Penn’s Wharton School and lead paper author. “The exception is people who are financially well-off but unhappy. For instance, if you’re rich and miserable, more money won’t help. For everyone else, more money was associated with higher happiness to somewhat varying degrees.”

Mellers digs into this last notion, noting that emotional well-being and income aren’t connected by a single relationship. “The function differs for people with different levels of emotional well-being,” she says. Specifically, for the least happy group, happiness rises with income until $100,000, then shows no further increase as income grows. For those in the middle range of emotional well-being, happiness increases linearly with income, and for the happiest group the association actually accelerates above $100,000.

Joining forces
The researchers began this combined effort recognizing that their previous work had drawn different conclusions. Kahneman’s 2010 study showed a flattening pattern where Killingsworth’s 2021 study did not. As its name suggests, an adversarial collaboration of this type—a notion originated by Kahneman—aims to solve scientific disputes or disagreements by bringing together the differing parties, along with a third-party mediator.

Killingsworth, Kahneman, and Mellers focused on a new hypothesis that both a happy majority and an unhappy minority exist. For the former, they surmised, happiness keeps rising as more money comes in; the latter’s happiness improves as income rises but only up to a certain income threshold, after which it progresses no further.

To test this new hypothesis, they looked for the flattening pattern in data from Killingworth’s study, which he had collected through an app he created called Track Your Happiness. Several times a day, the app pings participants at random moments, asking a variety of questions including how they feel on a scale from “very good” to “very bad.” Taking an average of the person’s happiness and income, Killingsworth draws conclusions about how the two variables are linked.

A breakthrough in the new partnership came early on when the researchers realized that the 2010 data, which had revealed the happiness plateau, had actually been measuring unhappiness in particular rather than happiness in general. “It’s easiest to understand with an example,” Killingsworth says. Imagine a cognitive test for dementia that most healthy people pass easily. While such a test could detect the presence and severity of cognitive dysfunction, it wouldn’t reveal much about general intelligence since most healthy people would receive the same perfect score.

“In the same way, the 2010 data showing a plateau in happiness had mostly perfect scores, so it tells us about the trend in the unhappy end of the happiness distribution, rather than the trend of happiness in general. Once you recognize that, the two seemingly contradictory findings aren’t necessarily incompatible,” Killingsworth says. “And what we found bore out that possibility in an incredibly beautiful way. When we looked at the happiness trend for unhappy people in the 2021 data, we found exactly the same pattern as was found in 2010; happiness rises relatively steeply with income and then plateaus.”

“The two findings that seemed utterly contradictory actually result from data that are amazingly consistent,” he says.

Implications of this work
Drawing these conclusions would have been challenging had the two research teams not come together, says Mellers, who suggests there’s no better way than adversarial collaborations to resolve scientific conflict.

“This kind of collaboration requires far greater self-discipline and precision in thought than the standard procedure,” she says. “Collaborating with an adversary—or even a non-adversary—is not easy, but both parties are likelier to recognize the limits of their claims.” Indeed, that’s what happened, leading to a better understanding of the relationship between money and happiness.

And these findings have real-world implications, according to Killingsworth. For one, they could inform thinking about tax rates or how to compensate employees. And, of course, they matter to individuals as they navigate career choices or weigh a larger income against other priorities in life, Killingsworth says.

However, he adds that for emotional well-being money isn’t the be all end all. “Money is just one of the many determinants of happiness. Money is not the secret to happiness, but it can probably help a bit,” he says.

Matthew Killingsworth is a senior fellow in Wharton People Analytics in the Wharton School and an associate in MindCORE in the School of Arts & Sciences at the University of Pennsylvania.

Daniel Kahneman is professor of psychology and public affairs emeritus at the Princeton School of Public and International Affairs, the Eugene Higgins Professor of Psychology Emeritus at Princeton University, and a fellow of the Federmann Center for Rationality at the Hebrew University of Jerusalem.

Barbara Mellers is the I. George Heyman Penn Integrates Knowledge University Professor with appointments in the Department of Psychology in the School of Arts & Sciences and in the Department of Marketing in the Wharton School at Penn.

---

JOURNAL

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2208661120 

ARTICLE TITLE

Income and emotional well-being: A conflict resolved

ARTICLE PUBLICATION DATE

3-Mar-2023

Wheat’s ancient roots of viral resistance uncovered

The DNA sequence of a gene in wheat responsible for resisting a devastating virus has been discovered, providing vital clues for managing more resistant crops and maintaining a healthy food supply.

Peer-Reviewed Publication

UNIVERSITY OF MELBOURNE

The DNA sequence of a gene in wheat responsible for resisting a devastating virus has been discovered, providing vital clues for managing more resistant crops and maintaining a healthy food supply.

Wheat crops across the Americas, Asia, Europe, and Africa are frequently ravaged by Wheat Yellow Mosaic Virus (WYMV), so there is high demand for wheat varieties or cultivars that can resist this virus.

Published today in PNAS, the study found the resistance gene originated in an ancient Mediterranean wild plant relative of wheat.

Study lead researcher University of Melbourne Dr Mohammad Pourkheirandish said: “This discovery could assist with the development of more resistant wheat cultivars, increase crop yields, and reduce the use of harmful fungicides. It also emphasises the need to preserve biodiversity to protect food supplies.”

WYMV reduces grain yield by up to 80 per cent, causing significant economic losses. The virus is hosted and transmitted by a soil-dwelling fungus that colonises the roots of wheat plants, discolouring wheat leaves, and stunting plant growth.

Microscopic fungal spores containing WYMV can live in soil for up to a decade. While fungicides can kill the spores and stop transmission, the fungicide treatment is neither cost-effective nor ecologically sustainable.

“The viable alternative is to selectively breed or genetically engineer wheat with resistance to WYMV,” Dr Pourkheirandish said.

“Before this research, we knew that a dominant gene called Ym2 reduces the impact of WYMV on wheat plants by more than 70 per cent, but we didn’t understand how the gene achieved this.”

The research team used a technique called positional cloning to locate the Ym2 gene on a chromosome in bread wheat, and found that its DNA sequence codes for a protein of the type known as NBS-LRR. These proteins are ‘guardians’ that detect pathogens and trigger an immune response in plants.

“Now that we know the gene’s DNA sequence, we can select breeding lines carrying Ym2 by simply analysing DNA from a small piece of leaf even without the virus inoculation step,” Dr Pourkheirandish said.

“It will also make it easier to find variants of Ym2 in wild relatives of wheat, which may provide superior disease resistance for further crop improvement.”

The DNA of modern wheat is chimeric, meaning its genetic material derives from several ancestral plants through natural interbreeding, or hybridisation, followed by selective breeding by humans.

By comparing DNA sequences across related species, the researchers discovered that Ym2 in modern bread wheat derives from an ancient wild plant called Aegilops sharonensis, native to eastern Mediterranean countries. A similar gene occurs in Aegilops speltoides, another wild ancestor of bread wheat.

“These wild species would have interbred with cultivated wheat at some point and passed on the genetic resistance that is now so commercially critical,” Dr Pourkheirandish said.

“Ancestral wild plants are a rich source of useful traits, like disease resistance, that plant breeders and geneticists can mine to protect modern crops and maintain a healthy food supply – including the bread, pasta, noodles, couscous, pastries, cakes and other wheat products that many of us depend upon and enjoy.”

---

JOURNAL

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2214968120 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Wheat Ym2 originated from Aegilops sharonensis and confers resistance to soil-borne Wheat yellow mosaic virus infection to the roots

ARTICLE PUBLICATION DATE

6-Mar-2023

Major medical organizations form a coalition to stem the rising tide of firearm violence using a comprehensive public health approach

The increase in firearm-related violence since the COVID-19 pandemic requires urgent and comprehensive action to address the problem

Peer-Reviewed Publication

AMERICAN COLLEGE OF SURGEONS

Key Takeaways

• A new coalition to address firearm violence: A new group — the Healthcare Coalition for Firearm Injury Prevention — is being established to advance firearm injury prevention using a public health approach.
• Violence prevention starts in the community: Community engagement programs at the local level have been effective in preventing repeat offenders and improving attitudes toward reducing violence.
• Firearm owners must be part of the solution: Engaging firearm owners as part of the solution allows for broad-level engagement from everyone dedicated to reducing firearm injury and is critical to the implementation of firearm safety initiatives.

CHICAGO (March 6, 2023): Leading medical and public health professional organizations across the United States are coming together to form the Healthcare Coalition for Firearm Injury Prevention to push for a comprehensive public health approach to advance firearm injury prevention efforts through education, advocacy, and community-centered approaches to address this growing problem.  

Representatives from 46 organizations convened for the second Medical Summit on Firearm Injury Prevention in September 2022, one of the largest gatherings of medical and injury prevention professionals on this issue. This Summit featured a review of community violence initiatives, strategies to support healthcare-centered communication, and a review of the evidence informing public policy for firearm injury prevention. The objectives of the Summit focused on identifying consensus-based, non-partisan strategies that can be effective in reducing the burden of firearm injury in communities across the United States. The proceedings from the Summit are published today in the Journal of the American College of Surgeons (JACS).

Healthcare professionals see the impact of firearm violence in their communities every day. This perspective, and the direct contact they have to those at risk of firearm violence, allow medical professionals to propose real, workable solutions to reduce firearm-related injury, death, and disability.

The scope of the problem

The inaugural Medical Summit on Firearm Injury Prevention took place in 2019. Since then, levels of violence have continued to increase in the U.S.—firearm-related deaths increased 28.4% during the first year of the COVID-19 pandemic and non-fatal firearm injuries increased 34.2% during the same period.1 Further, firearm-related injury has now eclipsed motor vehicle fatalities as the leading cause of death in the U.S. for children and adolescents, age 1-19 years.2

To renew efforts to address this ongoing public health crisis, leaders of the American College of Surgeons (ACS), American College of Physicians (ACP), American College of Emergency Physicians (ACEP), American Academy of Pediatrics (AAP), and the Council of Medical Specialty Societies (CMSS) cohosted the second Medical Summit on Firearm Injury Prevention. Forty-six organizations attended the Summit, during which sessions were held on public policy initiatives, addressing community violence, and effective healthcare-centered communication on firearm injury prevention.

Community-level firearm injury prevention efforts

“All clinicians who care for patients have the opportunity to identify those at risk of firearm injury and provide counseling to mitigate these risks,” the authors wrote in the article. They provided specific examples of what these clinical opportunities include:

• Education on secure firearm storage
• Lethal means safety counseling, where healthcare providers work with patients who are at-risk of injury or death and their families to reduce access to firearms
• Family support in the implementation of extreme risk protection programs (to temporarily remove firearms from the homes of those at risk for suicide or domestic violence)
• Hospital and community-centered violence intervention programs
• Mentoring programs for at risk youth
• Integration of social care into the delivery of health care

These community engagement programs are rooted in the understanding of social determinants of health and the principles of Trauma Informed Care, which is an approach that addresses implicit bias and creates an environment for patients that promotes equity, sensitivity of broader needs, and empowerment.

Engaging firearm owners as part of the solution

Summit attendees noted the importance of broad community engagement to address firearm violence, which requires engagement from everyone dedicated to reducing firearm injury.

“All too often the community of firearm owners in the U.S. are approached as part of the firearm injury problem, and less commonly as part of the solution,” the authors wrote.

An example of this engagement is a strategy pursued by the ACS Committee on Trauma (COT) that acknowledges both the constitutional right to keep and bear arms and the critical and significant problem of intentional firearm violence in the U.S. The ACS has established a Firearm Strategy Team (FAST) of firearm owning surgeons to inform and advise on firearm safety initiatives.

The authors also noted that there have been successful partnerships between health professionals and firearm retailers, instructors, and advocates. Firearm owners and experts are seen as “trusted messengers” and have effectively delivered firearm safety messages in their communities.

Summit attendees called for further engagement with firearm owners through the new Healthcare Coalition for Firearm Injury Prevention.

A consensus-based, comprehensive public health approach

Just as motor vehicle deaths have sharply declined over the years due to public health-based injury prevention strategies, a comprehensive public health and medical approach is necessary to reduce firearm injury, death, and disability.

To achieve the goals outlined at the Summit, the sponsoring organizations agreed to establish the Healthcare Coalition for Firearm Injury Prevention. This Coalition will include the following workgroups: Health Professional Education, Advocacy and Policy Initiatives, Healthcare Professional Engagement for Firearm Safety, Communications, and Community-Centered Approach for Violence Prevention.

“Establishing this coalition provides a venue to continue ongoing multidisciplinary collaboration and leverage the resources of the entire public health and healthcare community,” the authors concluded. “The opportunity is before us, and the time is now to address this critically important American public health problem.”

The following comments were issued by article authors and leaders from the five organizations that co-hosted the Summit:

“Preventing firearm violence requires a multifaceted approach, one that includes not only common-sense firearm legislation, but also addressing the underlying social and economic factors that contribute to it,” said Joseph V. Sakran, MD, MPH, MPA, FACS, survivor and trauma surgeon at Johns Hopkins Medicine. “We have come together as a medical community to create a society where every person feels safe and valued, and where the senseless loss of life due to firearm violence becomes a thing of the past.”

“Effective healthcare is not just about treating the wounds of firearm violence, but also preventing them in the first place. By addressing the root causes of violence and providing education and support, healthcare professionals can play a crucial role in preventing firearm violence and promoting a safer, healthier society,” said Eileen M. Bulger, MD, FACS, Medical Director, ACS Trauma Programs. “This renewed effort to create a Healthcare Coalition for Firearm Injury Prevention leverages the talents of major medical organizations across America as we guide the nation in tackling this public health crisis.”

“The crisis of firearm violence continues to afflict communities across this country, day after day. The American College of Surgeons and our coalition partners have come together because the medical community is well positioned to help address this vexing issue,” said Patricia L. Turner, MD, MBA, FACS, ACS Executive Director & CEO. “By taking an approach that we know works for other public health issues, and by engaging all stakeholders, including those who own firearms, we can create actionable solutions to reduce death and save lives.”

“Firearms-related deaths and injuries are a public health crisis that need immediate action. We need to employ commonsense strategies that will help to keep our patients and our communities safe. For nearly 30 years, the American College of Physicians has called attention to this issue and believes that as trusted resources for our patients, physicians should be part of informing our patients about what they can do to keep themselves and their families safer,” said Sue S. Bornstein, MD, MACP, chair, ACP Board of Regents.

“Firearm violence indelibly affects emergency department patients and their families as well as those of us who care for them,” said Christopher S. Kang, MD, FACEP, president of ACEP. “Efforts to curb firearm violence and promote safety and injury prevention are a public health imperative. Emergency physicians are a vital partner in these collaborative efforts by the healthcare community to improve treatments, save lives, and prevent more tragedies from occurring.”

“As firearms are now the leading cause of death for U.S. children and youth, the American Academy of Pediatrics was proud to be one of the organizing members of the Medical Summit on Firearm Injury Prevention,” said Lois K. Lee, MD, MPH, FAAP, chair of the AAP Council on Injury, Violence and Poison Prevention. “We understand the lifelong consequences firearm injuries and deaths have to children, their families, and communities, and we must do better for our children. By using a multi-pronged approach, we can start to address this serious public health crisis.”

“The complex topic of firearm injury prevention requires a coordinated and concerted effort on the part of the entire medical community. As an organization of 50 specialty societies, we recognize the enormous potential of working together in this new coalition to prevent firearm injuries,” said Helen Burstin, MD, MPH, chief executive officer of the Council of Medical Specialty Societies. “By jointly addressing key levers that prevent firearm injury, including health professions education, community engagement, and advocacy, we can ensure that our collective efforts will be greater than the sum of individual organizational efforts.”

Article authors are Joseph V. Sakran, MD, MPH, MPA, FACS; Sue S. Bornstein, MD, MACP; Rochelle Dicker, MD, FACS; Frederick P. Rivara, MD, MPH, FAAP; Brendan T. Campbell, MD, MPH, FACS, FAAP; Rebecca M. Cunningham, MD, FACEP; Marian Betz, MD, MPH; Stephen Hargarten, MD, MPH; Ashley Williams, MD, FACS; Joshua M. Horwitz, JD; Deepika Nehra, MD, FACS; Helen Burstin, MD, MPH, MACP; Karen Sheehan, MD, MPH; Fatimah L. Dreier; Thea James, MD, FACEP; Chethan Sathya, MD, MSCE; John H. Armstrong, MD, FACS; Ali Rowhani-Rahbar, MD, MPH, PhD; Scott Charles, MAPP; Amy Goldberg MD, FACS; Lois K. Lee, MD, MPH, FAAP, FACEP; Ronald M. Stewart, MD, FACS; Jeffrey D. Kerby, MD, PhD, FACS; Patricia L. Turner, MD, MBA, FACS; and Eileen M. Bulger, MD, FACS.

The article authors have no relevant disclosures to report.

This article is published as an article in press on the JACS website.

Citation: Sakran JV, Bornstein SS, Dicker R, et al. Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach. Journal of American College of Surgeons. DOI: 10.1097/XCS.0000000000000662

Further information on ACS firearm injury prevention activities, including resources for journalists, is available on the ACS website.

________________

1Sun S, Cao W, Ge Y, Siegel M, Wellenius GA. Analysis of Firearm Violence During the COVID-19 Pandemic in the US. JAMA Netw Open. 2022 Apr 1;5(4):e229393.

2JE Goldstick, RM Cunningham, P Carter Current Causes of Death in Children and Adolescents in the United States. N Engl J Med, 386 (2022), pp. 1955-1956.

# # #

About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons. For further information, contact pressinquiry@facs.org.

About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 160,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook, and Instagram.

About the American College of Emergency Physicians
The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education, and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million people they treat on an annual basis. For more information, visit www.acep.org and www.emergencyphysicians.org. 
Contact: Steve Arnoff | sarnoff@acep.org | Twitter @EmergencyDocs

About the American Academy of Pediatrics
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds.

About the Council of Medical Specialty Societies
The Council of Medical Specialty Societies (CMSS) is a coalition of specialty societies representing more than 800,000 physicians across the house of medicine. CMSS works to catalyze improvement across specialties through convening, collaborating, and collective action. For more information, visit www.cmss.org. 

---

JOURNAL

Journal of the American College of Surgeons

DOI

10.1097/XCS.0000000000000662 

ARTICLE TITLE

Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach

ARTICLE PUBLICATION DATE

6-Mar-2023